Health insurance system in Japan will soon face the financial crisis because of the growing number the elderly people who expend nearly half of total health care expenditures. In this paper, I investigated the possibility of full-funded social health insurance system which is not based on individual account, but requires the solidarity among the same generations. What I have inquired was (1) future prediction of health expenditures for each generation, (2) prediction of health insurance premiums for each generation, and (3) transitional problems from the present system to proposed full-funded system.

Recently, there has been much discussion on Health Care Reform in Japan in order to control health care expenditures. In this discussion, the stratification of health care has been examined, but it has been criticized extensively as being against the principle of equality, opposed to social consciousness and resulting in rising health care costs. This paper examines those reasons and the disadvantages of the nonstratification. The conclusions are as follows:

1) It may be reasonable to hold the principle of equality in which the whole nation has an equal right to receive a high level of health care. But this does not mean that the whole nation has an equal right to receive the same level of health care.

2) Non-stratification may contribute to the control of health care expenditures. On the other hand, it may bring with it a paternalistic policy, lower the quality of health care services, lower efficiency and obstruct empowerment of the citizens.

The authors conducted an Input-Output analysis of the investment in the health sector in inducing production for each industry through inter-industry transaction based on the I-O table of Kitakyushu city in 1990. It was suggested that the investment in health sector might have the almost same effect in inducing production as that in construction sector. However, our analysis contains some methodological problems in its evaluation. For example, we used the average propensity to consume for the estimation of introduced consumption instead of the marginal propensity to consume. Furthermore, we did not include the induced consumption through the capital formation by the enterprises. Thus, the present results must be regarded as a hypothesis based on a relatively simple presumption. Besides these methodological problems, our result suggested that the investment in health sector might have a considerable economic effect in inducing production and job opportunity.

This paper tries to determine who takes care of the cared elderly at their home, i.e. a family member or home helper, by using Basic Survey on the Life of the People from 1986, 1989 and 1992. It finds that the cared elderly and/or their family demand home helpers as normal goods in an economical sense, and clearly denies the view point of rationing in public services by local governments. Its marginal effect of income means that demand for home helpers incrreases 0.03% to 1.4% with a 1% increase in income level. Assuming that Social Insurance of Long Term Care for the Elderly covers this kind of home services and that users pay 10% of the total cost, demand for home helpers is 1.2 ~ 2.8 times larger than without such a insurance system by using numerical simulation. Even in the case where users pay 50%, the demand is 1.14 ~ 1.95 times.