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October 22, 1997, Vol 278, No. 16 >
ARTICLE | October 22, 1997

Public Long-term Care Insurance in Japan FREE

Naoki Ikegami, MD, Dr Med Sci, MA
[+] Author Affiliations

Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

The author has been commissioned by the Japan Medical Association Research Institute to develop an alternate method of assessment and classification for the long-term care insurance program.

Reprints: Naoki Ikegami, MD, Dr Med Sci, MA, Department of Health Policy and Management, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan 160 (e-mail: ikegami@mc.med.keio.ac.jp).


JAMA. 1997;278(16):1310-1314. doi:10.1001/jama.1997.03550160030017
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References

A public long-term care (LTC) insurance program is likely to be introduced to Japan in the year 2000. A consensus on the need for more LTC resources in the rapidly aging society and dissatisfaction with the current system are some of the factors that have contributed to its introduction. Half the costs will be paid by premiums that will be levied on all those older than 40 years, and half will be covered by general taxation. The insurer will be the municipalities with a pooling mechanism at the national level to balance the differences in their demographic structure. The benefits will include institutional care, respite care, day care, home help, visiting nurses, and loan of devices. Eligibility status will be classified into 6 levels that will be determined by assessment of functional and cognitive status. However, there are few mechanisms to limit benefits and contain costs. Problems also exist in the design of the eligibility classification and in the assessment instrument. The proposed LTC insurance system highlights the need for defining what should be included in a "basic package" of LTC as an entitlement for every citizen, for an organizational mechanism and an assessment instrument to deliver services efficiently and equitably, and for physicians to work outside the traditional medical model. To what degree the Japanese public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21st century.

REFERENCES

1 +
Organisation of Economic Co-operation and Development (OECD).  The policy context . In: OECD. Caring for Frail Elderly People: Policies in Evolution: Social Policy Studies No. 9 . Paris, France: OECD; 1996;:13-31.
2 +
Ikegami N.  Best medical practice: the case of Japan . Int J Health Plann Manage . 1989;;4:181-195.
3 +
Clark DW, Williams TF, eds. Teaching of Chronic Illness and Aging. Bethesda, Md: Government Printing Office; 1973. DHEW publication (NIH) 75-876.
4 +
Kerkstra A.  Home care in the Netherlands . In: Hutten JBF, Kerkstra A, eds. Home Care in Europe . Aldershot, Hampshire: Ashgate Publishing Ltd; 1996;: 219-244.
5 +
Alber J.  The debate about long-term care reform in Germany . In: Organisation of Economic Co-operation and Development (OECD). Caring for Frail Elderly People: Policies in Evolution: Social Policy Studies No. 9 . Paris, France: OECD; 1996;:261-278.
6 +
Ikegami N, Campbell JC.  Medical care in Japan . N Engl J Med . 1995;;333:1295-1299.
7 +
Ishikawa A.  Population . In: Miura F, ed. Illustrated White Paper for the Elderly, 1996 [in Japanese]. Tokyo, Japan: Zenkoku Shakai-fukushi Kyogikai; 1996;:32.
8 +
Okuyama M.  Family . In: Miura F, ed. Illustrated White Paper for the Elderly, 1996 [in Japanese]. Tokyo, Japan: Zenkoku Shakai-fukushi Kyogikai; 1996;:48.
9 +
Tokyo Metropolitan Government Welfare Dept. Survey of the Lives of the Elderly, FY 1990 [in Japanese]. Tokyo, Japan: Tokyo Metropolitan Government Welfare Dept; 1991;:115.
10 +
Prime Minister's Office. Opinion Survey of People's Attitude Towards LTC Insurance [in Japanese]. Tokyo, Japan: Prime Minister's Office; 1995.
11 +
Campbell JC. How Policies Change: The Japanese Government and the Aging Society . Princeton, NJ: Princeton University Press; 1992;:245-247.
12 +
Japan Ministry of Health and Welfare. Trends in the Nation's Welfare [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1996;:198-200.
13 +
Ikegami N, Fries BE, Takagi Y, et al.  Applying Rug-III in Japanese long-term care facilities . Gerontologist . 1994;;34:628-639.
14 +
Japan Ministry of Health and Welfare. 1993 Patient Survey [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1995;.
15 +
Japan Ministry of Health and Welfare. 1963 Patient Survey [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1965;.
16 +
Ohkuma K. Geriatric Hospitals [in Japanese]. Tokyo, Japan: Asahi Shinbunsha; 1988;.
17 +
Japan Ministry of Health and Welfare. 1995 Report on the State of Health Facilities for the Elderly [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1997;.
18 +
Ikegami N, Morris JN, Fries BE. Low-care cases in long-term care settings: variation among nations. Age Ageing. In press.
19 +
 Interview with Dr Tsuboi, President, Japan Medical Association . Nichi (JMA) News . (January) 20,1997;:1.
20 +
Japan Ministry of Health and Welfare. Points for LTC Insurance [in Japanese]. 2nd ed. Tokyo, Japan: Ministry of Health and Welfare; 1996;.
21 +
Kaihara N. Estimation of the New Demand for Physicians, FY 1992: Report of the Health Science Grants Study [in Japanese]. Tokyo, Japan: Ministry of Health & Welfare; 1992;.
22 +
Japan Ministry of Health and Welfare. Points for Determining Eligibility Criteria and Care Plans . Distributed at the 36th meeting of the Health and Social Services Council for the Elderly; March 28, 1996;; Tokyo, Japan.
23 +
Campbell JC.  Bureaucracy and democracy in Japan . In: Ishida T, Kraus ES, eds. Democracy in Japan . Pittsburgh, Pa: University of Pittsburgh Press; 1989;:113-137.
24 +
Campbell JC, Ikegami N. The Art of Balancing in Health Policy: Maintaining Japan's Low Cost, Egalitarian System. New York, NY: Cambridge University Press. In press.
25 +
Japan Medical Association. Reform of the Health Insurance System for the 21st Century [in Japanese]. Tokyo, Japan: Japan Medical Association; 1997;.
26 +
Ikegami N.  Functional assessment and its place in health care . N Engl J Med . 1995;;332:598-599.
27 +
Challis D, Davies B, Traske K.  Immediate concerns and long-term care perspectives . In: Challis D, Davies B, Traske K, eds. New Agendas and Challenges in Community Care of the Elderly: Lessons From the UK and Overseas . Aldershot, Hampshire: Ashgate Publishing Ltd; 1994;:303-316.
28 +
Ikegami N, Fries BE, Igarashi C,et al.  Long-term care payment: assessment and care planning in home care [in Japanese] . Byoin Kanri . 1996;;33:343-352.
29 +
Morris JN, Fries BE, Steel K, Ikegami N, et al.  Comprehensive clinical assessment in community setting: applicability of the MDS-HC . J Am Geriatr Soc . 1997;;45:1017-1024.
30 +
Japan Ministry of Health and Welfare. 1995 White Paper on Health and Welfare [in Japanese]. Tokyo, Japan: Gyousei; 1995;:19.
31 +
Block SD, Clark-Chiarelli N, Peters AS, et al.  Academia's chilly climate for primary care . JAMA . 1996;;276:677-682.

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1 +
Organisation of Economic Co-operation and Development (OECD).  The policy context . In: OECD. Caring for Frail Elderly People: Policies in Evolution: Social Policy Studies No. 9 . Paris, France: OECD; 1996;:13-31.
2 +
Ikegami N.  Best medical practice: the case of Japan . Int J Health Plann Manage . 1989;;4:181-195.
3 +
Clark DW, Williams TF, eds. Teaching of Chronic Illness and Aging. Bethesda, Md: Government Printing Office; 1973. DHEW publication (NIH) 75-876.
4 +
Kerkstra A.  Home care in the Netherlands . In: Hutten JBF, Kerkstra A, eds. Home Care in Europe . Aldershot, Hampshire: Ashgate Publishing Ltd; 1996;: 219-244.
5 +
Alber J.  The debate about long-term care reform in Germany . In: Organisation of Economic Co-operation and Development (OECD). Caring for Frail Elderly People: Policies in Evolution: Social Policy Studies No. 9 . Paris, France: OECD; 1996;:261-278.
6 +
Ikegami N, Campbell JC.  Medical care in Japan . N Engl J Med . 1995;;333:1295-1299.
7 +
Ishikawa A.  Population . In: Miura F, ed. Illustrated White Paper for the Elderly, 1996 [in Japanese]. Tokyo, Japan: Zenkoku Shakai-fukushi Kyogikai; 1996;:32.
8 +
Okuyama M.  Family . In: Miura F, ed. Illustrated White Paper for the Elderly, 1996 [in Japanese]. Tokyo, Japan: Zenkoku Shakai-fukushi Kyogikai; 1996;:48.
9 +
Tokyo Metropolitan Government Welfare Dept. Survey of the Lives of the Elderly, FY 1990 [in Japanese]. Tokyo, Japan: Tokyo Metropolitan Government Welfare Dept; 1991;:115.
10 +
Prime Minister's Office. Opinion Survey of People's Attitude Towards LTC Insurance [in Japanese]. Tokyo, Japan: Prime Minister's Office; 1995.
11 +
Campbell JC. How Policies Change: The Japanese Government and the Aging Society . Princeton, NJ: Princeton University Press; 1992;:245-247.
12 +
Japan Ministry of Health and Welfare. Trends in the Nation's Welfare [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1996;:198-200.
13 +
Ikegami N, Fries BE, Takagi Y, et al.  Applying Rug-III in Japanese long-term care facilities . Gerontologist . 1994;;34:628-639.
14 +
Japan Ministry of Health and Welfare. 1993 Patient Survey [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1995;.
15 +
Japan Ministry of Health and Welfare. 1963 Patient Survey [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1965;.
16 +
Ohkuma K. Geriatric Hospitals [in Japanese]. Tokyo, Japan: Asahi Shinbunsha; 1988;.
17 +
Japan Ministry of Health and Welfare. 1995 Report on the State of Health Facilities for the Elderly [in Japanese]. Tokyo, Japan: Kousei Tokei Kyokai; 1997;.
18 +
Ikegami N, Morris JN, Fries BE. Low-care cases in long-term care settings: variation among nations. Age Ageing. In press.
19 +
 Interview with Dr Tsuboi, President, Japan Medical Association . Nichi (JMA) News . (January) 20,1997;:1.
20 +
Japan Ministry of Health and Welfare. Points for LTC Insurance [in Japanese]. 2nd ed. Tokyo, Japan: Ministry of Health and Welfare; 1996;.
21 +
Kaihara N. Estimation of the New Demand for Physicians, FY 1992: Report of the Health Science Grants Study [in Japanese]. Tokyo, Japan: Ministry of Health & Welfare; 1992;.
22 +
Japan Ministry of Health and Welfare. Points for Determining Eligibility Criteria and Care Plans . Distributed at the 36th meeting of the Health and Social Services Council for the Elderly; March 28, 1996;; Tokyo, Japan.
23 +
Campbell JC.  Bureaucracy and democracy in Japan . In: Ishida T, Kraus ES, eds. Democracy in Japan . Pittsburgh, Pa: University of Pittsburgh Press; 1989;:113-137.
24 +
Campbell JC, Ikegami N. The Art of Balancing in Health Policy: Maintaining Japan's Low Cost, Egalitarian System. New York, NY: Cambridge University Press. In press.
25 +
Japan Medical Association. Reform of the Health Insurance System for the 21st Century [in Japanese]. Tokyo, Japan: Japan Medical Association; 1997;.
26 +
Ikegami N.  Functional assessment and its place in health care . N Engl J Med . 1995;;332:598-599.
27 +
Challis D, Davies B, Traske K.  Immediate concerns and long-term care perspectives . In: Challis D, Davies B, Traske K, eds. New Agendas and Challenges in Community Care of the Elderly: Lessons From the UK and Overseas . Aldershot, Hampshire: Ashgate Publishing Ltd; 1994;:303-316.
28 +
Ikegami N, Fries BE, Igarashi C,et al.  Long-term care payment: assessment and care planning in home care [in Japanese] . Byoin Kanri . 1996;;33:343-352.
29 +
Morris JN, Fries BE, Steel K, Ikegami N, et al.  Comprehensive clinical assessment in community setting: applicability of the MDS-HC . J Am Geriatr Soc . 1997;;45:1017-1024.
30 +
Japan Ministry of Health and Welfare. 1995 White Paper on Health and Welfare [in Japanese]. Tokyo, Japan: Gyousei; 1995;:19.
31 +
Block SD, Clark-Chiarelli N, Peters AS, et al.  Academia's chilly climate for primary care . JAMA . 1996;;276:677-682.

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