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Naoki Ikegami, MD, Dr Med Sci, MA

JAMA. 1997;278(16):1310-1314.

Abstract
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 21st century.

Author Affiliations
From the Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan.

Footnotes
Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

The author has been commissioned by the Japan Medical Association Research Institute to develop an alternate method of assessment and classification for the long-term care insurance program.

Reprints: Naoki Ikegami, MD, Dr Med Sci, MA, Department of Health Policy and Management, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan 160 (e-mail: ikegami@mc.med.keio.ac.jp).

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