Skip to content
World Health Systems Facts

Japan: Long-Term Care

Japan: Long-Term Care

Japanese Health System Overview
Health System Rankings
Health System Outcomes
Health System Coverage
Consumer Costs
Japan’s COVID-19 Strategy

Health System Expenditures
Health System Financing
Medical Personnel
System Resources and Utilization
Long-Term Care
Medical Training
Pharmaceuticals

Political System
Economic System
Population Demographics
People With Disabilities
Aging
Social Determinants & Health Equity
Health System History and Challenges


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.


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


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.


“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“

Source: Naoki Ikegami and Thomas Rice. Controlling Spending For Health Care And Long-Term Care: Japan’s Experience With A Rapidly Aging Society. Health Affairs 2023 42:6, 804-812.


“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“

Source: Naoki Ikegami and Thomas Rice. Controlling Spending For Health Care And Long-Term Care: Japan’s Experience With A Rapidly Aging Society. Health Affairs 2023 42:6, 804-812.


“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.”

Source: Naoki Ikegami and Thomas Rice. Controlling Spending For Health Care And Long-Term Care: Japan’s Experience With A Rapidly Aging Society. Health Affairs 2023 42:6, 804-812.


“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.


“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.


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.


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

  • Home
  • About World Health Systems Facts
    • Contact Us
    • Join Our Email List
  • Breaking News & Opinion
  • Upcoming Events
  • Seventeen National Health Systems
    • Austria
    • Canada
    • Costa Rica
    • Czechia
    • Denmark
    • France
    • Germany
    • Hungary
    • Italy
    • Japan
    • Netherlands
    • South Korea
    • Spain
    • Sweden
    • Switzerland
    • United Kingdom
    • United States
  • Comparing National Health Systems
    • Healthcare Access and Quality Index
    • Sustainable Development Goals Health Index
    • Mirror Mirror 2021
    • World Health Report 2000
    • International Health Systems In Perspective
    • Lessons for US Health Reform
  • Aging
  • Health System Outcomes
  • Healthcare Spending
  • Healthcare Workforce
    • Healthcare Workers
    • Healthcare Workforce Education & Training
  • Information and Communications Technologies
  • Long-Term Services and Supports
  • People With Disabilities
  • Pharmaceutical Pricing and Regulation
  • Social Determinants & Health Equity
  • Wasteful Healthcare Spending
  • Various US Health System Proposals
    • Affordable Care Act
    • All Payer
    • Public Option
    • Single Payer / “Medicare For All”
    • Universal Health Coverage
  • Recommended Resources
  • Privacy Policy
    • Cookie Policy
  • Facebook
  • LinkedIn
  • Twitter

© 2019-2023 Real Reporting Foundation | Theme by WordPress Theme Detector

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept”, you consent to the use of ALL the cookies.
.
Cookie SettingsAccept
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDurationDescription
_GRECAPTCHA5 months 27 daysThis cookie is set by Google. In addition to certain standard Google cookies, reCAPTCHA sets a necessary cookie (_GRECAPTCHA) when executed for the purpose of providing its risk analysis.
cookielawinfo-checkbox-advertisement1 yearThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Advertisement".
cookielawinfo-checkbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
CookieDurationDescription
_ga2 yearsThis cookie is installed by Google Analytics. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. The cookies store information anonymously and assign a randomly generated number to identify unique visitors.
_gat_UA-71314304-21 minuteThis is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. It appears to be a variation of the _gat cookie which is used to limit the amount of data recorded by Google on high traffic volume websites.
_gcl_au3 monthsThis cookie is used by Google Analytics to understand user interaction with the website.
_gid1 dayThis cookie is installed by Google Analytics. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. The data collected including the number visitors, the source where they have come from, and the pages visted in an anonymous form.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
CookieDurationDescription
IDE1 year 24 daysUsed by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. This is used to present users with ads that are relevant to them according to the user profile.
test_cookie15 minutesThis cookie is set by doubleclick.net. The purpose of the cookie is to determine if the user's browser supports cookies.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT
Powered by CookieYes Logo