Public Long-Term Care Insurance / Public Nursing Care Insurance

■What Is Public Long-Term Care Insurance / Public Nursing Care Insurance?

Due to the rapid aging of society on a scale that is probably unparalleled elsewhere in the world, Japan is currently experiencing a number of serious problems such as an increase in the number of elderly people requiring care, the limits to the care that can be done by family members, and an increase of medical expenses for the elderly. Therefore, to enable the society as a whole to shoulder the duties related to care, Long-Term Care Insurance System was established in 2000.

Long-Term Care Insurance System is a mechanism allowing elderly people (limited to those, who were assessed and certified as recipients of the nursing care services) to enjoy nursing care services for less money (all the certified recipients are required to pay only ten percent of the service fee until the end of July 2015--see [Main points of revisions] below for details). In order to receive the benefit of the system, it is necessary to pay the insurance premium. This insurance premium is to be paid by citizens aged 40 and above. From the time a person reaches 40 years of age and until he or she starts receiving pension, the insurance premium for the Long-Term Care Insurance System is automatically added to the premium of medical insurance. And as soon as one starts receiving pension, the amount is, as a rule, deduced in advance from the pension. Although the insurance premium is paid from the age of 40, as a rule, one can start using the system upon reaching the age of 65.

However, even if one is between 40 and 64, it is possible to receive nursing services by those, who have contracted one of specified 16 diseases*, which are considered to be caused by aging.

Furthermore, if the sum total of the user's charge for any month exceeds a certain upper limit, upon submitting an application, one is entitled to reimbursement of the exceeding amount, which is called "High nursing-services expense*". Moreover, also in the event that the maximum out-of-pocket expense* is exceeded within the same household, members of which use both the nursing care insurance and a medical insurance, the amount* exceeding the limit is reimbursed upon submitting an application.

However, the total cost of nursing care insurance, which was 3,800 billion yen in the 2000 fiscal year, had continued increasing, and by the 2012 fiscal year has reached as much as 8,900 billion yen. In connection with this increase, the premium for nursing-care insurance paid by those aged 40 and above was also increased from the initial monthly amount of about 2900 yen to about 4900 yen. It is very likely that the amount borne by individuals will get even higher in the future. In order to continue offering the benefits on the same level, it will possibly be needed to change the amount of out-of-pocket expenses or revise the eligibility criteria for the nursing-care insurance.

*Specified 16 Diseases
1) Terminal cancer
2) Cerebrovascular diseases (cerebral hemorrhage, cerebral infarction, etc.)
3) Amyotrophic lateralsclerosis (ALS)
4) Diseases related to parkinson's disease
5) Spino-cerebellar degeneration
6) Multiple system atrophy (Shy-Drager syndrome)
7) Diabetic nephropathy , retinopathy, neuropathy
8) Arteriosclerosis obliterans
9) Rheumatoid arthritis
10) Ossification of posterior longitudinal ligament
11) Spinal canal stenosis
12) Fractures caused by osteoporosis
13) Progeria syndrome (Werner syndrome)
14) Dementia in the presenium ※1
15) Chronic obstructive pulmonary disease ※2
16) Osteoarthrosis accompanied by significant deformation of the knee and hip joint on both sides

※1 Alzheimer's disease, Pick's disease, cerebro-vascular dementia, Creutzfeldt-Jakob disease, etc.
※2 Pulmonary emphysema, chronic bronchitis, bronchial asthma, diffused panbronchitis

*High Nursing-services Expense

Stage	Eligible Person	Out-of-pocket Maximum Amount （Monthly）
Ⅰ	A person whose household does not pay a residence tax and who receives old age pension etc.	15,000 yen (Individual)
Ⅱ	A person whose household does not pay a residence tax and total of total income and pension income is 800,000 yen or less	15,000 yen (Individual)
Ⅲ	A person whose household does not pay a residence tax and total of total income and pension income is more than 800,000 yen	24,600 yen (Household)
Ⅳ	A person whose household pays a residence tax	37,200 yen (Household)

*Maximum Out-of-pocket Expense in Case of Using Both Long-Term Care Insurance and Medical Insurance within the Same Household
The maximum out-of pocket expense varies depending on age structure of your household, kind of medical insurance your household belongs to and income of each member of your household. Please check with a staff of the medical insurance.

Cf.)
◆Japan's Long-Term Care Insurance Programs
http://www.kaigo.gr.jp/JLCIhp.htm
◆Long-Term Care Insurance Act in Japan
http://www.japaneselawtranslation.go.jp/law/detail_main?vm=&id=94
◆Long-term Care Insurance in Japan (Ministry of Health, Labour and Welfare)
http://www.mhlw.go.jp/english/topics/elderly/care/

■Procedures and Applications Required for Long-Term Care Insurance

In order to apply for the Long-Term Care Insurance, one first has to have his/her attending physician. If one has a regular doctor, one should contact him or her and check whether it is possible to get a written opinion concerning the Long-Term Care Insurance. If one does not have a regular doctor, one should get a consultation at the Community General Support Center of the area one resides in.
　　　　　　　　　　　　　　　　　　　　　　　　　↓
The person himself/herself or his/her family needs to submit an application for Certification of Needed Long-Term Care and the Long-Term Care Insurance Certificate to the to the related municipal counter.
　　　　　　　　　　　　　　　　　　　　　　　　　↓
(1) Home-visit (a surveyor visits the place the person resides in and conducts a hearing survey of the person himself/herself and the family regarding the person’s physical and mental conditions and his/her daily life and determines how much nursing care the person requires)
* In order to convey the necessary information within the limited time of the visit, it is advisable to write down the list of what you want to tell the surveyor beforehand.
(2) Written opinion of the attending physician (requested by the government office to the doctor directly)
　　　　　　　　　　　　　　　　　　　　　　　　　↓
Certification of Needed Long-Term Care is determined after passing through two judgments.

Primary judgment

The results of the qualification questionnaire (74 headings of the basic survey and special items) created at the time of the home-visit survey and the written opinion of the attending physician are substituted by a computer software that is standardized across the country with the time of care (standard time of Certification of Needed Long-Term Care) needed by the recipient of the service.
　　　　　　　　　　　　　　　　　　　　　　　　　↓
Secondary judgment (by Certification Committee of Needed Long-Term Care)

A group of experts (consisting of academic experts in health, medical care, and welfare; as a rule the number of persons in the group is five) judges whether the judgment made by computer is appropriate. Here, the written opinion of the attending physician and the special items of the questionnaire serve as the material for judgment.
　　　　　　　　　　　　　　　　　　　　　　　　　↓
Certification of Needed Long-Term Care (in accordance with the judgment made by the Certification Committee of Needed Long-Term Care, municipal authorities determine the level of care needed, and notify the person thereof in written form. Usually, it takes about 30 days from the day, on which the application is submitted, to the report.)

If the person is certified as needing care, he/she receives the Long-Term Care Insurance Certificate with the level of care needed on it which submitted with the application, but if the person is deemed as self-reliant (not requiring the service), he/she receives the Long-Term Care Insurance Certificate without additional entries together with the notice. If one is certified with a level of care needed, 'term of validity' will also be stated in the insurance certificate. This term is also determined by the Certification Committee. This term of validity can be extended upon completion of the renewal procedures, if one is requalified. Although the renewal procedures can be conducted during the period from 60 days before the expiration date and until the expiration date, requalification as well as the first qualification requires a hearing survey, creation of a written opinion by the attending physician, and passing through two judgments. Requalification also takes about 30 days from the day, on which the application is submitted, to the report. Moreover, even during the term of validity, one can apply for a change of the level of care needed if there is a change in the condition of the person receiving care.
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The user chooses the service provider(s) for every service he or she wishes to use, and, after concluding an agreement with the service provider(s) (which is necessary because services provided under the Long-Term Care Insurance require agreements), starts using the service(s). However, concluding an agreement may be difficult for elderly people living alone, whose ability to judge has deteriorated. In these cases, use of the legal "adult guardianship system" established to protect and support adults with insufficient judgment can be a good option.

Certification of Needed Long-Term Care applies the 'care-need certification reference time', that is, time that serves as a criterion to indicate time and effort required in care to the following standards, and is, furthermore, implemented taking into account the indices of severity of dementia in cases of elderly people with dementia, and is prescribed in Ministerial Ordinance on Standards of Examination and Judgments by Certification Committee of Needed Long-Term Care concerning Selection of Recipients of Nursing Care Services, etc. (Ministry of Health and Welfare Ordinance No. 58 dated April 30, 1999)

Classification of Areas Care-need Certification Reference Time Is Applied to

Direct Life Support Service	Care offered for bathing, excretory processes, meals, etc.
Indirect Life Support Service	Help with household chores, such as washing or cleaning
Actions Related to Problematic Behavior	Search for wandering elderly, dealing with unsanitary acts, etc.
Actions Related to Functional Training	Functional training in abilities required in day-to-day living such as walking
Medicine-related Acts	Administering intravenous fluids, attending to bedsores, and offering other medical assistance

Classification of Care-need Certification Reference Time

Support Needed	Care-need certification reference time for the five areas above is from 25 minutes to 32 minutes or the equivalent of that time period
Nursing Care Level 1	Care-need certification reference time for the five areas above is from 32 minutes to 50 minutes or the equivalent of that time period
Nursing Care Level 2	Care-need certification reference time for the five areas above is from 50 minutes to 70 minutes or the equivalent of that time period
Nursing Care Level 3	Care-need certification reference time for the five areas above is from 70 minutes to 90 minutes or the equivalent of that time period
Nursing Care Level 4	Care-need certification reference time for the five areas above is from 90 minutes to 110 minutes or the equivalent of that time period
Nursing Care Level 5	Care-need certification reference time for the five areas above is more than 110 minutes or the equivalent of that time period

Reference
The Health Enhancement under Health Care of the Aged Enterprise in the 2002 fiscal year released the following results based on the research on care need assessment and the tendencies appearing in the care need assessment results since the 1999 fiscal year.

In general, people in ‘state requiring support’ and ‘state requiring nursing care’ usually are in the following conditions.

Self-reliant State (non-applicable)	State of people, who are capable of basic activities of daily living, such as walking, getting up, etc., and also have the ability to conduct such instrumental activities of daily living as oral administration of medicine, use of the telephone, etc.
State Requiring Support	State of people, who are for the most part capable of basic activities of daily living, but still require certain support regarding instrumental activities of daily living, which, by offering care as regards to activities of daily living and prevention of aggravation of the conditions, can contribute to preventing the person from entering a state requiring care.
State Requiring Nursing Care	State of people, who have difficulties in carrying out basic activities of daily living by themselves and need certain nursing care.

People in ‘state requiring nursing care’ usually are in the following conditions..

Nursing Care Level 1	State of people, whose capacity to carry out instrumental activities of daily living is even lower that of those in the state of needed support, and need partial nursing care.
Nursing Care Level 2	State of people, who, in addition to nursing care required by those in the nursing care level 1 category, require some partial nursing care related to activities of daily living.
Nursing Care Level 3	State of people, whose capacity for both activities of daily living and instrumental activities of daily living is substantially lower than of those in the nursing care level 2 category, and who require nursing care in almost all aspects of the living.
Nursing Care Level 4	State of those, who, in addition to difficulties experienced by those in the nursing care level 3 state, have even less mobility, and for whom it is difficult to lead everyday life without nursing care.
Nursing Care Level 5	State of those, whose mobility is even more constrained than those in the nursing care level 4 state, and for whom it is almost impossible to lead everyday life without nursing care.

■Premiums for Long-term Care Insurance of People Aged 65 and above

The premium for long-term care insurance of people aged 65 and above is determined depending on the base amount prescribed by the municipality, the income of the person himself/herself, the the income of people of the same household, etc.

■Particulars of the Health and Welfare Policies for the Elderly

1963　　　　Act on Social Welfare Service for Elderly
　　　　　　　・Establishment of Special Nursing Home for the Aged
　　　　　　　・Legalization of Home Helpers
1973　　　　Medical care fees are eliminated for the elderly
1982　　　　Enactment of the Act on Assurance of Medical Care for Elderly People
　　　　　　　・Abolition of the free medical care for elderly people system
1989　　　　A "Ten year plan to improve health and welfare services for elderly people," the so-called "Gold plan," is formulated
　　　　　　　・Urgent preparation of homes for the aged and promotion of home welfare
1993　　　　Start of "Conversazione concerning Welfare Vision in Aging Society (personal advisory panel to the Minister of Health and Welfare "Aging society welfare vision round-table")
1994　　　　New Gold plan is formulated （ten-year strategy for promotion of the health welfare of the aged)
　　　　　　　・Enhancement of Home Care
19940328　"21st Welfare Vision"
19940909　Plans for a "long-term care insurance" appear in the second report by the Social Security Council Internal Committee on the Future of Social Security
19941213　"Aiming to create a new nursing care system for elderly people" (Elderly people nursing care/independent living support system research association)
199507　　Social Security System Council advocates the creation of a "long-term care insurance system" in their first recommendation in 33 years.
199712　　Long-Term Care Insurance Act is passed
200004　　Long-Term Care Insurance begins
200006　　Revision of Long-Term Care Insurance upon agreement of the ruling parties 200304　　Revision of nursing-care benefits
　　　　　　　Revision of the insurance premium
200506　　Act is approved concerning partial revision of Long-Term Care Insurance etc.
200510　　Partial enforcement of the above revised act （revision of institutional benefits)
200604　　Full enforcement of the above revised act
　　　　　　　Revision of nursing-care benefits
　　　　　　　Revision of the insurance premium
2008.05 Establishment of the Act for Partial Revision of the Old-Age Welfare Act and Nursing-care Insurance Premium
2009.04 Nursing-care benefits revised
　　　　　　　First revision of the insurance premium
2009.05 Full enactment of the revised act (Establishment of a system for operational control of enterprises offering nursing-services, measures to ensure availability of the services, etc.)
2011.06 Establishment, proclamation, and partial enactment of the Act for Partial Revision of the Long-Term Care Insurance Act, etc. in order to strengthen long-term care service infrastructure
2012.04 Full enactment of the revised act (establishment of the 24-hour regular home visitation and as-needed visitation services, combined services, etc., enabling suctioning of phlegm by nursing care staff, mitigation of insurance premium increases by elimination of fiscal stability funds, etc.)
　　　　　　Revision of nursing-care benefits
　　　　　　Revision of the insurance premium
※ In April, 2014, following the increase of the consumption tax rates to 8%, nursing-care benefits were revised. Revision of the base amount for limit of payment was made by classes.
2014.06.18 Establishment of the Act for Maintenance of Acts related to Legislation for Promotion of Comprehensive Availability of Medical and Nursing Care in the Regions, etc." (also known as the Act for Promotion of Comprehensive Availability of Medical and Nursing Care)

＊The Act raised the burden for those who can pay more, which resulted in the services being used predominantly by those, who require it more, and thus adding up to a more balanced system

[Main Points of Revisions]
(1) Increase in the burden on users (August, 2015 -)
Although presently the user burden of the elderly care insurance is uniform at ten percent, the amount of premium for people with income exceeding certain amount (2,800,000 yen for single-person households and 3,590,000 yen for married couples) will be raised to twenty percent.

(2) Tightening of the criteria for admission into special elderly nursing homes (April, 2015 -)
Although presently one has the right to be admitted starting from nursing care level 1, the general rule will be changed moving the eligibility up to level 3 and above. As the tightening will only concern new admissions, the change will not affect people with nursing care levels 1 and 2, who are already at special elderly nursing homes.

(3)Food and room expenses of special elderly nursing homes (August, 2015 -)
There is a system of aid for food and room expenses for low income earners admitted to the special elderly nursing homes. So far, the low income earners were defined as members of households exempt from the resident tax, but this classification was criticized as unfair as it includes people with ample deposits and savings and those, who receive tax-free survivor's annuities. Therefore, the 'low income earners', who are exempt from resident tax, will not be able to receive the aid if they have savings of over 10 million yen for single-person households and over 20 million yen for married couples.

(4)Transfer to the municipalities of jurisdiction over enterprises offering services to those requiring support (April, 2015 -)
This measure will separate the prevention benefits for people requiring support for home-visit nursing care from the care offered at day care institutions, entrusting the provision to the discretion of municipalities.

(5) Application of the domicile exception of elderly housing with supportive services (April, 2015 -)
This will mean a substantial expansion of the scope. Moreover, this will enable those, who are subject to the domicile exception, to use the community-based services, etc. specified by the municipalities at the place of residence and also make them eligible for services offered by the support enterprises of the municipalities they belong to.

■Theme-Related Links

◆Aging
◆Chronology: The History of Medical Care/Welfare Systems in Japan
◆Delinquency in Long-term Care Insurance premium of dues will result in service restriction
http://www.city.musashino.lg.jp/dbps_data/_material_/_files/000/000/016/010/kaigohoken2013.pdf [PDF]
◆Formats of the Application Forms Related to the Long-Term Care Insurance (Iwaki City)
http://www.city.iwaki.fukushima.jp/gaikokugo/english/3879/4549/16712/016151.html [PDF]
◆Guidebook for Long-term Care Insurance (Fiscal 2012) (Shinjuku City)
http://www.city.shinjuku.lg.jp/foreign/japanese/pdf/other/kaigo2012_e.pdf [PDF]
◆Highlights from Help Wanted? Providing and Paying for Long- Term Care, OECD Publishing, 2011
http://www.oecd.org/els/health-systems/47891458.pdf [PDF]
◆Long-term Care Insurance (Chuo City)
http://www.city.chuo.lg.jp/multilingual/english/guidebook/files/JE_4_8.pdf [PDF]
◆Long-Term Care Insurance (Nagoya International Center)
http://www.nic-nagoya.or.jp/en/e/archives/4770
◆Long-term Care Insurance (Setagaya City)
http://www.city.setagaya.lg.jp/kurashi/105/145/603/608/d00004781_d/fil/72.pdf [PDF]
◆Long-term Care Insurance Program (City of Osaka)
http://www.city.osaka.lg.jp/contents/wdu020/fukushi/english/kaigo/03_kaigohoken_seido.html
◆Long-Term Care Insurance System (City of Yokohama)
http://www.city.yokohama.lg.jp/lang/en/06/06-64.html
◆Long-Term Care Insurance System (Kobe City)
http://www.city.shinjuku.lg.jp/foreign/japanese/pdf/other/kaigo2012_e.pdf [PDF]
◆Long-Term Care Insurance System (Tokyo Metropolitan Government)
http://www.fukushihoken.metro.tokyo.jp/kourei/koho/kaigo_pamph.files/kaigohoken-english.pdf [PDF]
◆Overview of the Revision of the Long-term Care Insurance System: Amendment of the Long-term Care Insurance Law and Long-term Care Fee (Ministry of Health, Labour and Welfare)
http://www.ilcjapan.org/linksE/doc/Overview_of_the_Revision_of_LTCI.pdf [PDF]
◆Study Group on Aging
◆Study Group on Ars Vivendi of Nanbyo
◆The long-term care insurance program (IBM Japan Health Insurance Association)
http://www.ibmjapankenpo.jp/eng/member/outline/system03.html

■Literature

Our Center's Members

◆TATEIWA Shin'ya　August 12, 2010　"Disability Movement / Studies in Japan 3: To Use Public Fund to Organize Services by Themselves"

◆TATEIWA Shin'ya　June 30, 2010　"The Disabled Movement Versus Public Long-Term Care Insurance- 2000~2003,"Socail Policy Studies 10:166-186　[Abstract in English]

◆TATEIWA Shin'ya　May 28, 2010 "Fights over Limits: Analysis of the Past Decade in Japan," Conference of Social Welfare Program Society of South Korea; held in Seoul, South Korea

◆KAWAGUCHI Yumiko & KONAGAYA Momoe (Eds.) August 10, 2009 Pocket Guide of Using Ventilators at Home: Life and Support, Ishiyaku Shuppan, 212p ISBN-10:4263235290, ISBN-13:9784263235294, \2,730 (with tax)

◆TATEIWA Shin'ya　July 24, 2009 "Notes on Direct Payments," Points on Direct Payments: Asking Dr.Simon Prideaux, Ritsumeikan University

◆TATEIWA Shin'ya　July 24, 2009 "Notes on Direct Payments," Points on Direct Payments: Asking Dr.Simon Prideaux, Ritsumeikan University

Others

◆SHIMIZUTANI Satoshi September 12, 2013 "The future of Japan’s Long-term Care Insurance Program"
http://www.rieti.go.jp/jp/publications/dp/13e064.pdf [PDF]

◆SHIMIZUTANI Satoshi July 2013 "The Future of Long-term Care in Japan"
http://www.voxeu.org/article/future-japan-s-long-term-care-insurance-program

◆HATANO Eiji 2012 "Long-term Care Insurance in Japan: How physicians are involved in providing rehabilitation for the elderly," JMAJ 55(3): 231?239
https://www.med.or.jp/english/journal/pdf/2012_03/231_239.pdf [PDF]

◆YONG Vanessa & SAITO Yasuhiko 2012 "National Long-Term Care Insurance Policy in Japan a Decade after Implementation: Some Lessons for Aging Countries"
http://link.springer.com/article/10.1007%2Fs12126-011-9109-0#page-1

◆SUNWOO Duk March 2012 "The Present situation and problems of the long-term care insurance in South Korea: from comparative perspectives between South Korea and Japan," Japanese Journal of Social Security Policy Vol.9 (1): 49-60
http://www.ipss.go.jp/webj-ad/WebJournal.files/SocialSecurity/2011/spring/Web%20Journal_Dr%20Sunwo.pdf

◆OLIVARES-TIRADO Pedro, TAMIYA Nanako, KASHIWAGI Masayo & KASHIWAGI Kimikazu 2011 "Predictors of the highest long-term care expenditures in Japan," BMC Health Services Research 11:103
http://www.biomedcentral.com/1472-6963/11/103

◆TAMIYA Nanako et.al. September 24, 2011 "Population ageing and wellbeing: lessons from Japan's long-term care insurance policy," The Lancet Vol.378 (9797): 1183 - 1192
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61176-8/abstract [Abstract]

◆CAMPBELL John Creighton April 28, 2011 "Japan's Universal Long‐Term Care Insurance: Generous, Affordable, Workable"
http://asia-center.utah.edu/_documents/humis/docs/organization-669-1328047588.pdf [PDF]

◆ONO Taichi April 12, 2011 "Aging in Japan: Focusing on Long-Term Care Insurance" (Presentation at Healthy Aging Summit)
http://www.slideshare.net/keiroservices/aging-in-japan-focusing-on-longterm-care-insurance

◆YASUKAWA Fumiaki 2010 "Reforming Public Long‐term Care insurance and Caregiver Burden in Japan: How to Relieve Care Cost," Japanese Journal of Health Economics and Policy Vol.21E1: 227-245
http://fumiakiyasukawa.web.fc2.com/report1.pdf [PDF]

◆TSUTSUI Takako 2010 "The Current State and Future Development of the Long-term Care Insurance System in Japan," Journal of the National Institute of Public Health Vol.59 (4): 372-379
http://www.niph.go.jp/journal/data/59-4/201059040009.pdf [PDF]

◆CAMPBELL John Creighton, IKEGAMI Naoki & GIBSON Mary Jo January 2010 "Lessons From Public Long-Term Care Insurance In Germany And Japan," Health Affairs Vol.29 (1): 87-95
http://content.healthaffairs.org/content/29/1/87.full

◆IWAMOTO Yasushi & FUKUI Tadashi November 2009 "Prefunding Health and Long-term Care Insurance," Public Policy Review Vol.5(2): 255-286
http://www.jbaudit.go.jp/english/exchange/pdf/e14d03.pdf [PDF]

◆KANAZAWA Kimiaki & WANAKA Katsumi February 21, 2009 "The Current Status and Challenges of Home Care of Patients with ALS in Japan"[Word]/[PowerPoint]
International Symposium "Research on Home Care of Patients with ALS in East Asia", Ritsumeikan University

◆MITCHELL Olivia S., PIGGOTT John & SHIMIZUTANI Satoshi　January 2008 "Developments in Long-Term Care Insurance in Japan," UNSW Australian School of Business Research Paper No. 2008 ECON 01
http://www.google.co.jp/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=46&ved=0CF0QFjAFOCg&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F228171707_Developments_in_Long-Term_Care_Insurance_in_Japan%2Ffile%2F5046351a401d0b6690.pdf&ei=N6uvUtv7Cs-HkgX8pYCQBg&usg=AFQjCNHmgFnL2q12Y6gvRiq5Clv4I0oCdw [PDF]

◆MITCHELL Olivia S., PIGGOTT John & SHIMIZUTANI Satoshi October 2007 "Developments in Long-Term Care Insurance in Japan," CPS Discussion Paper
http://www.jbaudit.go.jp/english/exchange/pdf/e14d03.pdf [PDF]

◆IKEGAMI Naoki July 2007 "Rationale, Design and Sustainability of Long-Term Care Insurance in Japan ? In Retrospect," Social Policy and Society Vol.6(3): 423-434
http://journals.cambridge.org/action/displayFulltext?type=1&fid=1036572&jid=SPS&volumeId=6&issueId=03&aid=1036568

◆SHIMIZUTANI Satoshi & INAKURA Noriko March 2007 "Japan’s Public Long-term Care Insurance and the Financial Condition of Insurers: Evidence from Municipality-Level Data," Government Auditing Review Vol.14: 27-40
http://www.jbaudit.go.jp/english/exchange/pdf/e14d03.pdf [PDF]

◆IWAMOTO Yasushi, KOHARA Miki & SAITO Makoto October 2006 "On the Consumption Insurance Effects of Long-term Care Insurance In Japan : Evidence from Micro Household Data" (Discussion Paper F series)
http://repository.dl.itc.u-tokyo.ac.jp/dspace/handle/2261/2860

◆IKEGAMI N. October 1997 "Public long-term care insurance in Japan," JAMA 278(16):1310-4
http://www.ncbi.nlm.nih.gov/pubmed/9343449 [Abstract]

◆IGATA Akihiro 1997 "The long term care insurance system in Japan ?Significance of nutritional preventive care?"
http://www.nuas.ac.jp/IHN/report/pdf/01/09.pdf [PDF]

◆CRUME Yoko 1997 "Publicly-Mandated Long Term Care Insurance Programs: Japan Chooses a Modified German Model," Occasional LTC Policy Paper Series
http://ltc.duke.edu/occasional_5.htm

◆CAMPBELL John Creighton 1997 "Initiating Public Long-Term-Care Insurance in Japan," The Journal of the International Institute Vol.5 (1)
http://quod.lib.umich.edu/j/jii/4750978.0005.104/--initiating-public-long-term-care-insurance-in-japan?rgn=main;view=fulltext

◆TOMIHARI Masato "Current Situation and Actuarial Issues of Long-Term Care Insurance in Japan"
http://www.actuaries.jp/lib/meeting/reikai21-6/1_1450_2.pdf [PDF]

◆FUJINO Yoshihisa & MATSUDA Shinya "Can long-term care insurance system reduce health inequality among Japanese elderly ?"
http://cis.ier.hit-u.ac.jp/Japanese/society/conference090114hosei/Paper_Yoshihisa%20Fujino.pdf [PDF]

◆OKAMOTO AtoZ "The Long Term Care Insurance [Kaigo Hoken] and its Impact on Society and Health Care System in Japan"
http://www2.pitt.edu/~super7/4011-5001/4841.ppt#258,1,The Long Term Care Insurance [Kaigo Hoken] and its Impact on Society and Health Care System in Japan

◆IHARA Kazuhito "Japan's Policies on Long-Term Care for the Aged : The Gold Plan and the Long-Term Care Insurance Program"
http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN023659.pdf [PDF]

◆MURAKAWA Hirokazu & YASUMURA Kaori "Reforms of Elderly Long-Term Care Insurance System in Germany and Japan - Focused on the Development of Community Services for the Elderly with Consulting and Support Functions - "
http://www.jcsw.ac.jp/research/files/jspsw15_murakawa.yasumura.pdf [PDF]

■Newspaper Articles

UP:December 10, 2013 REV:December 16, 2013/December 17, 2013/June 23, 2014/February 23, 2015/February 24, 2015

Prepared by: KATAOKA Minoru

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