Director, Office of Global Health Cooperation, Division of International Affairs,
Ministry of Health, Labour and Welfare, Government of Japan 1
23 October 2017
Universal Health Coverage
and Long-term Care
in Japan
Toru Kajiwara
• Ageing Population = “Every government’s business”
• UHC for Elderly = integrated Medical + Long-term care
• Long-term care = “nationally-led” But “community-managed”
• Act Fast to develop long-term care workforce
• Strengthen ICT / data for evidence-based approach
2
Key Messages
(10,000 persons)
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Population Aged 15-64 (Working-Age People)
Population Aged -15
Population Aged 65+
In 2030, aged population (65+) will be above 30% in Japan.
Ageing in Japan
Sources : “Population Census,” Statistics Bureau, Ministry of Internal Affairs and Communications
“Population Projections for Japan,” (January 2012), National Institute of Population and Social Security Research
“Vital Statistics,” Ministry of Health, Labour and Welfare
58.1%
31.6% Aged Population Rate (% of population aged 65+)
Active Population Rate (% of Population Aged 15-64)
2
(Year)
50%
40%
20%
10%
70%
2015
2050
Percentage aged 65+ years
Source: US Census Bureau (2015)
Ageing in the World in 2050
Goal 3. Ensure healthy lives and promote well-being for all at all ages
3.8 Achieve universal health coverage, including financial risk protection, access to
quality essential health-care services and access to safe, effective, quality and
affordable essential medicines and vaccines for all
Sustainable Development Goal
- Align health systems to supporting “intrinsic capacity” and “functional ability” of older
persons (= integrated, older-person centered care)
- Develop national framework for action on Healthy Ageing
- Develop sustainable, equitable systems for long-term care
- Build workforce capacity and support caregivers
WHO Global Strategy for Ageing (2016-2020)
UHC and Ageing in Global Framework
Aging rate Major policies
1960s Beginning of welfare policies for the elderly
5.7% (1960)
1961 Universal Health Coverage established (through medical insurance) 1963 Enactment of the Act on Social Welfare Services for the Elderly
◇ Intensive care homes for the elderly created ◇ Legislation on “home helpers“ for the elderly
1970s Expansion of healthcare expenditures for the elderly
7.1% (1970)
1973 Free healthcare for the elderly
1980s “Social hospitalization” and “bedridden elderly people” as social problems
9.1% (1980)
1982 Enactment of the Health and Medical Services Act for the Elderly ◇ Re-introduction of co-payments for elderly healthcare, etc.
1987 Enactment of Certified Social Worker and Certified Care Worker Act
1989 Establishment of the Gold Plan (10-year strategy for the promotion of health and welfare for the elderly) ◇ Promotion of the urgent preparation of facilities and in-home welfare services
1990s Promotion of the Gold Plan
12.0% (1990)
1994 Establishment of the New Gold Plan (new 10-year strategy for the promotion of health and welfare for the elderly) ◇ Improvement of in-home long-term care
Preparation for the Long-Term Care Insurance System
14.5% (1995)
1997 Enactment of the Long-Term Care Insurance Act (Funding Pool: Premium 50% / National Gov’t 25% / Local Gov’t 25%)
2000s Introduction of the Long-Term Care Insurance System
17.3% (2000)
2000 Enforcement of the Long-Term Care Insurance System
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Japan’s Ageing Policies (1960s-2000)
Before • Local governments decided
facilities / services, with expensive fees for middle-income and above persons.
• Funding came mainly from national / municipal budgets.
• Elderly / Medical care provided separately.
(mismatched, inefficient medical care under UHC)
After • Older persons, assisted by care
managers, decide a variety of
services and providers.
(= old person-centered)
• A larger pool (premium + tax)
enables strategic funding to
workforce, etc.
• Coordination has been
strengthened (funded through
LTC insurance scheme)
(= integrated care (gradually))
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What changed with Long-term Care Insurance?
Home-visit Services
Care, Nursing, Bathing, Care Support, etc.
Day Services
Outpatient Day Long-Term Care, Outpatient
Rehabilitation, etc.
Short-stay Services
Short-Term Admission for Daily Life Long-Term Care, etc.
Residential Services
Daily Life Long-Term Care Admitted to a Specified
Facility and People with Dementia etc.
In-facility Services
Facility Covered by Public Aid Providing Long-Term Care to the Elderly, Long-Term Care Health Facility,
etc.
Older persons’ Home
Long-term Care Facility
Municipalities (Insurer)
Service Providers
Insured Persons
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Long-term Care Insurance Services (2000-)
Care Managers
1. Strengthening Workforce for Long-Term Care
Ongoing Challenges for Japan’s long-term care
3. Making More Equitable Long-term Care Insurance system
5. Expanding Cooperation in Asia on Healthy Ageing
2. Promoting the ‘Community-based Integrated Care System’
4. Strengthening ICT / Data for Evidence-based Approach
1.0(0.8%) 1.8 2.7 3.2 4.0 4.5 5.0 5.6 6.2(3.4%)
32.1 33.9 37.5 41.9 49.2 54.8 60.3 64.0 67.8 72.4 75.3 78.2 83.6 86.9 89.5 92
(50.3%)
4.8(8.7%) 5.9 7.2
8.8 10.4
12.5 14.1
15.5 16.6 19.0
21.0 23.0
26.4 28.6
30.6 32.1
(17.5%)
18.0 23.7 27.7
34.2
36.8
41.3 39.7
39.1 37.1
42.3 43.2
45.8
48.5 50.2
50.7
52.8 (28.8%)
218
258
303
348
387 411
435 441 455
469 487
508 533
564 586
608
0
100
200
300
400
500
600
0
50
100
150
200
FY2000 FY2001 FY2002 FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015
Home-visit service
Outpatient
Facility admission
Multifunctional small group home service
(32.7%)
(13.0%)
(53.5%)
(32.8%)
(58.5%)
(unit:10,000)
54.9
63.5
72.4 84.9
96.4
108.6 114.1
119.6 123.3
136.3 142.7 150.9
163.0
Persons in need of long-term care (in need of support)
Number of persons in need of long-term care
Long-term Care Workers has increased…but need more
Number of certified long-term care workers
【Source】 The MHLW 「Survey on Lon-term care facilities and long-term care providers”(The number of long-term care workers) “Report on status of long-term care projects” ( the number of persons
with the long-term care requirement certification ( the support requirement)
176.5 170.8
183.1
1
current Future
Unemployed women Middle-aged and older
people youths
Early retirement
More understanding of long-term care work by public and enhancing the image of work are needed
Uncertain Future visions and career paths
Leave a job soon after
getting hired
change
Unclear expertise and mixed roles
Unemployed women Other job field youths people with disabilities Middle-aged and older people
Potential long-term care public
aid workers
Encourage 1.Broad the base strengthen diversity of human resources
Improve working condition and environment
2.Create a career path Create a career path according to one’ ability and the role assigned
3.Retain workforce Improve working environment (e.g. salary increase)
Enhance skills
4.Make the mountain higher
Promote continuous improvement of quality of staff by clarifying and sophisticating professional skills
5.Set a target altitude specialize functions in order to take advantage of limited human resource
Infrastructure development by national and municipal governments
People with specialist skills
People with basic knowledge
Strengthening Workforce for Long-Term Care
Healthcare Long-term care
Living support
Housing
Commuting to
medical facilities/care
facilities
Home-visit care • Nursing care
Own home/elderly housing with long-term care
Provides consultation and coordinating
services
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Community-based integrated care support center/ care manager
Old people’s club, residents’ association, long-term care prevention, living support, etc.
Prevention
Promoting Community-based Integrated Care System - Enriching long-term care, healthcare, support and preventive services in order for elderly people to continue their lives in their accustomed areas.
1. Enhancing coordination between In-home Medical Care and In-home Long-term Care
2. Promoting measures against dementia
3. Enhancing Community Care Meetings
4. Improving the Livelihood Support Services
Community Support Projects under Long-term Care Insurance Scheme
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1. Transferring nationally-unified Preventive benefits (Home-visit Care and Out-patient Long-tem Care) to Community Support Projects of municipalities, and diversifying them.
2. Restricting users of in-facility services of Special Long-term Care Health Facilities to people whose care level is 3 or higher in principle.
Making Long-term Care Insurance Services More Efficient and Focused
Recent measures to Promote Community-based Integrated Care System
Expanding the reduction rate of premiums of people with low-income: (For example, people with pension income lower than 800,000 yen per year benefit from new reduction rate of 70%, expanded from 50%
Expanding Reduction of Premiums of People with Low-income
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1. Increasing co-payments of users with income more than a certain level (10% to 20%).
2. Adding assets to the check list of requirement for “Supplementary Benefits” (which provides money for food and residence to in-facility users with low income)
Review of Co-payments etc
Making More Equitable Long-term Care Insurance system
Medical Record Data
Sharing
Emergency Medical
Record Data Sharing
Linkage/ Analysis Service
Search Service
AI development
Genomic data linkage
PHR Personal Health Record
Hospital/Clinic/Pharmacy
・・・
-National Network
Healthcare portal site
Access
Data Center
Data sharing
-Health Data Platform-
Researcher
Private Sector
Insurer
Connect Utilize
Create -Utilization of AI-
NDB
…
MoH
Long-term DB
DPC
Patient
AI Development
Search Service
Linkage/ Analysis Service
Medical Data Sharing Service
Genomic data linkage
Strengthening ICT / Data for Evidence-based Approach
The Government of Japan has launched “Data-driven Health Reform,” to establish by
2020 a nation-wide data platform which integrates health-related data from providers,
payers and governments on preventive, medical, and long-term care.
Asian countries are “Fast Ageing”
Population
(million)
Ageing rate 2010 (65+) (%)
Ageing rate (65+)
7% Aging society
Ageing rate (65+)
14% Aged society
Number of years required for the proportion of the
aged population from 7% to 14%
Ageing rate (65+) 21%
Super Aged society
Japan 127.82 23.0% 1970 1995 25 years 2008
Republic of Korea 49.78 11.1% 1999 2017 18 years 2027
Singapore 5.18 9.0% 1999 2019 20 years 2027
Thailand 69.52 8.9% 2001 2024 23 years 2038
China 1,344.13 8.4% 2000 2025 25 years 2037
Vietnam 87.84 6.5% 2018 2033 15 years 2047
Myanmar 48.34 5.1% 2021 2041 20 years 2060
Cambodia 14.31 5.0% 2030 2053 23 years 2068
Indonesia 242.33 5.0% 2021 2038 17 years 2056
Malaysia 28.86 4.8% 2020 2046 26 years 2073
Lao PDR 6.29 3.7% 2034 2053 19 years 2065
Philippines 94.85 3.7% 2032 2062 30 years 2088
Brunei Darussalam 0.41 3.7% 2023 2041 18 years 2063
Source: World Population Prospects: The 2012 Revision Population Database World Bank, World Development Indicators database Compiled by Mitsubishi UFJ Research and Consulting based on data from the United Nations’ World Population Prospects, the 2010 revision
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Cooperation Framework ・ASEAN+3 Health Ministers and Senior Officials Meeting ・ASEAN+3 Ministers and Senior Officials Meetings on Social Welfare and Development ・ASEAN & Japan High Level officials Meeting on Caring Societies
Malaysia: 2015-2017 JICA Technical Cooperation “The Project on Successful Ageing: Social Support System and Community Based Programmes”.
Indonesia: 2014-2017 JICA Technical Cooperation “The Project for Strengthening Social Security System”
Laos, Cambodia, Myanmar: Tripartite cooperation with the support of Thailand
Viet Nam: Technical Cooperation on Active Aging
Philippines: Technical Cooperation on support for elderly in devastated areas
Singapore, Brunei: Policy Dialogues on ageing, including care services, utilizing assistive devices, and human developing for professional care
Thailand 2007-2011 JICA Technical Cooperation CTOP (The Project on the Development of a Community Based Integrated Health Care and Social Welfare Services Model for Older
Persons in the Kingdom of Thailand) 2013-2017 JICA Technical Cooperation LTOP ( The Project of Long-term Care Service Development for the Frail Elderly and Other Vulnerable People in the Kingdom of
Thailand)
Study Group for Japan's International Contribution to Active Aging, MHLW 17
Expanding Cooperation in Asia on Healthy Ageing
〇‘AHWIN’ aims to amass bilateral and regional cooperation, business and projects on aging-related challenges in the Asian region.
First approach image suggested by Japan
Asia
Training
Building economic ties among industries related to elderly care
Training for professional elderly care service such as Functional Recovery Care
Japan
Enrichment of human resources for professional elderly care service such as Functional Recovery Care
〇The goal of the initiative is to create a vibrant and healthy society where people can enjoy long and productive lives, and to contribute to the economic growth.
Career Development
Asia Health and Wellbeing Initiative (AHWIN)
Thank you!
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