What Has the Long-Term Care Insurance System Achieved ?

The Direction of Social Security and Social Welfare System Reform and Future Challenges

Abstract

This study examines the transformation of Japan’s Long-Term Care Insurance （LTCI） system and the evolution of support frameworks for elderly care, with the aim of clarifying the achievement of the LTCI system since its introduction. Through successive institutional reforms, the LTCI system has made progress, in emphasizing the importance of comprehensive care that supports the overall lives of older adults and in promoting the development of community-based support systems. These reforms have contributed to a broader recognition that elderly care should not be limited to the provision of specific services but should instead be organized as integrated support for daily living within local communities.

However, several structural challenges remain unresolved. These include instability in service provision, regional disparities in access to care, a persistent shortages of care workers, and continued reliance on family-based caregiving. The recent initiative to establish the Comprehensive Support System Development Program represents an important step toward institutional restructuring, but also highlights the need to reconsider the relationship between social insurance and public financing, including insurance premiums and financial resources.

Future policy discussions should move beyond incremental institutional adjustments and consider the fundamental redesign of the broader social security and social welfare systems.