Abstract
We need further deliberation on the Social Insurance for Long-term Care in terms of the accompanying risk and the function of the insurance.
1. Characteristics of social insurance for long-term care are unbalanced (asymmetric) in terms of benefits and burdens. From the point of view of benefits, the insurance system resembles medium-and long-term insurance which possesses similar characteristics between medical insurance and pension insurance. From the viewpoint of burden, it is said to be a more similar to short-term insurance because unlike sickness insurance there is not much possibility of covered risk occurrence. In order to resolve these contradictions, or reduce the gap between these two characteristics, the social insurance for long-term care must be better supported by the common bonds between generations than is normal medical insurance. To support this insurance system, the rate of public burden will be higher than for medical insurance. We need to deliberate carefully on the balance between the deterioration of its purity as an insurance and the increase of public burden which is necessary for ensuring that the insurance functions properly.
2. The function of the social system can be divided into social insurance and social assistance. When we adopt a connected-type approach as a basis for the system in which both the principles of social insurance and social assistance are connected and interlocked to each other, instead of applying a separated-type approach, we should reexamine the principles of the entire approach. To evaluate the incidental enlargement of the mixed area between insurance and assistance at the introduction of the social insurance for long-term care, it is indispensable to review the mixed compromise of both principles and to convert the compromise into the connection and sharing of the principles. The“compromise”means the negative influence of the mixture because each principle would not function completely. On the contrary the“connection”requires clear separation of both principles and shared functioning of both principles. The issue will be to differentiate between the types and characteristics of assistance and public expense used for the support of the insurance system
3. The introduction of the social insurance for long-term care itself is vitally important, and it will affect all of Japan's social security systems and inevitably have a great influence upon all three pillars of the Social Security system; medical care, pension and social welfare. I further discuss reasons why the cross-system reconstruction should be connected and coupled with the system design of the social insurance for long-term care itself.
