Organizer and Chair: John C. Campbell, University of Michigan, Japan Japan has the oldest and the most rapidly aging population in the world and its experiences offer lessons to others. The broad socioeconomic implications of the aging society are often discussed, but Japanese public policies for older people themselves are interesting and significant. The mandatory Long-Term-Care Insurance (LTCI) program that started eleven years ago in particular is distinctive in its size and approach.
Japan's old-age policies have had substantial effects. One paper looks broadly at the impact of LTCI at the national level and the reforms carried out to deal with inevitable problems. Another examines the new roles forced on municipal governments in LTCI and assesses the extent to which the program can be shaped to local preferences. A third paper looks at interactions among the central government, localities, and residents in meeting the problem of rural transportation, for the elderly and then for everyone. The final paper focuses on the level of older people themselves, to see how their lives have been affected by changes in material culture induced in part by the provision of assisted devices and home renewal under LTCI. The discussion will seek to draw lessons for programs in other nations, insights about how public policy works in Japan, and a deeper understanding of the implications of the aging society.
Japan's Kaigo Hoken program promised the "socialization of care" when it was initiated in 2000. The system distinctively combines German and Scandinavian approaches-a social-insurance program that relies on formal services without cash payments-and it is one of the biggest in the world. LTCI in operation turned out to cover more people and cost more money than expected, which brought important reforms. People with lighter needs had some reductions in their access to services, and those with more resources covered a somewhat larger share of costs. Thus, the growth of participation and spending was controlled to some extent while the core of the program continued essentially unchanged.
It can be said that the problems of providing appropriate services for people living in the community have essentially been solved, but that cannot be said about nursing home care. Since the program began, more people than expected have preferred institutionalization, so waiting lists for nursing homes are long although in fact the proportion of older people in institutions is not particularly low (e.g. higher than in the US). The long-run answer would seem to be better housing alternatives for older people but prospects are uncertain. More generally, concerns are frequently raised on the one hand about sustainability of the fiscal burden, and on the other that caregiving remains quite burdensome to families-that is, too some the program is too small and to others too big.
The initiation of Long-Term-Care Insurance in 2000 drastically changed the role of municipal governments in providing services for frail older people. Until then, they had been directly responsible for providing services, with detailed regulations and much of the financing coming from the national government. Now they were to administer a social insurance program where the recipients choose the services they want from an array of for-profit and not-for-profit agencies, with indirect oversight by local officals. This approach to program management is novel in Japanese local government.
Initially, it appeared that the municipalities would have considerable autonomy in determining both the level of services and the amount of premiums to be collected from their elderly residents (who provide 1/6 of the revenues). How has this worked out? It turned out that national-level regulations constrained local choices substantially. Still, there are real variations among municipalities, due in part to differences in circumstances and in part to differences in preferences. This issue is examined with particular attention to variations in the amount of the average premium and the formula for computing it, and in the extent of limitations on the use of "home help" services provided to older people who are living with their children.
Many among Japan's rapidly growing population of older people are not so frail but still face problems. Transportation is often the most serious problem, especially in rural areas. Most rural dwellers rely on private cars but non-driving older adult households are increasing in number. Distances are great in the countryside, and due to population loss and declining economic conditions, train and bus services have been withering.
In 2008, the Ministry of Land, Infrastructure, Transport and Tourism initiated an experimental program of grants to localities, called the Local Public Transport Systems Invigoration and Rehabilitation Comprehensive Project. The aim is to encourage regional and local governments to restructure and integrate their public transportation services, drawing on local originality and ingenuity. While this program is not specifically aimed at the older population, many local initiatives were initially motivated by concern for isolated rural seniors. In many cases, the scope then expanded to include other populations in the community, partly in an attempt to become more sustainable. A rural region of Yamanashi Prefecture provides a case to see how a national program can lead local officials to interact with community groups, and how development of services for the older population are being viewed increasingly as an integral part of regional and rural revitalization and infrastructural transformation.
This paper is co-authored by Ruth Campbell, Hiroo 5-23-2 #1005, Shibuya-ku, Tokyo, Jaan 150-0012 rcampbell@umich.edu
Contemporary Japan is known for both its devotion to technology and its rapidly aging population. The challenge of using technology to meet the needs of the elderly and their caregivers has received increasing attention from researchers and the media, but the main focus has been on the potential future role of robots. Less attention has been given to the more mundane tools that are already assisting frail elderly with daily life tasks. These are substantially affecting their material culture. The national Long-Term-Care Insurance system provides both "assistive devices" (wheelchairs, walkers, hospital beds) and home renovations (ramps, railings, bathtubs), and many families have taken advantage of these opportunities since the program started in 2000.
The resulting shifts in the interactions of aging bodies, official ideology, and consumption of assistive technologies raise important questions, which are explored using interviews conducted in 2003-2007 as part of a study of caregivers and care receivers in an urban and a rural area. What technology is available and to whom to aid failing bodies? How do "things" mediate ideological change and help to create new understandings of self and one's relation to others? How does the advocacy of independence create new forms of consumption? One such issue came to be openly debated when the government moved in 2005 to limit wheelchair use to light-need recipients on grounds that they promoted dependency rather than independence. The implicit and explicit cultural messages carried by the technology must be considered in evaluating the effect of policy on citizens.
Contemporary Japan is known for both its devotion to technology and its rapidly aging population. The challenge of using technology to meet the needs of the elderly and their caregivers has received increasing attention from researchers and the media, but the main focus has been on the potential future role of robots. Less attention has been given to the more mundane tools that are already assisting frail elderly with daily life tasks. These are substantially affecting their material culture. The national Long-Term-Care Insurance system provides both "assistive devices" (wheelchairs, walkers, hospital beds) and home renovations (ramps, railings, bathtubs), and many families have taken advantage of these opportunities since the program started in 2000.
The resulting shifts in the interactions of aging bodies, official ideology, and consumption of assistive technologies raise important questions, which are explored using interviews conducted in 2003-2007 as part of a study of caregivers and care receivers in an urban and a rural area. What technology is available and to whom to aid failing bodies? How do "things" mediate ideological change and help to create new understandings of self and one's relation to others? How does the advocacy of independence create new forms of consumption? One such issue came to be openly debated when the government moved in 2005 to limit wheelchair use to light-need recipients on grounds that they promoted dependency rather than independence. The implicit and explicit cultural messages carried by the technology must be considered in evaluating the effect of policy on citizens.
|
