Social security in Japan consists of social welfare, social insurance, living assistance, health care, and unemployment benefits. The National Health Insurance started about 60 years ago and basically covers all Japanese people. About 60% of the country’s population is covered by employee health insurance, and the rest are covered by national health insurance. The old-age pension system covers about 70 million people in Japan. In one year, society’s overall welfare is over 100 trillion yen, with about half of the spending going to the elderly.
Japan’s social security system is designed to guarantee a minimum standard of living and to protect the public from certain social and economic risks. In Japan, where the average age of the population is rising rapidly due to the low birthrate and longevity of the population, it is inevitable that the total population will soon begin to decline. In this context, the challenge is how to pay for and control the increasing number of pensions and medical care.
In addition, as society tries to build a humane and sustainable social security system, the burden of caregiving and the burden of caregiving has become an important issue.
Given that the population is rapidly aging and declining due to a declining birth rate, the social security system, including pensions, needs to be reviewed. About 60 years ago, a system was put in place that allowed all citizens to receive a pension. There were two types of pensions: the “National Pension” for the self-employed and the “Welfare Pension” for salaried workers.
Also, a two-tiered pension scheme has been introduced since then. The first stage is the “National Pension”, which is a basic pension common to all citizens and supported by all citizens. The second tier consisted of a “welfare pension” for employees of private companies and a “mutual aid pension” for public employees. In addition, the “Mutual Aid Pension” for civil servants was merged into the “Welfare Pension” to further unify the welfare pension system.
As a result, the first stage of the two-tiered system is currently the “National Pension”, which is generally enrolled by people between the ages of 20 and 60.
As the average age increases, the number of seniors who need care is increasing rapidly. On the other hand, while the proportion of older people living with younger family members is higher than in other countries, it is decreasing and the average age of family caregivers is also increasing.
In order to meet the care needs of these people, the National Diet passed the Long-Term Care Insurance Law, which was followed by the creation of the Long-Term Care Insurance System. This system collects insurance premiums from a wide range of people (all people aged 40 and over) and provides services such as home-based care by home helpers, visits to care centers, and long-term stays in nursing homes for elderly people who are bedridden due to geriatric dementia or health reasons. For each individual case, it is necessary to obtain a certification of nursing care requirements at the municipal office in charge of administering the long-term care insurance system. The premiums are deducted from the pension for those aged 65 and over, and collected as a lump sum along with the health insurance premiums for those aged 40 to 64. Recipients must be 40 years of age or older and pay 10 percent of the costs incurred when receiving the service, in addition to the regular premium.
Recent amendments to the Long-Term Care Insurance Law have placed an emphasis on “prevention,” with the aim of maintaining and improving the condition of even relatively mild people and preventing it from deteriorating to a condition requiring nursing care. This preventive care management is carried out by the Regional Comprehensive Support Center.