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

Document Type : Commentary

Authors

1 Independent Researcher

2 School of Public Health, Rutgers University, New Brunswick, NJ, USA

3 The Hastings Center, Garrison, NY, USA

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.

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  1. Norris F. Rethinking Early Retirement in Europe. The New York Times. October 29, 2010. https://www.nytimes.com/2010/10/30/business/30charts.html .
  2. Asher MG, Kimura F. Strengthening Social Protection in East Asia. New York: Routledge; 2015.
  3. Liu T, Sun L. Pension Reform in China. J Aging Soc Policy. 2016;28(1):15-28. doi:10.1080/08959420.2016.1111725
  4. Organisation for Economic Co-operation and Development (OECD). Pensions at a Glance 2017: How Does Germany Compare? OECD; 2017.  https://www.oecd.org/germany/PAG2017-DEU.pdf.   
  5. de Meijer C, Wouterse B, Polder J, Koopmanschap M. The effect of population aging on health expenditure growth: a critical review. Eur J Ageing. 2013;10(4):353-361. doi:10.1007/s10433-013-0280-x
  6. Okma K, Gusmano MK. The Bright Side of Aging. Presented at: the American Political Science Association Annual Meeting; September 2016; Philadelphia, PA.
  7. Gusmano MK, Okma KGH. Population Aging and the Sustainability of the Welfare State. Hastings Cent Rep. 2018;48 Suppl 3:S57-S61. doi:10.1002/hast.915
  8. Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V. It’s the prices, stupid: why the United States is so different from other countries. Health Aff (Millwood). 2003;22(3):89-105. doi:10.1377/hlthaff.22.3.89
  9. Gusmano MK, Allin S. Framing the issue of ageing and health care spending in Canada, the United Kingdom and the United States. Health Econ Policy Law. 2014;9(3):313-328. doi:10.1017/s1744133114000115
  10. Wong A, van Baal PH, Boshuizen HC, Polder JJ. Exploring the influence of proximity to death on disease-specific hospital expenditures: a carpaccio of red herrings. Health Econ. 2011;20(4):379-400. doi:10.1002/hec.1597
  11. French EB, McCauley J, Aragon M, et al. End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported. Health Aff (Millwood). 2017;36(7):1211-1217. doi:10.1377/hlthaff.2017.0174
  12. Butler RN. The Longevity Revolution: The Benefits and Challenges of Living a Long Life. New York: Public Affairs; 2008.
  13. Fries JF. The compression of morbidity. Milbank Mem Fund Q Health Soc. 1983;61(3):397-419.
  14. Fries JF, Bruce B, Chakravarty E. Compression of morbidity 1980-2011: a focused review of paradigms and progress. J Aging Res. 2011;2011:261702. doi:10.4061/2011/261702
  15. Ikegami N. Financing long-term care: lessons from Japan. Int J Health Policy Manag. 2019;8(8):462-466. doi:10.15171/ijhpm.2019.35
  16. Saad L. Social Security Still Financial Bedrock for Retirees. Gallup News; 2018. https://news.gallup.com/poll/234032/social-security-financial-bedrock-retirees.aspx.  
  17. Arno PD, Viola D, Gusmano MK. The Caregiving Workforce in the United States. Presented at: The International Conference on Evidence-Based Policy in Long-Term Care; September 9, 2010; London, London School of Economics and Political Science.
  18. Okma KGH, de Roo A, Maarse H. The Netherlands. In: Okma KGH, Tenbensel T, eds. Changing Healthcare Systems Across the World. The Diverging Health Reform Experience of Twelve Small and Medium-Sized Nations. Singapore: World Scientific; Forthcoming.
Volume 9, Issue 5
May 2020
Pages 218-221
  • Receive Date: 14 September 2019
  • Revise Date: 09 November 2019
  • Accept Date: 09 November 2019
  • First Publish Date: 01 May 2020