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Population, Midyear 2022: 123,951,692
Population Density (Number of Persons per Square Kilometer): 328.94
Life Expectancy at Birth, 2022: 84.82
Projected Population, Midyear 2030: 118,514,802
Percentage of Total Population Aged 65 and Older, Midyear 2022: 29.92%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 31.38%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 37.50%

Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.

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Percent of Adults Aged 65 Years and Over Reporting To Be In Good Or Very Good Health (2015): 25.4%
People With Dementia Per 1,000 Population (2017): 23.3
Projected Number of People With Dementia Per 1,000 Population in 2037: 38.4
Long-Term Care Workers Per 100 People Aged 65 And Over (2015): 6
Long-Term Care Beds In Institutions and Hospitals Per 1,000 Population Aged 65 And Over (2015): 34.3
Long-Term Care Expenditure (Health and Social Components) By Government and Compulsory Insurance Schemes, as a Share of GDP (%) (2015): 2.0%

Source: OECD (2017), Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris. dx.doi.org/10.1787/health_glance-2017-en

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Formal Long-Term Care Workers At Home (FTE) (2017): 995,389
Formal Long-Term Care Workers In Institutions (FTE) (2017): 425,184
Long-Term Care Recipients In Institutions Other Than Hospitals (2018): 939,900
Long-Term Care Recipients At Home (2006): 2,724,100

Source: Organization for Economic Cooperation and Development. OECD.Stat. Last accessed Oct. 15, 2019.

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“The proportion of older people in Japan increased from 18 percent of the population in 2000 to 30 percent in 2020.¹ Meanwhile, health care spending as a proportion of gross domestic product (GDP) rose by 57 percent between 2000 and 2019 (from 7.0 percent to 11.0 percent), ranking the country as the fifth-highest in the percentage of GDP devoted to health expenditures among Organization for Economic Cooperation and Development (OECD) countries. In comparison, in the US, health care spending as a proportion of GDP rose by 34 percent between 2000 and 2019 (from 12.5 percent to 16.7 percent).² In estimating total health expenditures that are used to compare health care spending across countries, the OECD includes long-term care expenditures in its estimates, with the exception of expenditures for assistance in cooking and cleaning.

“There are several reasons why Japan’s proportional increase was so much larger than that in the US during 2000–19. First, the denominator, GDP, barely increased in Japan during those years. Second, the aging of the population progressed rapidly. Third, Japan added public long-term care insurance alongside its social health insurance (in which all permanent residents of Japan are enrolled). After the program was implemented in 2000, spending for that insurance increased dramatically, from one-tenth of social health insurance expenditures in 2000 to one-quarter in 2020.³“

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“Japan reached a consensus several decades ago to make every effort to meet the challenges of its aging society.¹⁷ The long-term inpatient care that had been financed by health insurance was perceived as being too costly and too focused on treating diseases, and the social services that had been provided by municipal governments were perceived as being bureaucratic and were focused on those with low income and no family support.¹⁸

“Long-term care insurance was designed to resolve these issues. People ages forty and older are required to enroll in this insurance. In addition to this age stipulation, long-term care insurance differs from health insurance in that the insurers are the municipalities, and the maximum monetary amount of benefits is limited by applicants’ eligibility level. Although people ages 40–64 pay premiums and taxes, they are responsible for only 2 percent of their long-term care insurance expenditures.¹⁹ Their premiums are levied together with their health insurance premiums and are allocated to the municipalities.

“Long-term care is provided both in the community and in institutions. In community care, the monetary amount of the benefit is primarily determined by a computer algorithm that either groups applicants into one of seven eligibility levels or notes that they are ineligible. The algorithm is based on applicants’ responses to questions on the level of assistance needed in walking, dressing, decision making, cognition, and so forth. The final decision is made by a panel of experts in each municipality. Monthly benefits range from ¥49,700 ($340) to ¥358,400 ($2,440) of services from accredited providers.²⁰ There are no cash benefits. In institutional care, care services are covered, but not room and board.

“Long-term care insurance expenditures were expected to increase rapidly as the program expanded.²¹ Actual expenditures tripled from 2000 to 2020,²² compared with a 1.4-fold increase in national medical expenditures during that period.⁶“

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“To mitigate the budget burden, the government took the following measures. First, charges for room and board were introduced in long-term care insurance–designated facilities starting in October 2005. However, these charges have been partially waived for those with low income.²⁴ Starting in 2015, people having more than ¥10 million ($68,000 US) in a bank account, regardless of their income, had to pay the full room and board charge.²⁵ However, the leveling of the full room and board charge has had marginal impacts because property holdings were not included as assets.

“Second, in 2006, benefits were reduced for those requiring only light care. However, the impact of this change on expenditures has been limited because although a third of the beneficiaries are at light care eligibility levels, they account for only 5 percent of long-term care insurance expenditures because their benefit amounts are much less.^26,27

“Third, in 2015, the government increased the coinsurance rate from 10 percent to 20 percent for people with higher incomes. The coinsurance rate was increased again in 2018, to 30 percent for those in the highest income bracket. However, those who pay 20 percent or 30 percent coinsurance make up less than 10 percent of all beneficiaries because most beneficiaries have low incomes.²⁸

“Municipalities have little power to control long-term care insurance spending, despite being the insurers. This is because the national government sets the eligibility criteria, the entitlement amount of the eligibility levels, the long-term care insurance fee schedule, and the standards for certifying long-term care insurance providers.”

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“As Japan’s total population began to decline while the older population continued increasing, the proportion of older people in the population (aged 65 years or older) rose from 17.4% in 2000 to 26.7% in 2015. It is expected that the proportion of older people will reach 39.4% in 2055 (Cabinet Office, Government of Japan, 2016). As a result of the two baby booms (1947–1949 and 1971–1974), the population of older people above 75 years of age will reach its peak in 2025.”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

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“The traditional family system in Japan placed primary responsibility for support of older people on families, and nearly 55% of people aged 65 years and above lived with their children in 1995. However, the proportion of one-person households among this older population more than doubled between 1975 and 1995. With rapid demographic change and the dissolution of traditional family structures, the government took a number of measures to promote the “socialization of care” for frail older people during the mid-1990s. In response to the expected shift from traditional family care to social care, the Japanese government started the national LTCI [Long-Term Care Insurance] system in 2000 to alleviate the burden on family caregivers.

“LTCI is based on the Long-Term Care Insurance Act (Ministry of Health, Labour and Welfare, 2016b). This system aims to certify the care-level needs of the elderly and to provide care services suited to this level. There are seven care levels, including two requiring support (levels 1 and 2) and five requiring long-term care (levels 1–5). Although the original purpose of LTCI was to support the elderly with physical and/or cognitive malfunction due to ageing, its focus has been shifting from supporting disabilities to promoting self-independence. The total number of the elderly certified as requiring one of these care levels was reported to be 5.69 million in 2013 (Ministry of Health, Labour and Welfare, 2016b), which is twice the number it was at the time the system was implemented in 2000 (2,180,000 beneficiaries) (Olivares-Tirado P et al., 2011). Because of this, the sustainability of the system has been a major issue.”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

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Page last updated July 14, 2023 by Doug McVay, Editor.