Aging, Pensions and Long-term Care: What, Why, Who, How? Comment on "Financing Long-term Care: Lessons From Japan"

Abstract

Japan has been aging faster than other industrialized nations, and its experience offers useful lessons to others. Japan has been willing to expand its welfare state with a long-term care (LTC) insurance to finance home care and nursing home care for frail elderly. As Ikegami shows, it created new facilities and expanded specialized staffing for home care, developed a country-wide assessment system and shifted responsibilities between the central and local authorities over that assessment and the determination of co-payments for LTC. Faced with rapid growth in demand for LTC, the government felt the need for new cost control measures. The Japanese experience illustrates that new social policies take time to develop. There is often a need to adjust. But there are also other lessons. The main one is that there is no direct relation between the degree of population aging and total health spending. While aging requires adjustments in the organization of care, and expanding LTC for frail elderly, international studies show there is no need to worry about the ‘unaffordability’ of aging. In this commentary, we have framed four "What, Why, Who, and How" questions about LTC to (re-)define the borderlines between public and private responsibilities for the range of activities for which some (but certainly not all) frail elderly as well as many non-elderly require support in daily life.

Cost-Free LTC Model Incorporated into Private Pension Schemes

“…After defining LTC as the cost of providing services to facilitate the range of activities mentioned above, coverage should be considered—from family benefits, income, housing, to daily living costs. The good news is that, in general, the need for LTC only arises at a later age and only for a part of the population aged over 80 [ 31 ]. However, an individual is faced with uncertainty about what the true costs of LTC services will be.…”

“…Its aim was to relieve families and private charities of the financial burden of caring for frail, elderly and disabled relatives. This prompted a rapid expansion of nursing homes, rest homes and institutional care [ 31 ].…”

Key Issues in Designing Long-term Care Systems: A Response to Recent Commentaries

“…This may be more about principles because even if LTC were made available to all, most would be allocated to those 80 over as Okma and Gusmano note. 16 However, there may be more public support if the program were targeted on elders. In Japan, there was a consensus on the need to meet the challenges of the rapidly aging society which was instrumental in implementing the LTC Insurance.…”

Job Satisfaction and Perceived Importance of Oral Medicine Amongst Dentists

“… 3 Japan has one of the fastest-aging populations in the world. 4 Dental treatment of aged populations requires a background knowledge of systemic diseases. 5 In particular, in Japan, maintenance of oral function including perioperative oral hygiene management, 6 continuous oral care for elderly patients, 7 and swallowing training 8 are regarded as important because improvement of oral function in elderly people helps prevent the need for long-term care.…”