Japan’s life expectancy has reached 87.7 years older for women and 81.6 years old for men in 2016 (OECD, 2017). During the last 30 years, the figures increased by 5 years. In addition, in 2040, it is estimated that the life expectancy will rise by two years. In 2040, 40% of men aged 65 and over will turn 90, and it will represent 20% of elderly people. Since it is not unthinkable for Japanese people to live 100 years or more, it’s crucial for the health care system to maintain a healthy standard of living for the elderly. In 2016 the life expectancy for both men and women rose by three years every year. In 2019, the healthy Quality of Life (QOL) expectancies for women and men were 75.4 and 72.7 years old. Important matters include an increase of elderly workers, social participation, and rationing care costs to achieve a sustainable society.
In 2022, Japan’s Ministry of Health, Welfare and Labour (MHWL) proposed an initiative aimed at preventing diabetes and lifestyle-related diseases. It also addresses long-term care prevention for older people and seeks to integrate both medical and long-term care (LTC).
Promotion of integrated medical and long-term care
Japan is facing a fundamental issue, it has few children and a growing number of elderly people. Japan’s support system for medical and long-term care has developed under the umbrella of the compulsory medical and long-term care insurance. However, elderly people are increasingly impacted by life-style diseases. To cope with the situation, medical care has encouraged elderly people to keep a healthy quality of life. On the other hand, long-term care needs have increased with the growing number of senile dementia and bed-bound elderly people. Senile dementia in particular requires that medical and long-term care facilities are coordinated with each other. Under these circumstances, the MHWL promotes comprehensive and efficient care for the elderly. However, there is also a difference in urban and rural needs.
Regional Medical Care and LTC Fund
Based on the Act on Promotion of Comprehensive Securing of Medical and Long-Term Care in Local Communities, financial support, regional medical care, and long-term care comprehensive security funds utilising consumers' livelihoods have been established in each prefecture. Prefectural governments prepare plans to implement projects to comprehensively ensure that medical and long-term care in the region is available according to the local needs. It is implemented in order to carry out the plan while utilising the regional medical care insurance certificate securing fund. Regarding regional medical fees, prefectures evaluate the project annually and discuss the promotion of medical and long-term care in order ensure that the fund is used effectively.
Stable and sustainable medical insurance system
Japan has one of the world's highest life expectancies and the promotion of health care is carried out under its universal health insurance system. In the 8th Long-Term Care plan of 2025, the seniors will have an educational background that will allow an easier use of in-vehicle devices, whose production will therefore accelerate. There must be reforms that anticipate changes of the Japanese society in 2040.
Based on the social security reform for the previous generation in 2020, the MHLW will review how social security has been conceived so far, which states that benefits are limited to the working generation and that they are centred on older people, while the cost-sharing is centred on the working generation. The law was enacted in 2021 and sought to build a social security system that supports all generations while offering peace of mind.
The end of the counter burden in medical care for the oldest-old, and about 50% of the payment date for medical care for these elders is public funds, and about 40% is from the working generation to the oldest-old support fund, and about 10% is over 75 years old. It is a support to bear with the basic needs of the late elders, and understanding the working generation is essential. With the declining birth rate and ageing population, the MHLW would require as many people as possible to actively support the older generation, as they begin to reach the advanced age of 75 and above. It is necessary to curb the rise in the working generation by having them bear the burden.
This review of the co-payment ratio will be implemented in January 2022, in order to suppress the increasing burden on the working generation as much as possible and promote the social security system for the older generation. Based on the ability of older people to pay and on their living situation, only those who have an annual taxable income of 280,000 yen or more for older people who live alone and whose annual income is 2,000,000 yen or more for a single person will be taken into consideration. Furthermore, for outpatients who will be greatly affected by the change to a 10% co-payment, measures will be undertaken so that the care delivery costs for one month will be calculated for three years after the enforcement.
Construction of comprehensive community care system and safe, high-quality long-term care insurance system
In 2000 the long-term care insurance system was established as a method to support the elderly care.
That same year, the number of users of long-term care services, mainly in-home services, steadily increased to 1,490,000 in cities. The number of service users increased 3.4 times reaching 5,070,000 in 2022, and the long-term care insurance system is steadily taking root in society.
As the population grows older, members of the baby boomer generation will be 75 years old or older. In 2025, about 1 in every 5.5 people in Japan will be 75 years old or older, and it is estimated that the percentage of older people with dementia and the percentage of households with only elderly couples living alone will increase. Urban areas, such as the metropolitan area, are being promoted as the population ages rapidly.
Therefore, in order to respond to such changes in social structure and the needs of elderly people in society, the integrated community care system aims to realize a comprehensive community care system. Since the prevalence of diseases in later life is increasing and the utilisation of resources differs from region to region, it is crucial to enable a community care system that meets the situational demands of each region.
In addition, since the establishment of the long-term care insurance system and the increase in the number of users, a universal insurance system has emerged that allows for consulting on long-term care costs. In the Budget Law of 2000 there were about 3.6 trillion JPY. The cost will reach 11.1 trillion yen in 2022, and the ageing of the population will progress further, and large cohorts of baby boomers will be over 75 years old. With long-term care costs expected to reach 15.3 trillion yen in 2025, the national average for the long-term care insurance system will be around JPY 3,000. Long-term care insurance premiums are currently about JPY 6 trillion and are expected to reach about JPY 7,200 in 2025.
Apart from this situation of inter-sessional politics, seafarers on the subject of so-called gradualism will be over 65 in the future. In 2040, as the elder population is expected to reach its peak, the demand for nursing care services will further increase and diversify, while there will be a marked decrease in the working generation. Based on the discussion in the long-term care insurance subcommittee, a partial revision of the Social Welfare Act for the realization of community coexistence and society has been undertaken.
This has been implemented sequentially since 2020. This law includes the promotion of countermeasures against dementia according to the demands set by the region, the promotion of the development of nursing care service physical education systems, the promotion of the development of health and a nursing care data infrastructure, securing of nursing care personnel, and the strengthening of efforts to improve operational efficiency. Based on these developments, the following matters are included in the basic plan of the 8th long-term care business plan from 2021: maintenance of service infrastructure; human infrastructure; planning of activities ahead to 2025.
Towards a Social Quality of Life
Currently, Japan is facing a serious ageing issue due to the rapidly ageing population. Japan is trying to cope with the issues. Is it possible for the country to solve them? There is a large cohort of ageing baby boomers, and it affects Japan’s policy targets for them.
Japan will be the first country in the world to become a super-aging society, but the limits of the existing socio-economic life system are being exposed. In order to address these issues, first of all, maintaining QOL and health, which are prerequisites for people's living environment, has become an issue for public policy.
On the other hand, from the environmental issue, the people’s quality of life related to the survival of mankind has come into question. In the New Public Health Centre of WHO, the improvement of individual QOL has come to be achieved through social medicine and epidemiology from the perspective of environmental, genetic, and social factors. Furthermore, in the EU, an integrated research method that considers society as a single body, analyses its quality, and improves Social Quality of Life in the society as a whole. This Modern Public Health policy approach to induce social change has been proposed as a social quality method. Using this approach, this research combines the evaluation of the community as a whole, the evaluation of society from the individual's point of view using the ICT, and the evaluation of the individual's ability to live, to create micro-evaluation methods and indicators, and to apply policies.