2009 Volume 3 Issue 1 Pages 1-9
In order to respond the expanding needs of health and ADL care for the aged, the Japanese government has implemented a series of health and social programs for the aged. The author thinks that the political populism is the most important cause of current difficulty of re-organizing the Japanese health system. For example, the introduction of free medical program for the aged in 1972 was decided as a result of political rivalry between the Ruling party and the left-wing Opposition parties. This program made our system too much medicalized and caused a rapid expansion of medical expenditures. The Long-term care insurance scheme (LTCI) was introduced in 2000 in order to de-medicalize the system by expanding home care capacity, but has not reduced medical expenditures as estimated before. In order to re-organize the system for the aged, the new scheme of health insurance for the aged has been introduced in 2008. However, just before the introduction of the new health insurance scheme, there started very strong opposition against the introduction of new scheme. Mass media launched a tremendous volume of negative campaigns and the Opposition parties has been criticizing the responsibility of government and Ruling parties. The two main points of critics are ageism and heavy financial burden for the aged, especially for those of lower economic status. According to the author's perspective, the most important cause of mistake for the introduction of new scheme is insufficient consideration for QOL and clinical outcomes. The debate has too much focused on cost sharing and financial burden. The philosophy of social security policy must be QOL issue, not financial control. The well organized health insurance scheme for the aged must be one of basic infrastructures in order to construct an active aged society. More creative debate is necessary.