The Program
The new LTCI program departs from past Japanese practices in
several important respects. It aims to (1) shift a major responsibility
for caregiving from the family to the state; (2) integrate medical care
and social services via unified financing; (3) enhance consumer
choice and competition by allowing free choice of providers, including
even for-profit companies; (4) require older persons themselves
to share the costs via insurance premiums as well as copayments;
and (5) expand local government autonomy and management capacity
in social policy. The government plans to expand the new
program gradually over ten years, leading to a major expansion of
community-based care, a fundamental reform of financing and regulation
of institutional care, and, more generally, a flexible approach
to social policy based on individual entitlement and choice