Long-Term Care Insurance Comes To Japan

PROLOGUE: Would-be Medicare reformers regularly emphasize the fact that population aging is expected to put severe stress on the Medicare budget over the coming decades. So familiar are the statistics on aging baby boomers that it is often lost on Americans that many other industrialized nations face even more dire predicaments. For example, while nearly 17 percent of U.S. citizens are expected to be over age sixty-five by the year 2020, Japan has already surpassed this figure and expects a staggering one-fourth of its population to be over age sixty-five in twenty years. U.S. policymakers should take heart that other nations have already been down this road, and, as in the case of Japan, are even aggressively attacking the problem. John Campbell and Naoki Ikegami chronicle the development of Japan's new mandatory long-term care insurance program, in this paper written just before its implementation. Campbell, a political scientist with a long-standing interest in Japan and its institutions, is a professor at the University of Michigan. He earned his doctorate from Columbia University. Ikegami is professor and chair of the Department of Health Policy and Management at Keio University's School of Medicine in Tokyo, where he received his medical and doctoral degrees. He is a board member of inter RAI, an international organization committed to developing and promoting care planning instruments. Campbell and Ikegami have been collaborating on Japanese health policy research for nearly a decade. ABSTRACT: Japan has moved decisively toward “socialization of care” for the frail elderly by initiating public, mandatory long-term care insurance (LTCI) on 1 April 2000. The LTCI program covers both institutional and community-based caregiving. Everyone age forty and older pays premiums. Everyone age sixty-five and older is eligible for benefits based strictly on physical and mental disability, in six categories of need. Benefits are all services, with no cash allowance for family care, and are generous, covering 90 percent of need. Long-term costs seemed not to be a major consideration in program design. Consumers can choose the services and providers they want, including use of for-profit companies.