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Lancet. 2011 Sep 24;378(9797):1183-92. doi: 10.1016/S0140-6736(11)61176-8. Epub 2011 Aug 30.

Population ageing and wellbeing: lessons from Japan's long-term care insurance policy.

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Department of Health Services Research, Graduate School of Human Care Sciences, University of Tsukuba, Ibaraki, Japan.


Japan's population is ageing rapidly because of long life expectancy and a low birth rate, while traditional supports for elderly people are eroding. In response, the Japanese Government initiated mandatory public long-term care insurance (LTCI) in 2000, to help older people to lead more independent lives and to relieve the burdens of family carers. LTCI operates on social insurance principles, with benefits provided irrespective of income or family situation; it is unusually generous in terms of both coverage and benefits. Only services are provided, not cash allowances, and recipients can choose their services and providers. Analysis of national survey data before and after the programme started shows increased use of formal care at lower cost to households, with mixed results for the wellbeing of carers. Challenges to the success of the system include dissatisfaction with home-based care, provision of necessary support for family carers, and fiscal sustainability. Japan's strategy for long-term care could offer lessons for other nations.

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