In this slideshow, Dr Mayumi Hayashi, Leverhulme Early Career Fellow, Institute of Gerontology, Kingโs College London, gives an overview of social care reforms in Japan, and outlines the achievements, challenges and lessons for England.
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Mayumi Hayashi: Lessons from Japan on social care reform
1. Shifting values: how should we care for
older people in society?
The Daiwa Anglo-Japanese Foundation
2013 Seminar Series with the Nuffield Trust
6 November 2013
Dr Mayumi Hayashi
Institute of Gerontology
Kingโs College London
2. Outline
โข Experience - ใป 2000๏ผ2005: Expansion phase
ใป After 2005: Reforms
โข Comprehensive support network
โข Achievements
โข Challenges
โข Lessons for England?
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3. 2000๏ผ2005: Expansion Phase
Achievements:
โข Expansion in service users & reduction in unmet
need
โข Success in shedding stigma of public care
โข Growing sense of entitlement & willingness to pay
premiums
Concerns:
โข Soaring expenditure requiring increased funding (i.e.
taxes & insurance premiums)
โข Abuse of services (unwarranted use of home care by
less needy)
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4. After 2005: Reforms
โข Government measures to ensure sustainability
- Means-tested accommodation fees in nursing
homes
- Clarified and reduced services for less needy,
emphasising โno-frillsโ, rehabilitation-led
preventative services
โข Slowed growth of users and of service use,
permitting stabilised expenditure
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5. New comprehensive approach
โข Municipalities responsible for low-level and
preventative support
โข Seniors encouraged to offer voluntary support,
promoting healthy, active lives & earning credits
towards their own insurance premiums
โข Extended the systemโs scope, offering
comprehensive support to entire older population
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6. System Achievements
โข Financial sustainability โ worldโs most generous
long-term care system (outside Scandinavia),
within controlled, stable increases in expenditure
โข Universal coverage fostered higher service quality
(and user expectations)
โข Promoted prevention and active ageing
โข Shift in attitudes towards responsibilities for care
(people now prefer public care to family care)
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7. System Challenges
โข Maintaining financial sustainability โ requires
higher premiums/taxes/user-fees or cutting
services (popular?)
โข Unequal service distribution - shortages of nursing
homes, burden on family carers remains heavy
โข Increased financial burdens on low income groups
โข Shortages of care workers
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8. The lessons from Japan?
โข Cost control possible, but requires negotiation
and trust in system
โข Universal entitlement important, reinforcing
quality and โconsumerismโ
โข Clear, agreed definitions of eligibility and service
content necessary
โข Strong central government control, flexible
funding and system structures & clear role and
autonomy for municipalities crucial
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