Abstract
In Japan, the development of a long-term care service market has supported the fragile elderly and their families since 2000. The public long-term care insurance system has performed the role of a “promotion engine” to develop the service industry.
Several issues with respect to the evolution of government policies regarding long-term care insurance and the service market are discussed in this paper. The issues were chosen among those which I took some responsibility when they were discussed in government committees and councils. The purpose of explaining these issues is to offer resources to researchers of the next generation who plan to study these policies.
First I explain a couple of analytic tools. Then I talk about the process of the care market creation using these tools. Next I discuss nursing care insurance benefits for the elderly and the insurance payment to the long-term care service providers. A difference of “characteristics of the goods” as compared with medical care services from the view point of economics is one very important point to understand.
With the development of the market, the extent of insurance coverage, i.e. what services should be covered and what should be paid only by out-of-pocket payment became the critical issue. Housekeeping support and the food and housing costs for nursing home residents are examples of such controversy.
Then I mention the importance of the new information disclosure system imposed on long-term care service providers since 2006.
Finally, I give an opinion about four key points for the future of the long-term care system in our country: (1) prolongation of the fragile period for senior citizens at the end of their life and the rapidly growing number of elderly with dementia, (2) changes in the care labor market, (3) the current lack of barrier-free housing for the elderly, and (4) comprehensive care systems in each local community.
