Care‐Needs Certification in the Long‐Term Care Insurance System of Japan

Abstract

The introduction of Japan's long-term care insurance (LTCI) system in April 2000 has made long-term care an explicit and universal entitlement for every Japanese person aged 65 and older based strictly on physical and mental status. At the start of the program, more than two million seniors were expected to apply for services to approximately 3,000 municipal governments, which are the LTCI insurers. The LTCI implementation required a nationally standardized needs-certification system to determine service eligibility objectively, fairly, and efficiently. The current computer-aided initial needs-assessment instrument was developed based on data collected in a large-scale time study of professional caregivers in long-term care institutions. The instrument was subsequently tested and validated by assessing data of 175,129 seniors involved in the national model programs before the start of LTCI. The computer-aided initial assessment (an 85-item questionnaire) is used to assign each applicant to one of seven need levels. The Care Needs Certification Board, a committee of medical and other professionals, reviews the results. Three years after implementation, the LTCI system and its needs-assessment/certification system have been well accepted in Japan. Despite the overall successes, there remain challenges, including area variations, growing demands for services, and the difficulty of keeping the needs certification free of politics. The LTCI computer network that links municipalities and the central government is instrumental in continuously improving the needs-certification system. Future challenges include promoting evidence-based system improvements and building incentives into the system for various constituencies to promote seniors' functional independence.

The Japanese National Health Screening and Intervention Program Aimed at Preventing Worsening of the Metabolic Syndrome

“…It should be noted that since the establishment of the long-term care insurance (LTCI) system in 2000, 4) most long-term care costs that were previously covered by healthcare programs for the elderly are now covered by the LCTI system. A rapid increase in LTCI-related expenditure has been reported, 2,5) and when combined with medical expenditure, the overall growth rate of healthcare-related expenditure is much greater than that shown in Figure 1. Several reforms have been introduced in order to restrain the exponential increase in healthcare expenditure, such as increasing copayment rates, decreasing the list price of prescription drugs, and in 2005, decreasing the listed fees for medical claims.…”

Validation of Each Category of Kihon Checklist for Assessing Physical Functioning, Nutrition and Cognitive Status in a Community-Dwelling Older Japanese Cohort

“…The Community-based Rehabilitation Support System Promotion Project was officially started in 2000 and revised in 2006, led by the Office of Elderly Health Care of the MHLW. The project participants were both healthy and in the "assistance required" category of elderly individuals, which form the lowest of the seven levels of frailty in elderly individuals who need public LTCI support because of physical and mental disabilities [11,12]. Elderly individuals certified in the "assistance required" category use community care or preventive services to lead self-supporting lives while maintaining their present physical condition as long as possible.…”

“…We checked each category of physical strength (Q.6-10), nutritional status (Q. [11][12], and cognition (Q. [18][19][20].…”

Bakım Sigortası ve Türkiye İçin Model Önerisi

“…40 yaş ve üzerindeki çalışan kişilerden, almış oldukları ücretlerin %0,9 oranında, emekli aylığı alan kişilerden ise almış oldukları aylıklara göre standart prim tutarına ulaşmak için %0,5 ile %1,5 arasında değişen beş farklı oranda prim alınmaktadır. Ayrıca bakım sigortasından faydalanan kişilerden, bakım masrafının %10'u katkı payı olarak geri alınmaktadır (Tsutsui, 2005). Japonya'da bakıma muhtaç kişiler, bakıma muhtaçlık derecelerine göre sadece yardım desteği de dahil olmak üzere, 6 bakım seviyesinde sınıfl andırılmaktadır.…”