Director, Office of Global Health Cooperation, Division of International Affairs,

Ministry of Health, Labour and Welfare, Government of Japan 1

23 October 2017

Universal Health Coverage

and Long-term Care

in Japan

Toru Kajiwara

• Ageing Population = “Every government’s business”

• UHC for Elderly = integrated Medical + Long-term care

• Long-term care = “nationally-led” But “community-managed”

• Act Fast to develop long-term care workforce

• Strengthen ICT / data for evidence-based approach

2

Key Messages

(10,000 persons)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030

Population Aged 15-64 (Working-Age People)

Population Aged -15

Population Aged 65+

In 2030, aged population (65+) will be above 30% in Japan.

Ageing in Japan

Sources : “Population Census,” Statistics Bureau, Ministry of Internal Affairs and Communications

“Population Projections for Japan,” (January 2012), National Institute of Population and Social Security Research

“Vital Statistics,” Ministry of Health, Labour and Welfare

58.1%

31.6% Aged Population Rate (% of population aged 65+)

Active Population Rate (% of Population Aged 15-64)

2

(Year)

50%

40%

20%

10%

70%

2015

2050

Percentage aged 65+ years

Source: US Census Bureau (2015)

Ageing in the World in 2050

Goal 3. Ensure healthy lives and promote well-being for all at all ages

3.8 Achieve universal health coverage, including financial risk protection, access to

quality essential health-care services and access to safe, effective, quality and

affordable essential medicines and vaccines for all

Sustainable Development Goal

- Align health systems to supporting “intrinsic capacity” and “functional ability” of older

persons (= integrated, older-person centered care)

- Develop national framework for action on Healthy Ageing

- Develop sustainable, equitable systems for long-term care

- Build workforce capacity and support caregivers

WHO Global Strategy for Ageing (2016-2020)

UHC and Ageing in Global Framework

Aging rate Major policies

1960s Beginning of welfare policies for the elderly

5.7% (1960)

1961 Universal Health Coverage established (through medical insurance) 1963 Enactment of the Act on Social Welfare Services for the Elderly

◇ Intensive care homes for the elderly created ◇ Legislation on “home helpers“ for the elderly

1970s Expansion of healthcare expenditures for the elderly

7.1% (1970)

1973 Free healthcare for the elderly

1980s “Social hospitalization” and “bedridden elderly people” as social problems

9.1% (1980)

1982 Enactment of the Health and Medical Services Act for the Elderly ◇ Re-introduction of co-payments for elderly healthcare, etc.

1987 Enactment of Certified Social Worker and Certified Care Worker Act

1989 Establishment of the Gold Plan (10-year strategy for the promotion of health and welfare for the elderly) ◇ Promotion of the urgent preparation of facilities and in-home welfare services

1990s Promotion of the Gold Plan

12.0% (1990)

1994 Establishment of the New Gold Plan (new 10-year strategy for the promotion of health and welfare for the elderly) ◇ Improvement of in-home long-term care

Preparation for the Long-Term Care Insurance System

14.5% (1995)

1997 Enactment of the Long-Term Care Insurance Act (Funding Pool: Premium 50% / National Gov’t 25% / Local Gov’t 25%)

2000s Introduction of the Long-Term Care Insurance System

17.3% (2000)

2000 Enforcement of the Long-Term Care Insurance System

6

Japan’s Ageing Policies (1960s-2000)

Before • Local governments decided

facilities / services, with expensive fees for middle-income and above persons.

• Funding came mainly from national / municipal budgets.

• Elderly / Medical care provided separately.

(mismatched, inefficient medical care under UHC)

After • Older persons, assisted by care

managers, decide a variety of

services and providers.

(= old person-centered)

• A larger pool (premium + tax)

enables strategic funding to

workforce, etc.

• Coordination has been

strengthened (funded through

LTC insurance scheme)

(= integrated care (gradually))

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What changed with Long-term Care Insurance?

Home-visit Services

Care, Nursing, Bathing, Care Support, etc.

Day Services

Outpatient Day Long-Term Care, Outpatient

Rehabilitation, etc.

Short-stay Services

Short-Term Admission for Daily Life Long-Term Care, etc.

Residential Services

Daily Life Long-Term Care Admitted to a Specified

Facility and People with Dementia etc.

In-facility Services

Facility Covered by Public Aid Providing Long-Term Care to the Elderly, Long-Term Care Health Facility,

etc.

Older persons’ Home

Long-term Care Facility

Municipalities （Insurer)

Service Providers

Insured Persons

11

Long-term Care Insurance Services (2000-)

Care Managers

1. Strengthening Workforce for Long-Term Care

Ongoing Challenges for Japan’s long-term care

3. Making More Equitable Long-term Care Insurance system

5. Expanding Cooperation in Asia on Healthy Ageing

2. Promoting the ‘Community-based Integrated Care System’

4. Strengthening ICT / Data for Evidence-based Approach

1.0(0.8%) 1.8 2.7 3.2 4.0 4.5 5.0 5.6 6.2（3.4％）

32.1 33.9 37.5 41.9 49.2 54.8 60.3 64.0 67.8 72.4 75.3 78.2 83.6 86.9 89.5 92

（50.３%）

4.8（8.7%） 5.9 7.2

8.8 10.4

12.5 14.1

15.5 16.6 19.0

21.0 23.0

26.4 28.6

30.6 32.1

（17.5%）

18.0 23.7 27.7

34.2

36.8

41.3 39.7

39.1 37.1

42.3 43.2

45.8

48.5 50.2

50.7

52.8 （28.8%）

218

258

303

348

387 411

435 441 455

469 487

508 533

564 586

608

0

100

200

300

400

500

600

0

50

100

150

200

FY2000 FY2001 FY2002 FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015

Home-visit service

Outpatient

Facility admission

Multifunctional small group home service

(32.7%)

(13.0%)

(53.5%)

(32.8%)

(58.5%)

（unit：10,000）

54.9

63.5

72.4 84.9

96.4

108.6 114.1

119.6 123.3

136.3 142.7 150.9

163.0

Persons in need of long-term care (in need of support）

Number of persons in need of long-term care

Long-term Care Workers has increased…but need more

Number of certified long-term care workers

【Source】 The MHLW 「Survey on Lon-term care facilities and long-term care providers”（The number of long-term care workers） “Report on status of long-term care projects” ( the number of persons

with the long-term care requirement certification ( the support requirement)

176.5 170.8

183.1

１

current Future

Unemployed women Middle-aged and older

people youths

Early retirement

More understanding of long-term care work by public and enhancing the image of work are needed

Uncertain Future visions and career paths

Leave a job soon after

getting hired

change

Unclear expertise and mixed roles

Unemployed women Other job field youths people with disabilities Middle-aged and older people

Potential long-term care public

aid workers

Encourage １．Broad the base strengthen diversity of human resources

Improve working condition and environment

２．Create a career path Create a career path according to one’ ability and the role assigned

３．Retain workforce Improve working environment (e.g. salary increase)

Enhance skills

４．Make the mountain higher

Promote continuous improvement of quality of staff by clarifying and sophisticating professional skills

５．Set a target altitude specialize functions in order to take advantage of limited human resource

Infrastructure development by national and municipal governments

People with specialist skills

People with basic knowledge

Strengthening Workforce for Long-Term Care

Healthcare Long-term care

Living support

Housing

Commuting to

medical facilities/care

facilities

Home-visit care • Nursing care

Own home/elderly housing with long-term care

Provides consultation and coordinating

services

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Community-based integrated care support center/ care manager

Old people’s club, residents’ association, long-term care prevention, living support, etc.

Prevention

Promoting Community-based Integrated Care System - Enriching long-term care, healthcare, support and preventive services in order for elderly people to continue their lives in their accustomed areas.

1. Enhancing coordination between In-home Medical Care and In-home Long-term Care

2. Promoting measures against dementia

3. Enhancing Community Care Meetings

4. Improving the Livelihood Support Services

Community Support Projects under Long-term Care Insurance Scheme

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1. Transferring nationally-unified Preventive benefits (Home-visit Care and Out-patient Long-tem Care) to Community Support Projects of municipalities, and diversifying them.

2. Restricting users of in-facility services of Special Long-term Care Health Facilities to people whose care level is 3 or higher in principle.

Making Long-term Care Insurance Services More Efficient and Focused

Recent measures to Promote Community-based Integrated Care System

Expanding the reduction rate of premiums of people with low-income: (For example, people with pension income lower than 800,000 yen per year benefit from new reduction rate of 70%, expanded from 50%

Expanding Reduction of Premiums of People with Low-income

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1. Increasing co-payments of users with income more than a certain level (10% to 20%).

2. Adding assets to the check list of requirement for “Supplementary Benefits” (which provides money for food and residence to in-facility users with low income)

Review of Co-payments etc

Making More Equitable Long-term Care Insurance system

Medical Record Data

Sharing

Emergency Medical

Record Data Sharing

Linkage/ Analysis Service

Search Service

AI development

Genomic data linkage

PHR Personal Health Record

Hospital/Clinic/Pharmacy

・・・

－National Network

Healthcare portal site

Access

Data Center

Data sharing

－Health Data Platform－

Researcher

Private Sector

Insurer

Connect Utilize

Create －Utilization of AI－

NDB

…

MoH

Long-term ＤＢ

DPC

Patient

AI Development

Search Service

Linkage/ Analysis Service

Medical Data Sharing Service

Genomic data linkage

Strengthening ICT / Data for Evidence-based Approach

The Government of Japan has launched “Data-driven Health Reform,” to establish by

2020 a nation-wide data platform which integrates health-related data from providers,

payers and governments on preventive, medical, and long-term care.

Asian countries are “Fast Ageing”

Population

(million)

Ageing rate 2010 (65+) （%）

Ageing rate (65+)

7% Aging society

Ageing rate (65+)

14% Aged society

Number of years required for the proportion of the

aged population from 7% to 14%

Ageing rate (65+) 21%

Super Aged society

Japan 127.82 23.0% 1970 1995 25 years 2008

Republic of Korea 49.78 11.1% 1999 2017 18 years 2027

Singapore 5.18 9.0% 1999 2019 20 years 2027

Thailand 69.52 8.9% 2001 2024 23 years 2038

China 1,344.13 8.4% 2000 2025 25 years 2037

Vietnam 87.84 6.5% 2018 2033 15 years 2047

Myanmar 48.34 5.1% 2021 2041 20 years 2060

Cambodia 14.31 5.0% 2030 2053 23 years 2068

Indonesia 242.33 5.0% 2021 2038 17 years 2056

Malaysia 28.86 4.8% 2020 2046 26 years 2073

Lao PDR 6.29 3.7% 2034 2053 19 years 2065

Philippines 94.85 3.7% 2032 2062 30 years 2088

Brunei Darussalam 0.41 3.7% 2023 2041 18 years 2063

Source: World Population Prospects: The 2012 Revision Population Database World Bank, World Development Indicators database Compiled by Mitsubishi UFJ Research and Consulting based on data from the United Nations’ World Population Prospects, the 2010 revision

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Cooperation Framework ・ASEAN+3 Health Ministers and Senior Officials Meeting ・ASEAN+3 Ministers and Senior Officials Meetings on Social Welfare and Development ・ASEAN & Japan High Level officials Meeting on Caring Societies

Malaysia: 2015-2017 JICA Technical Cooperation “The Project on Successful Ageing: Social Support System and Community Based Programmes”.

Indonesia: 2014-2017 JICA Technical Cooperation “The Project for Strengthening Social Security System”

Laos, Cambodia, Myanmar: Tripartite cooperation with the support of Thailand

Viet Nam: Technical Cooperation on Active Aging

Philippines: Technical Cooperation on support for elderly in devastated areas

Singapore, Brunei: Policy Dialogues on ageing, including care services, utilizing assistive devices, and human developing for professional care

Thailand 2007-2011 JICA Technical Cooperation CTOP (The Project on the Development of a Community Based Integrated Health Care and Social Welfare Services Model for Older

Persons in the Kingdom of Thailand) 2013-2017 JICA Technical Cooperation LTOP ( The Project of Long-term Care Service Development for the Frail Elderly and Other Vulnerable People in the Kingdom of

Thailand)

Study Group for Japan's International Contribution to Active Aging, MHLW 17

Expanding Cooperation in Asia on Healthy Ageing

〇‘AHWIN’ aims to amass bilateral and regional cooperation, business and projects on aging-related challenges in the Asian region.

First approach image suggested by Japan

Asia

Training

Building economic ties among industries related to elderly care

Training for professional elderly care service such as Functional Recovery Care

Japan

Enrichment of human resources for professional elderly care service such as Functional Recovery Care

〇The goal of the initiative is to create a vibrant and healthy society where people can enjoy long and productive lives, and to contribute to the economic growth.

Career Development

Asia Health and Wellbeing Initiative (AHWIN)

Thank you!

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