Long-term care insurance in Japan

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1 Shifting Values : How should we care for older people in society Long-term care insurance in Japan - Social background, evaluation and future - November 2013 Masahiko HAYASHI Deputy Assistant Minister for International Affairs Ministry of Health, Labor and Welfare Japan

2 Agenda for this presentation 1. Why do they accept establishment of long-term care insurance system in Japan? 2. Evaluation of the long-term care insurance system and its challenges 3. Future of long-term care 2

3 1. Why do they accept establishment of long-term care insurance system in japan?

4 Social background for establishment of long-term care insurance system Rapidly ageing society (Demographic structure change) very high life expectancy declining (and low) birthrate The nuclearization of the family Increasing participation of women Very heavy burden a family care person is forced no family care person Some problems with former long-term care system Social consensus about establishment of long-term care insurance existed

5 Rapid increase in number of the elderly aged 75 and older Population (10,000 persons) 14,000 12,000 10,000 8,000 6,000 4,000 Population aged 75 and older Population aged Population aged Actual values (Population Census ) Population peak (2004) 127,790 thousand people 11.9% 12,806 1,419 1,529 8, % 2012 estimation (Population Projections for Japan) 18.1% 12,067 2,179 1,479 Percentage of the population aged 75 and older Percentage of the population aged % 7,085 Peak of the number of elderly 38,780 thousand people (2042) 26.9% 8,674 2, % 1,128 (%) ,000 4, Source: Population aged 14 and younger Statistics Bureau of the Ministry of Internal Affairs and Communications Population Census, National Institute of Population and Social Security Research Population Projections for Japan assuming medium-fertility/medium-mortality (estimated in Jan. 2012), Values of 2010 are from Statistics Bureau of the Ministry of Internal Affairs and Communications Base Population according to 2010 Population Census (Base Population is the population that was corrected by dividing the population of unknown citizenship and age proportionally) 1,684 1,

6 Percentage of population over 80 in OECD countries OECD EU27 Japan Korea USA World Brazil China 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Source:OECD Help Wanted?

7 Shocking outcomes of public opinion poll! Difficulties in house care too heavy workload (meal, bath, elimination) : 57.5% going out is impossible : 36.2% great psychological burden and stress : 32.0% lack of sleep : 25.2% source : Survey on Trend of Health and Welfare Ministry of Health and Welfare (1990) Feel a hatred against a person who requires nursing care? daughter in law (wives who nurse her husband's parents) : 46.2% daughter (women who nurse her parents) : 30.0% wife (women who nurse her husband) : 33.6% source : Survey on the actual conditions of house care person Japanese Trade Union Confederation (1994)

8 Problems with the system for long-term care of the elderly before the adoption of the long-term care insurance system Welfare for the elderly Covered services Intensive care homes for the elderly, etc. Home help services, day services, etc. (Problems) Because municipalities decided the types of services and their providers, the users could not choose the services. Because income verification was required, people felt reluctant to use the services. Because municipalities generally provided services directly or via commission, there was no competition and services tended to be uniform. Because copayments were based on the income of the individual and persons with a duty of support (ability to pay), the burden on people with medium-level and high incomes was heavy Healthcare for the elderly Covered services Health facilities for the elderly, convalescent wards in hospitals, general hospitals, etc. Visiting nurses, day care, etc. (Problems) Because medical care was cheaper than the welfare services for medium- and high-income people and because the welfare services infrastructure was insufficient, extended hospital admissions for longterm care became a problem. Compared with intensive care homes for the elderly, the costs were higher and healthcare expenditures increased Systems for the extended recuperation of persons needing long-term care were inadequate in terms of staff and the living environment in hospitals was intended for patient treatment (living spaces were small, dining rooms and bathing facilities were lacking, etc.) There were limits on the ability of the systems for elderly welfare/healthcare to respond before the 8 adoption of the long-term care insurance system

9 Differences in the welfare system for the elderly from the user perspective before and after the introduction of the long-term care insurance system Before introduction (1) Apply at a government office; services determined by the municipality (2) Apply for healthcare and welfare services separately (3) Services provided mainly by municipalities and public institutions (social welfare councils, etc.) After introduction Users themselves choose the types of services and the vendors A long-term care services care plan is created, and comprehensive use is made of medical and welfare services Services are provided by diverse vendors, including private-sector firms, agricultural and other cooperatives, non-profits, etc. (4) Expensive and hard to use for people with medium or high incomes Example: In the case of the head of a household with an income of 8 million yen and an elderly parent with a monthly pension of 200,000 yen Intensive care home for the elderly: 190,000 yen/month Home helper: 950 yen/hour 9 Regardless of income, users pay 10% Example: In the case of the head of a household with an income of 8 million yen and an elderly parent with a monthly pension of 200,000 yen Intensive care home for the elderly: 50,000 yen/month Home helper: 400 yen/30 60 minutes

10 2. Evaluation of the long-term care insurance system and its challenges

11 Evaluation of long-term care insurance system Approx. 60% of persons are appreciating long-term care insurance system (Greatly appreciate: 14%, somewhat appreciate: 47%) Persons who are not appreciating account for approx. 20% (not appreciate so much: 19%, not appreciate at all: 4%) Evaluation of long-term care insurance system 4. Not appreciate at all 4% 5. Cannot say which 10% No response 6% 1. Greatly appreciate 14% 3. Not appreciate so much 19% 2. Somewhat appreciate 47% 21

12 Evaluation of long-term care insurance system [Family burden] Approx. 50% of persons feel family members burden has become lighter. On the other hand, approx. 10% of persons do not feel family members burden has become lighter. [Quality of services] Approx. 30% of persons feel quality of services has got better. On the other hand, approx. 10% of persons do not feel quality of services has got better. [Selection of services and service providers] Approx. 50% of persons feel it has got easier to select services and service providers. On the other hand, approx. 10% do not feel it has got easier. Family burden becomes lighter 3. No 13% 2. Yes and no 31% No respon se 5% 1. Yes 51% Quality of services gets better 3. No 14% 2. Yes and no 47% 無 回 答 5% 1. Yes 34% Selection of services and service providers get easier 3. No 14% 2. Yes and no 35% 無 回 答 5% 1. Yes 46% 22

13 Desire for long-term care (by their own) [If you need long-term care] The largest number of persons (46%) want to receive long-term care at home if there are services that enable them to live at home independently of their family members. The second largest (24%) is to live at home receiving combination of long-term care by my family The third largest (12%) is to receive move into fee charging home for the aged or house for the elderly with care to receive long-term care. 6. Stay in the hospital to receive long-term care 2% 5. Stay in special nursing home or other facility for the elderly to receive long-term care 7% How do you want to receive long-term care if you come to need it? 4. Move into fee charging home for the aged or house for the elderly with care to receive long-term care. 12% 7. Others 3% 8. No response 2% 1. Live at home receiving cares by mainly my family 4% 3. Receive long-term care at home if there are services that enable me to live at home independently of my family members 46% Source: Opinion collection from the citizens concerning long-term care insurance system (result outline) by Health and Welfare Bureau for the Elderly of MHLW Live at home receiving combination of external long-term care services and care by my family 24%

14 Desire for long-term care (by families) [If your parents need long-term care] The largest number of persons (49%) want their parents to receive combination of long-term care services by external providers and cares by themselves at home. The second largest (27%) want their parents to receive long-term care at home if there are services that enable them to live at home independently of themselves. The responses of the largest and second largest are inverted compared to the responses in the preceding section. In either case, larger number of persons want to live at home. Those who want to be institutionalized or hospitalized account for only less than 10%. How do you want your parents to receive long-term care if they come to need it? 6. Stay in the hospital to receive long-term care 2% 5. Stay in special nursing home or other facility for the elderly to receive long-term care 6% 4. Move into fee charging home for the aged or house for the elderly with care to 3. Receive long-term receive long-term care. care at home if there 5% are services that enable me to live at home independently of my family members 27% 7. Others 3% 8. No response 4% 2. Live at home receiving combination of external long-term care services and care by my family 49% Source: Opinion collection from the citizens concerning long-term 14 care insurance system (result outline) by Health and Welfare Bureau for the Elderly of MHLW 1. Live at home receiving cares by mainly my family 4%

15 3. Future of long-term care 15

16 Key points for future long-term care We will have to manage population aging in big cities, increasing solo or couple-only family and increasing dementia. The key word is comprehensive community care. Long term care costs will keep increasing more than any other area of social security. Consequently, the insurance contributions will also increase. We have to make efforts to keep the system acceptable for people including people who do not use services (because insurance contributions will become higher). 16

17 Long-term care in the future (Integrated Community Care System) Realization of an integrated community care system which provides housing, healthcare, long-term care, prevention, and livelihood support services in a unified manner enables the elderly to live in their community and familiar environment throughout their life even if they come to need advanced level care. [Measures based on five perspectives] Following measures based on five perspectives should be implemented comprehensively and consecutively to realize Integrated Community Care. 1. Cooperation with Healthcare Services 2. Improvement and Reinforcement of LTC Services 3. Promotion of Prevention Programmes 4. Ensuring various life support services such as watching over, meals-on-wheels and shopping, and Advocacy 5. Sufficient supply of Elderly Housings (Collaboration with MLIT) Healthcare Integrated community care system in 2025 Long-term care Commuting to medical facilities/care facilities Integrated community care support center/ care manager Housing Living support/ long-term care prevention * Integrated community care system regards its unit as juniorhigh school district of the population of approximately 10 thousand residents Old people s club, residents association, long-term care prevention, living support, etc.

18 Prospect of long-term care service costs Current cost of approx. 9 trillion yen will be approx. 20 trillion yen in trillion yen 8.9 trillion yen 18 trillion yen 21 trillion yen (Current scenario) 2025 (Reformed scenario) *Medical expenditure will be from 40 trillion yen (2012) to trillion yen (2025) Source: Prepared from Review of future estimation of social security-related expenditure (March, 2012) 18

19 Comprehensive Reform of Social Security and Tax Consumption tax (national/regional) will rise in stages to 8% in April, 2014, 10% in October, Use of consumption tax revenue will expand from three types for the elderly (basic pension, medical care for the elderly, long-term care) to four types of social security (pension, medical care, long-term care, childrearing). Clarification of use of consumption tax revenue (Using consumption tax revenue as social security fund resource) All consumption tax revenue is used for the sake of the citizens, not for expansion of public sector Approx 1% Approx 4% Improvement of social security Government share of contribution to pension is ½ (Including fund gained by government bonds for pension) Lowering the burden passed onto the next generation Existing social security fund that cannot secure stable financial resource and that is increasing due to aging (natural increase) Approx trillion yen Stabilization of social security: maintaining current social security system Approx trillion yen Approx. 2.9 trillion yen Approx. 7.0 trillion yen Increase in social security expenditure followed by rise of consumption tax Increase in pension, medical cost, etc. Approx. followed by price boost 0.8 trillion yen Measures for children/childrearing Approx. - Solving the issue of children 0.7 trillion yen waiting for admission to day-carecenter (quantitative improvement in day-care services, afterschool children s club) Improvement in medical/longterm care - Intensive use of medical resources in acute phase (strengthening of hospitalization medical care), improvement of home medical care/long-term care (from hospital/facilities to community/home), etc. Improvement of pension system - Additional pension to persons with low income, shortening of certification term Up to approx. 1.6 trillion yen Up to approx. 0.6 trillion yen Strengthening countermeasures Among above, against poverty/difference approximately up to 1.4 (measures against persons with trillion (already low income, etc.) mentioned above) Lowering premium of persons with low income, comprehensive payment/benefit system, etc. 19

20 Average insurance contributions Estimation

21 Thank you!

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