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Japanese Long-Term Care Insurance
Author: Yoko Marikawa - Japanese Expert in Eldercare & Healthcare
Opinion: The author introduced in a column on March 1 that Japanese long-term care insurance requires the insured to pay lifelong from the age of 40. Usually, it can only be used after the insured reaches the age of 65.
The general deterioration of the health of elderly will definitely increase with age. After a period of time or several years, the insured’s health condition deteriorates, or the economic condition changes - what should the insured do? It is time to apply for renewal of credentials to increase the level of nursing care, or to change nursing homes, etc.
The author introduced in a column on March 1 that Japanese long-term care insurance requires the insured to pay lifelong from the age of 40. Usually, it can only be used after the insured reaches the age of 65.
After paying the 25-year premium, the insured retired, and their physical condition went from bad to worse. They felt that it was more and more difficult to wash, cook and clean their houses, especially to climb the stairs. They were always careful, but there were still more and more minor accidents. A health survey shows that more than 75% of Japanese men who have just retired say that they have developed short temper, family conflicts surged, and they feel very depressed at home. These are the real situation and family problems faced by many retirees.
If I meet this situation, can I immediately contact the service center that provides nursing care at home, and request to arrange a caregiver to help in my home? The answer is no. Every insured person needs to go through a long application and identification process (usually taking about a month) to know whether he or she can start using long-term care insurance, how long the person can enjoy nursing care services, and how much the insurance will cover.
The Long-Term Care Insurance Act does stipulate that people over 65 are eligible to start using the Long-Term Care Insurance, but those who want to use the Long-Term Care Insurance must be issued a doctor’s medical certificate (or other medical certificate) to prove that they have reached the “need for nursing care” or “need to support” level, and need to apply to the management office of their own jurisdiction for “requiring nursing care”. After the second review, they will have to wait until they have passed the "Nursing Care Payment Review Committee" and obtained the "Recognition of Nursing Care Required" or "Recognition of Supporting Care" before they can start using the long-term care insurance. That is, it is determined that the long-term care expenses can be paid.
The content of the "Recognition of Nursing Care" review mainly covers five aspects, including physical functions and daily movements; daily functions; cognitive functions; mental and mobility disorders; and adaptability to social life. This review will not only review the applicant’s physical health, but also comprehensively consider the applicant’s mental burden, family structure, and financial status, that is, the ability to pay, because the long-term care insurance does not pay the full amount of the nursing care fee, and the user needs to pay a part of it.
This certificate is very important because it will make clear which services the insured can use that can be paid for by the insurance, what is the annual limit, and which proportion of the cost are self-paid, etc. Generally, the degree of physical deterioration the elderly will increase with age. After a period of time or several years, the health condition of the insured will deteriorate, or the economic situation will change. It is necessary to apply for renewal of identification to improve the level of care or change a nursing home.
This application process is still quite troublesome. Applicants who are inconvenient or unwilling to go to the management office can first contact the district management office and request for an appointment with a nursing support specialist, generally referred to as a care manager (this is a special occupation where one can only work with a certificate after passing the national standard examination). The care manager will be able to apply for the "Recognition of Nursing Care" on behalf of the insured and will be responsible for all matters related to the applicant's nursing care. The care manager is implicitly the official representative of the long-term care insurance and plays a very important role as the middleman. Generally, a care manager will stay in contact with the insured for life, so it is important to maintain a good relationship. Unless there is extreme dissatisfaction or conflict, under normal circumstances, people will not ask to change their care manager.
Long-term care insurance categorizes an insured’s degree of nursing care into levels 1 to 5, and the degree of support to be divided into levels 1 to 2. The higher the level, the higher the degree of need for nursing care, and the higher the proportion of insurance claims. This classification is mainly to divide the cost of care insurance compensation in the same way, so as to more accurately determine the services, compensation and out-of-pocket expenses that each insured can benefit from.
So how much does the long-term care insurance pay for nursing care? This fee is also adjusted every few years. The current compensation standard is (monthly ceiling): Level 1: 166,920 yen (approximately 9,958 yuan); Level 2: 196,160 yen (approximately 11,700 yuan); 3 Level: 269,310 yen (about 16067 yuan); Level 4: 308,060 yen (about 18,379 yuan); Level 5: 360,650 yen (about 21,517 yuan). Degree of support level 1: 50030 yen; level 2: 104,730 yen. The daily limit of the total amount of compensation is 5,000 yen, and the excess part needs to be paid by the insured. This grading system is very complicated, so the Long-term Care Insurance Act requires a second "judgment" review, and a personnel with professional medical or nursing knowledge is responsible for the review and grading, while the care manager is responsible for implementation. However, in the actual implementation of long-term care insurance, grading is still one of the most contradictory phase.
Are the No. 2 insurer between the ages of 40 and 64 completely unable to use the care insurance? Not so. It is just stipulated that you have to suffer from one of the 16 diseases caused by aging to get compensation. The 16 kinds of diseases include: cognitive disorder related to early aging; Cerebrovascular disease; Amyotrophic lateral sclerosis; Parkinson's disease (or its related diseases); Spinal cord and cerebellum lesions; Multiple system atrophy; Diabetic syndrome (nephropathy, omentum, neurological disorders); Arteriosclerosis obliterans; Chronic obstructive pulmonary disease; Degenerative arthropathy (bilateral knee arthropathy, or significant deformation of the femoral joint); Rheumatoid arthritis; Ossification of posterior longitudinal ligament; Spinal canal stenosis; Osteoporosis caused by fracture; Premature senility; terminal cancer.
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".
About the Author
About the Author
Yoko Marikawa
Japanese expert in Healthcare & Eldercare industry; Founder and Chairman of YOKO Management Consulting; United Nations Representative; Scholar & columnist; Former Chief Officer at World Blockchain Organization.
Yoko is an advocate for healthcare and eldercare, elderly wellbeing, senior care service, nursing home management, and medical care technology. Recently, she is focusing on implementing advanced technology to improve senior care service and nursing home management quality. She is an active columnist, enriching the knowledge of the eldercare industry and contributing to the academic field.
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