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.

View full abstract

The public programs for medical services in Japan until now have enjoyed relatively small size in costs and a relatively high reputation in function by international standards. We are now obliged, however, to sweepingly reform these services in order to reduce total costs (those for the aged in particular) and improvement of equity in inter-generational financing burdens. These measure are necessary because of the remarkable changes developing today as growing interest and demand for quality and consumer's sovereignty in medical services, tightening budgetary constraints imposed by a reduction in economic growth, and an aging of the population at the most rapid pace in the world.
The sweeping reform plans, now under consideration, consist of reorganization of the medical service provision system, achievement of the balanced budget of social insurance schemes for medical services, and coordination of benefits and financing burdens among medical and related programs. In any reform plan, I am sure that an introduction of new social insurance for long-term care will play a key role in making allocation of medical resources more efficient, holding down costs of medical services for the aged, and improving inter-generational equity of financing these burdens.

View full abstract

We first check the nation wide progress of THE NEW GOLD PLAN in reality, and attract reader's attention to the delay of“home care support center”,“elderly sanatorium”, and“service house”supply. Second, we point out that almost half of all the municipalities in Japan regard the completion of the above plan impossible due to the lack of personpower, financing and programming inabilities, based on a survey research. The delay of dimentia policies in general and regional differences in service supply are also the facts, according to the survey.
According to the Ministry of Health and Welfare, about 6% of the elderly survive in institutional care, with more than half of them living in medical facilities in 1993. But from now on group living becomes important. After looking through these conditions we emphasized the necessity of family doctors with 24 hours practice, patient visit at home, and with advice on social care to discharging patients. Increase of nursing facilities with ordinary living arrangement, short stay at clinic with beds and liberalization of advertisement by medical organization are desired by social care users and the concerned.

View full abstract

In this article, I first made comparisons between social insurance system and social assistance system in long-term care and medical care for the elderly. Second,
I examined the problems of the proposal which notes that long-term care and medical care for the elderly shall be provided through the social assistance system. I examined theoretically and practically the merits and demerits of the social insurance system and the social assistance system, using seventeen independent standards of analysis. In adaptability to the economic system, universality and entitlement of benefits, level of benefits, financing, easy access to services and selection of services, the social insurance system is superior both theoretically and practically. However, with respect to expenditure control, easy collection of taxes and cheap management cost the social assistance system is superior both theoretically and practically. It depends on how they are constructed on which is superior between social insurance contributions and taxes as financial resources, and between social insurance system and social assistance system in service delivery. In conclusion, the social insurance system is superior as a whole. This is why social insurance system plays a major part in the Japanese social security schemes.
Second, it has been insisted that long-term care and medical care insurance is not applicable to the elderly, since the risks are too high. In contrast, I clearly emphasize the concept of the insurance principle-pooling of risks-and that this is applicable even to the elderly in the social insurance system. I also pointed out that long-term care and medical care for the elderly through the social assistance system will make their financing difficult and it is anticipated that a limitation of benefits by income or assets shall be introduced and that benefit levels shall be decreased accordingly.

View full abstract

This article discusses the view toward fairness in Japanese society with respect to medical care and long-term nursing care for the aged from an economic viewpoint. I compare and contrast the characteristics of medical services and elderly nursing care service as economic“goods”. Based on the above discussion, a method to ensure fair and efficient distribution of resources is suggested by emphasizing a quasimarket system consisting mainly of non-profit firms. Subsequently, I examine the possible effects of deregulation in the medical care field, and my arguments are presented against both the potential mixture of insurance benefits and self-payment, and the entry of for-profit firms into this field. I disagree with the former because of the cost shifting that would result from the unfair and inefficient distribution of resources in the possible multi-tiered medical care system. Free entry by for-profit corporations is not appropriate in Japan because the medical system is currently unprepared for competing on a fair and equal basis

View full abstract

Japanese pharmaceutical firms have increased its R&D investment in the 1980s. This study investigates the relationship between a firm performance and R&D investment of the industry. Utilizing the q-ratio defined as the ratio of the firm value to the replacement cost of underlying assets, this study estimates the effects of R&D investments on the firm value. The results indicate that the value of R&D activities has increased in the late 1980s. In particular, R&D capital and the quality of patents have the positive effects on the fundamental value of the firm which is defined as the discounted future cash flow. The results also suggest that the optimal sale size of pharmaceutical firms was just less than 600 billion yen (1990 price) in the late 1980s. Most Japanese pharmaceutical firms are too small to exploit the positive effects of scale on the fundamental value.

View full abstract

This paper analyzes the policy evolution of nurses and the effects from a labor market viewpoint for nurses.
In Japan, three conditions have contributed to the 'nurse shortage'problems. The first problem arose from an expansion of demand because many medical facilities were built with the intention of supplying increased medical care services after the World War II. The second problem occurred when the nurses staffing scheme was introduced by the Ministry of Health and Welfare (MWH), thus the MWH has regulated the number (this is the existing regulation) and the percentage of nurses to the number of inpatients. The additional fees, so called“nursing fee”depended on staffing standards from the scheme implemented in 1958. The third problem was exacerbated by the additional expansion of demand for more hospital beds as a result of the“Medical Law”reform in 1985. It takes time for the labor market to achieve equilibrium despite the demand increases (demand curve shifts), thus giving rise to a dynamic shortage. However, the labor market for nurses is generally considered a monopsony or oligopsony in which the employer holds“market power”except in the cities. And under these conditions, a nurse shortage may occur frequently.
The MHW has made the policies which increases labor supply'of nurses with the other ministries and authorities whenever“shortage”problems occur. One of the policies is increasing the labor flow, for example, raising salary and improving working conditions. Another one is increasing labor stock for example increasing the number of the special schools and their capacity. These policies can decrease what the employers regard as“shortage”as well as the dynamic shortage. But these do not directly change the monopsonistic or oligopsonistic market into a competitive one Furthermore, the MHW established new advanced staffing standards, and also raised the“nursing fee”for increasing salaries and improving working conditions in response to the third“shortage”. This policy seems to increase demand by reducing the relative price of nursing to other inputs (the effect of subsidy on nurses employed by hospitals)

View full abstract

In Japan,“Long Term Care Insurance System”is expected to be implemented in the near future. This is because the Japanese society is aging rapidly. While some say that this rapid aging will reduce the rate of economic growth, others say that the growth rate of the overall economy will increase due to the growing health or welfare sector (long term care sector). These two kinds of arguments do not have definite foundations in economic theory. Hence this problem should be analyzed utilizing the framework of economic theory. In this paper, the foundamental framework for the economic analysis for the long term care problem in Japan is presented and discussed. I employ the two-sector overlapping generation model, which is largely based upon the results derived by Galor (1992).
I selected the two sector overlapping generation model for the following reasons. I want to discuss the effect on economic growth of the allocation of more resources to the long term care sector. Thus we must deal with this long term care sector as an independent industry, Therefore I employ-the“two-sector”model. Furthermore, I include into the analysis the fact that the younger generation often cares for the old in general by employing the overlapping generation model
This paper presents the model above and makes discussions on its steady state for the old in general by employing the overlapping generation model.

View full abstract