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Tuesday, Sept. 21, 2010


Looking after the elderly

Ten years have passed since the introduction of the nursing care insurance system in April 2000. In fiscal 2009, some 3.92 million people used nursing care insurance services. Discussions have started in preparation for a once-every-three-years reform of the system that will be implemented in fiscal 2012.

As Japan's population is rapidly graying, wide public discussions will be necessary to make the nation a society in which the elderly can live without worries while the financial burden is shared equitably by all generations. The nursing care insurance system has problems. Wages for nursing care workers are so low that they often quit after just a short period. Some 420,000 elderly people are waiting to be admitted into special nursing care homes for those with serious physical or mental impairment.

The total cost of the nursing care insurance system, including the out-of-pocket payments by benefit receivers, was about ¥3.6 trillion in fiscal 2000. It more than doubled to ¥7.9 trillion in fiscal 2010. The health and welfare ministry estimates that the cost will hit a maximum ¥25 trillion when the baby boomers born in 1947-49 become 75 years old or older. Under the current system, benefit receivers pay 10 percent of the cost out of pocket and the remaining is covered by premiums and public money on a fifty-fifty basis. Participants in the insurance system are now paying an average monthly premium of ¥4,160. It is estimated that the monthly payment will top ¥5,000 in fiscal 2012 if no reform efforts are made.

If the public money's portion is raised from the current 50 percent (of the total cost minus out-of-pocket payments) to 60 percent, it will require an additional ¥700 billion — a factor that will require a political decision. A panel at the ministry is discussing the introduction of 24-hour services for the elderly who live at home and increasing rental residences for the elderly who are dependent on life support services as a way to save money on the operation of nursing care facilities. The panel should explain its proposals in specific terms to the public and listen to opinions from them.

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