Long-term care (LTC) must be carefully delineated when expenditures are compared across countries because how LTC services are defined and delivered differ in each country. LTC’s objectives are to compensate for functional decline and mitigate the care burden of the family. Governments have tended to focus on the poor but Germany opted to make LTC universally available in 1995/1996. The applicant’s level of dependence is assessed by the medical team of the social insurance plan. Japan basically followed this model but, unlike Germany where those eligible may opt for cash benefits, they are limited to services. Benefits are set more generously in Japan because, prior to its implementation in 2000, health insurance had covered long-stays in hospitals and there had been major expansions of social services. These service levels had to be maintained and be made universally available for all those meeting the eligibility criteria. As a result, efforts to contain costs after the implementation of the LTC Insurance have had only marginal effects. This indicates it would be more efficient and equitable to introduce public LTC Insurance at an early stage before benefits have expanded as a result of ad hoc policy decisions.
Commentaries Published on this Paper
Financing Long-term Care: Some Ideas From Switzerland; Comment on “Financing Long-term Care: Lessons From Japan”
Institute of Medicine. Improving the quality of care in nursing homes. Washington, DC: The National Academies Press;1986:398.
Bates PB, Mayer KU. The Berlin aging study: Aging from 70 to 100. New York: Cambridge University Press; 1909.
Ikegami N, Campbell JC. Choices, policy logics and problems in the design of long–term care systems. Soc Policy Adm. 2002;36(7):719-734. doi:10.1111/1467-9515.t01-1-00313
Campbell JC, Ikegami N, Gori C, et al. How different countries allocate long-term care resources to older users: a comparative snapshot. In: Gori C, Fernandez JL, Wittenberg R, eds. Long-term care reforms in OECD countries: Successes and failures. London: Policy Press; 2016:47-76.
Brenna E, Gitto L. To What Extent Is Long-term Care Representative of Elderly Care? A Case Study of Elderly Care Financing in Lombardy, Italy. Int J Health Policy Manag. 2017;6(8):467-471. doi:10.15171/ijhpm.2017.22
Sundstrom G, Johansson L, Hassing LB. The shifting balance of long-term care in Sweden. Gerontologist. 2002;42(3):350-355. doi:10.1093/geront/42.3.350
Jensen J, Jacobzone S. Care allowances for the frail elderly and their impact on women care-givers. Labour Market and Social Market Occasional Papers No. 41. OECD; 2000. doi:10.1787/414673405257
Leutz WN. Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. Milbank Q. 1999;77(1):77-110.
Ishibashi T, Ikegami N. Should the provision of home help services be contained?: validation of the new preventive care policy in Japan. BMC Health Serv Res. 2010;10:224. doi:10.1186/1472-6963-10-224
Pena-Longobardo LM, Oliva-Moreno J, Garcia-Armesto S, Hernandez-Quevedo C. The Spanish long-term care system in transition: Ten years since the 2006 Dependency Act. Health Policy. 2016;120(10):1177-1182. doi:10.1016/j.healthpol.2016.08.012
Gori C, Barbabella F, Campbell C, et al. How different countries allocate long-term care resources to older users: changes over time. In: Gori C, Fernandez JL, Wittenberg R, eds. Long-term care reforms in OECD countries: Successes and failures. London: Policy Press; 2016:77-116.
Jones RN, Hirdes JP, Poss JW, et al. Adjustment of nursing home quality indicators. BMC Health Serv Res. 2010;10:96. doi:10.1186/1472-6963-10-96
Morris JN, Fries BE, Frijters D, Hirdes JP, Steel RK. interRAI home care quality indicators. BMC Geriatr. 2013;13:127. doi:10.1186/1471-2318-13-127
Ikegami N. Rationale, design and sustainability of long-term care insurance in Japan–in retrospect. Soc Policy Soc. 2007;6(3):423-434. doi:10.1017/S1474746407003739
Campbell JC. How Policies Change. Princeton: Princeton University Press; 1992:245-252.
Ministry of Health, Labour and Welfare. 1999 Survey of Social Welfare Facilities. Tokyo: Kousei Tokei Kyokai; 2001.
Research Committee on the History of Long-term Care Insurance (Omori Y, Yamazaki S, Katori T, Inagawa T, Sugawara H). History of long-term care insurance system: from its basic vision to implementation. Tokyo: Shakaihoken Kenkyujo; 2016:164-169.
Kenpo News. National Health Insurance Association has surplus of 519 billion yen. P15. No. 2188 2019.0115.
Rhee JC, Done N, Anderson GF. Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany. Health Policy. 2015;119(10):1319-1329. doi:10.1016/j.healthpol.2015.06.001