The long-term care insurance system was introduced in 2000. In the beginning, the amount of benefits was 3.6 trillion yen and the average premium was 2,911 yen. At present, the amount of benefits is 9.4 trillion yen and the average premium is 4,972 yen. According to the estimate of the Ministry of Health, Labour and Welfare, the amount of benefits will be 21 trillion yen and the average premium will be about 8,200 yen ten years from now. It is necessary to address the continuous increase in nursing care costs not by continuing to increase premiums but by reforming the system with a view to controlling the increasing costs.
1. Increase the Co-payment by Users of Long-term Care Insurance to 30%!
Under the long-term care insurance system, a user of long-term care services pays 10% of the costs and the government pays the remaining 90%. The benefits are financed by taxes and premiums on a fifty-fifty basis. In the present circumstances, just less than half of the long-term care benefits are covered by taxes. It would be ideal to achieve a long-term care insurance system that is sustained financially by premiums. The only way to create such a system is, as discussed in an earlier section regarding healthcare issues, to introduce an incentive into the system to minimize the use of care services. Similarly to health insurance plans, it is necessary in the long-term care insurance plan to increase the co-payment rate from 10 to 30%, in principle.
2. Apply a Relativistic Approach to Qualifying for Care Services Rather than an Absolute Approach! Set a Maximum Number of Those Qualified for Long-term Care Services!
The number of users of long-term care insurance services increased from 1,840,000 in 2000 to 4,340,000 in 2011. Whether a person needs long-term care or not is determined based on objective criteria, such as “whether the person can walk” and “whether the person can eat independently.” Under these criteria, the number of elderly people qualified for long-term care increases as their age advances.
I would propose applying a relativistic approach to qualifying elderly people to use long-term care services rather than an absolute approach. Firstly, elderly people who need long-term care should be defined as users of long-term care insurance services. Then, limits on the use of services should be set and a points system should be used to determine qualification levels, with the highest priority placed on those with the greatest need. A maximum number of those able to qualify for long-term care services should be determined in line with the revision of insurance premiums made every three years, which will help make the system sustainable.
3. Immediately Disqualify Those at Care Level 1 or Lower from Long-term Care Benefits to Encourage Them to Become Independent!
Under the current long-term care insurance system, elderly beneficiaries are classified into seven tiers according to their level of independence. These are Support Levels 1 and 2 and Care Levels 1 through 5, in the order from low to high need for care. Services provided are determined according to this classification. Services available to those classified as Support Level 1, Support Level 2, or Care Level 1, who need less assistance, include assistance in daily living, such as with shopping and cleaning. Some say that this kind of assistance may prevent users from claiming their independence. The cost of these services accounts for around 20% of the entire long-term care benefit expenditures. The most immediate reform needed is to disqualify those at Support Level 1, Support Level 2, or Care Level 1 from receiving long-term care benefits to encourage them to make efforts for their early recovery and independence.
4. Offer Incentives for Home-based Care!
To reduce the use of public care services as much as possible and address the shortage of professional caregivers, it is effective to offer incentives for care at home. While no subsidies are available for home-based care by family members, subsidies are offered for services by professional caregivers, which is an issue that needs to be addressed, partly in terms of fairness. With respect to this situation, I would propose to offer monetary incentives to those who receive care at home from family members, such as the reduction and/or elimination of care insurance premiums. The degree of premium reduction or elimination should be determined according to the severity of the condition of those qualified to receive care. A preferential system based on care levels should be developed. For example, make a family providing care at home to an elderly person at Care Level 2 eligible for a premium reduction and a family caring for someone at Care Level 4 or higher eligible for exemption from the premium.
It would also be desirable to foster a culture where families providing care at home, healthy elderly people, and those whose conditions have improved to a level where care is not necessary anymore are rewarded and praised for their efforts. It is necessary to use monetary incentives and award systems to motivate care recipients to become as independent from public care services as possible.