Public long-term care insurance in Japan
N. Ikegami
Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan. ikegami@mc.med.keio.ac.jp
A public long-term care (LTC) insurance program is likely to be introduced
to Japan in the year 2000. A consensus on the need for more LTC resources
in the rapidly aging society and dissatisfaction with the current system
are some of the factors that have contributed to its introduction. Half the
costs will be paid by premiums that will be levied on all those older than
40 years, and half will be covered by general taxation. The insurer will be
the municipalities with a pooling mechanism at the national level to
balance the differences in their demographic structure. The benefits will
include institutional care, respite care, day care, home help, visiting
nurses, and loan of devices. Eligibility status will be classified into 6
levels that will be determined by assessment of functional and cognitive
status. However, there are few mechanisms to limit benefits and contain
costs. Problems also exist in the design of the eligibility classification
and in the assessment instrument. The proposed LTC insurance system
highlights the need for defining what should be included in a "basic
package" of LTC as an entitlement for every citizen, for an organizational
mechanism and an assessment instrument to deliver services efficiently and
equitably, and for physicians to work outside the traditional medical
model. To what degree the Japanese public in general, and physicians in
particular, is willing to deal with these issues is a challenge for the 21
st century.
