Assessment Instruments and Allocation of Services in Japan

Abstract

Japan is facing the challenges of an aging population. The number of elderly people has increased significantly in the last decade, and further large increases are expected. High-quality services and security for old people are important priorities. The economic goals of cost-efficiency and sustainability are also joint concerns. The most important political issues for the state are reducing the gap between care needs and care resources and securing stable financial resources in severe economic conditions. It was under these circumstances that the April 2000 Public Long-term Care Insurance Law (LTCI) came into force in Japan. The major changes introduced by the LTCI can be summarized as follows (Masuda 1998):

• a shift from family-based care to community/institutional care services; that is, “socialization of care”

• a shift from a tax-based financing system to an insurance-based system

• separation of social care elements from health insurance and integration of medical and social services

• a shift from a purchase-of-service agreement system (municipality and provider) to a user-subsidized model (user and provider)

• introduction of a formalized system for certification of care needs