The document discusses caring for aging populations and compares approaches in Japan and England. It notes that Japan has the oldest population in the world and introduced significant reform to its long-term care system in 2000. Key aspects of Japan's system include universal compulsory insurance for those over 40 that provides home care and day services based on need for those over 65. England assesses eligibility based on a means and needs test and provides less support, with 44% of social care for the elderly being self-funded. Both countries are undergoing reforms to address the challenges of caring for growing older populations.

1. Shifting values: how should we
care for older people in society?
Holly Holder
Fellow in Health Policy
Nuffield Trust
6 November 2013
© Nuffield Trust

2. Caring for an ageing population: our research
Key questions:
• How should social care be funded?
• How should access to social care be decided?
• How can health and social care expenditure be contained?
• How can health and social care be better coordinated?
Research based on a study visit to Japan and literature review
Project sponsored by
The Great Britain Sasakawa Foundation
© Nuffield Trust

3. Why Japan?
• Japan has the oldest population in the world
• Similar amount spend on health and social care
• By 2025, Japan will need an extra ¥12.1bn to maintain current
levels of provision of long-term care, to support the increasing
proportion of those over 75 years old
• Increasing numbers of older people living alone
• A fiscal deficit twice its GDP
• Implemented significant reform during a period of slow
economic growth
© Nuffield Trust

4. Social care in Japan - Long Term Care Insurance
Introduced in 2000
Approximately 14% of people over 65 receive services
Eligibility
• People over 65 years old and some disabled people over
40 years old
• Access based solely on need
Costs
• Compulsory insurance payments for those over 40 years
old - approximately £30 per month
• National and local taxation
• Co-payment of 10 per cent, to a monthly maximum amount
© Nuffield Trust

5. Financing Long Term Care Insurance
50% through national/local taxation, 50% insurance premiums
Premiums
paid by 40-64
yr olds
29%
Central
government
25%
Prefectures
12.5%
Premiums
paid by 65+
yr olds
21%
Municipalities
12.5%
Premiums paid by
those aged 40 and
over
Users pay an
additional copayment when they
receive services
© Nuffield Trust

6. Social care goals
Japan
England
• Society as a whole supports
• A system for people who need
those in need of long-term care.
extra care or support - practical
or emotional - to lead an active
• The relationship between
life.
benefits and burdens are made
clear.
• Enable people to retain their
independence and dignity.
• Allow service users to receive
services from a variety of
institutions of their choice.
• Maintaining dignity and
independence of older people.
© Nuffield Trust

7. Social care in England
Approximately 12% of older people receive publically-funded social
care. There are other cash benefits available to older people who need
support.
Eligibility is assessed by a needs and means-test
•
Need – assessment based on national criteria, locally-defined
thresholds for access. Not age related.
•
Means – government support only for those with below £23,250 in
assets (approx ¥3,653,412). Those with assets over this amount
have to pay the full amount.
Options for service users includes cash payments
Costs: funded mainly through national taxation with some local taxation
© Nuffield Trust

8. Paying for social care in England (care homes only)
State funded
34%
State plus
"top up"
22%
Self-funded
44%
Estimates from Institute of Public
Care (2010)
© Nuffield Trust

9. Reform in Japan and England
Both countries are going through a period of reform
Japan
• Social security reform
• Long-term care insurance
• Health insurance
• VAT
England
• Care Bill
• Access to and paying for social care
© Nuffield Trust

10. Forthcoming research report
© Nuffield Trust