On February 22, local time, U.S. President Biden expressed condolences to the 500,000 Americans who lost their lives in the Coronavirus pandemic, and called on the people to unite in the fight against the pandemic.

Of these deaths, 80% were elderly people, especially those living in nursing homes. This has once again set off a heated discussion on issues such as nursing home management, eldercare and elderly welfare.

The author has written many articles to introduce Japan’s successful experience in eldercare and help countries in need provide learning and reference resources to promote the progress of the world’s eldercare system and the improvement of the welfare of the elderly.

Japan is one of the earliest countries in the world to enter the aging society. In 1970, the number of elderly people over 65 has exceeded 7%, and in 2020, it reached 29%, ranking the first in the world. Without precedents to learn from, Japan can only explore its own way. For a long time, in the process of coping with the economic and social problems brought about by the rapid growth of the elderly population, Japan has established a set of mature and effective systems, including the construction of eldercare institutions, supervision of facility management, supervision of medical and nursing services for the elderly, high-tech input into medical and nursing care for the elderly, long-term care insurance and so on, in order to protect the medical, nursing, social security, rehabilitation and welfare of the elderly.

Japan's eldercare management system and experience have been sought after and learned by countries all over the world as a successful model. The aging population brings not only huge economic pressures, but also complex social problems, such as family conflicts, eldercare funding difficulties, eldercare facilities and services, as well as declining birth rates and labor shortages. Even Japan, known for its high welfare, has a pension deficit, and the state cannot afford to pay for medical and long-term care expenses for the elderly. How to provide adequate medical and nursing services for this growing group is not only a social challenge, but also a financial burden for the government.

Under this embarrassment, the Japanese government enacted the Long-term Care Insurance Law in 1997 and implemented it in 2000. After 20 years of practice and continuous improvement, it is considered a successful program that has attracted various countries to learn from it. This article mainly explains how Japan's long-term care insurance system constructs a system where individuals, companies, and the government share this cost to ensure that the elderly are provided sufficient care.

The source of funds for nursing care insurance consists of three parts: government taxes, corporate contributions and personal payments. Generally speaking, the government pays 50%, which includes 25% from the central treasury and 25% from local government taxes; enterprises and individuals pay a total of 50% to jointly build a pool of nursing insurance funds. The 50% that is paid by the enterprise and the individual is a little complicated to calculate, because only full-time employees have the share of the enterprise. The following is a specific explanation:

The Long-term Care Insurance Law stipulates that citizens are obligated to pay the insurance premiums from their 40th birthday, and they need to pay lifelong. Insured persons are divided into two groups, No. 1 and No. 2 insured persons, No. 1 is an elderly person over 65 years old, and No. 2 is a group of people between 40 and 64 years old. No. 1 insured person pays 23%, and No. 2 insured person pays 27%. Because the insured No. 1 is a retired group, it is fully self-pay, while the No. 2 insured group is divided into three situations: corporate employees, self-employed persons (self-employed), freelancers and unemployed persons. Among them, 50% of the company’s employees’ premiums are borne by the company (that is, 13.5%), while the remaining No. 2 insured persons paid in full by themselves. When the No. 2 insured person reaches 65th birthday, the person will become the No. 1 insured person, and then he will pay 23% of the premium instead.

Many people cannot accept the fact that the insurance can only be used after 25 years of payment, and it is a lifetime payment. It is for this reason that the implementation of nursing care insurance is not very fast, and not everyone has participated in this insurance. However, it should be noted that the basic design concept of this insurance is the same as that of other serious illness insurance, that is, when one person is in trouble, everyone can help. Public and private funds jointly set up a fund pool to protect everyone's security through mutual assistance.

This system also directly shows that the government has been unable to bear the burden of 100% of the national pension expenses, especially as the elderly population in Japan is still increasing rapidly and the average life expectancy continues to increase. According to the latest statistics released by the Ministry of Health, Labour and Welfare of Japan, in 2020, the number of elderly people over 65 in Japan will account for 29%, reaching 36.17 million, and the number of centenarians will exceed 80,000. As a world-famous country with high welfare and longevity, the Japanese government feels a mingle of hope and fear.

The author Yoko Marikawa is an expert in the elderly care industry in Japan and a pioneer in the elderly care industry. She has long been committed to ensuring and improving the well-being of the elderly by improving the management of nursing homes and the quality of elderly care services. In recent years, in order to find effective solutions to the problems of poor medical services for the elderly, elder abuse, the surge of elderly dementia patients, and the shortage of eldercare workers, Yoko Marikawa has devoted a lot of energy in researching how to use high technology to help solve these serious and urgent social issues, including the use of nursing robots, quantitative management and monitoring systems, etc. This article is an article in Yoko Marikawa's newspaper column "Yoko Marikawa Talks about Eldercare".