A look at Japan’s long-term care insurance system and how Oita Prefecture is innovating preventive care for ageing populations
Oita Prefecture HQ Building
Oita City skyline
Japan is ageing at one of the fastest rates in the world. It is estimated that by 2040, the population aged 65 and over will reach approximately 40 million, accounting for more than one-third of the total population. To secure the funding required for the care services needed in an ageing society, Japan has established a system known as the Long-Term Care Insurance Scheme. The scheme is financed equally by insurance premiums and public funds: from the age of 40 citizens pay premiums deducted from their salaries, whilst those aged 65 and over generally pay premiums from their pensions. The remaining half is shared between the national government, prefectures and municipalities, and is paid by the municipalities to service providers as care remuneration. The total cost of the scheme for the 2024 financial year is expected to reach 14.2 trillion yen (£65.98 billion). Since the scheme’s inception, the monthly premium paid by those aged 65 and over has more than doubled, rising from 2,911 yen (£13.53) (2000–2002) to 6,225 yen (£28.93) (2024–2026), and costs continue to rise.
In Oita Prefecture, located in Kyushu, this ageing trend is progressing particularly rapidly. Already, 34.4% of the population (as of 1 October 2024) is aged 65 or over, significantly exceeding the national average of 29.3% (as of 1 October 2024), with some mountainous municipalities exceeding 50%. Oita Prefecture is currently grappling with the challenges that many regions of Japan will face in the coming decades. The prefecture is advancing initiatives aimed at preventive care and support for independent living. In November 2023, government officials from the 10 ASEAN countries, as well as China and South Korea, visited Oita City and Beppu City to inspect facilities providing support services for independent living.
Against this backdrop, Oita Prefecture faces a unique set of circumstances. Whilst the proportion of the elderly population, the rate of certified care needs, and expenditure on care benefits and insurance premiums all continue to rise, approximately 50% of those newly certified as requiring care fall into the mildest ‘support-needed’ category, and of these, around 50% were diagnosed with disuse syndrome. Disuse syndrome is not an illness but a decline in physical function caused by inactivity, and there is a prospect of recovery through exercise and rehabilitation. However, as of 2011, only 6.5% of those classified as requiring support had seen an improvement in their condition.
Considering this situation, Oita Prefecture aimed to establish an ‘independence support cycle’ linking short-term intensive preventive services, community centres (places for local social interaction run by residents themselves) and Community GeneralSupport Centres. Short-term intensive preventive services were established following the 2017 revision of the Long-Term Care Insurance System. Under this scheme, rehabilitation specialists work intensively with people requiring support for a period of three to six months, either on a day-care or home-visit basis, with the aim of improving daily living functions such as walking, bathing and cooking, and promoting self-care. Oita Prefecture implements this service across all municipalities within the prefecture; however, a survey conducted in the 2018 financial year revealed that whilst approximately 80% of service users achieved an improvement in their condition, the level of utilisation remained low. This highlighted the following challenges: (1) the difficulty in identifying individuals for whom the service is an effective form of support, and (2) management issues faced by service providers, who find it difficult to anticipate stable income as the service ends after a fixed period.
To address these challenges, Oita Prefecture introduced a unique additional remuneration scheme for service providers. Under this scheme, a maximum of 20,000 yen per case is added to the standard care remuneration if improvements in daily living functions are achieved based on a pre-determined service implementation plan, and a maximum of 3,000 yen per case is added if support is provided to maintain daily living functions after the service has ended. As of the 2024 financial year, 13 out of 18 municipalities have adopted this additional payment system.
Furthermore, Oita Prefecture is working to promote effective and efficient preventive care management through the use of ICT. As a specific initiative, the prefecture collaborated with private companies to evaluate the effectiveness of introducing ICT systems. In an effectiveness evaluation conducted from July 2024 across five cities; Tsukumi, Taketa, Bungo-takada, Kitsuki and Bungo-Ono, the number of care plans formulated at Community GeneralSupport Centres reached 301, approximately double the target of 156. Furthermore, the working hours required for assessments and care plan preparation were reduced by an average of 11–27 per cent; the higher the number of cases utilising ICT, the greater the reduction rate, with specific tasks such as form preparation seeing a maximum reduction of 37 per cent. Municipal staff who participated in the effectiveness verification provided feedback such as, ‘We were able to clarify issues by viewing the data objectively,’ and ‘We were able to share challenges among stakeholders,’ which also played a role in determining the direction of future initiatives.
The severity of the ageing population facing Oita Prefecture has accelerated the prefecture’s efforts in preventive care. From the design of financial incentives to the utilisation of ICT, the accumulation of these practical measures is surely worthy of reference for local authorities in the UK, which are also grappling with the common challenges of an ageing population and fiscal constraints.
Top picture: By Papyrus at Japanese Wikipedia – Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2591149
