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2018 Conference Presentation

Policy developments Japan

12 September 2018

Challenges for twenty years old LTC system of Japan

Tsuneo Inoue, Doshisha University, Japan


Background: Long term care expenditure in Japan has increased remarkably despite various reforms during the last twenty years. Parts of LTC insurance benefits have been replaced by discretionary care services managed by local authorities. The ageing of the baby boomers will add further burdens on its LTC finance and service provision. Although Japanese people remain in support of the present public insurance system, they need to overcome critical challenges with radical thinking so that the LTC system may continue sustainable.

Objectives: This presentation will examine the main challenges Japan’s LTC system faces and present some future directions for reforms.


Firstly, its LTC premiums have gone up so high that service users should bear more financial burdens through copayments. In this way service users are expected to be motivated to be independent of rather than dependent on LTC services.

Secondly, carers’ access to care services, which they do not presently enjoy as of their right, should be legally recognised. Ease of carers’ burden will mitigate demand for LTC services such as day services, as a result.

Thirdly, Japan should step up its care efforts for a growing number of elderly population with dementia, who are likely to slip off dementia pathway due to lack of knowledge and stigmatisation.

While extending its national dementia strategy, Orange Plan, so that people with dementia may continue to live in their homes as long as possible, Japan needs to establish locally coordinated care services, especially for those in their early stages of dementia.

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