1. Aims of Establishing Long-term Care Insurance

To establish a system which responds to society's major concern about aging, the care problem, whereby citizens can be assured that they will receive care and be supported by society as a whole.

Lengthening and seriousness of long-term care One of every two bedridden persons is bedridden for three years or more Aging of care attendants Over 50 % of care attendant are 60 years or over Declining percentage of elderly persons living with their children This has declined to approximately 50% Increase in the number of working women To build a stable system in which the relationship between benefits and costs is made clear, which can easily gain public understanding

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Social support system for long-term care is indispensable

Efficient delivery of a user-centered, quality long-term care service

• Organize a system so that users can use services of their choice.
• Provide necessary welfare services and health and medical care services in a comprehensive and unified manner, to persons requiring long-term care.
• Promote the participation of a variety of independent enterprises such as people in private enterprise, agricultural cooperatives and citizens' non-profit organizations, and provide service that is not uniform, but diverse and efficient.

Separate long-term care from medical care insurance, and establish a system as a first step towards revising the structure of social security

• Separate long-term care services from medical care insurance, and promote suitable revisions to make medical care and medical treatment oriented.
• Re-examine the inequalities of users costs associated with the separation of welfare for the elderly and medical care services for the elderly, and do away with long-term so called social hospitalization in ordinary hospitals, etc., when long-term care is the overriding need.
• Make elderly persons the policyholders, and have them bear the cost of premiums where possible.
• Introduce a fixed rate 10% charge for long-term care services.
• Currently, such combinations are not covered by medical care insurance.
• Confirm benefit requirements, which are fair nationwide, in accordance with the required care certification standards for benefits.

(Unit: 10,000 people)

Category 1993 2000 2010 2025 Physically weak elderly persons 100 130 190 260 Suffering from dementia and needs long-term care (except for the bedridden elderly) 10 20 30 40 Bedridden elderly (including bedridden and suffering from dementia) 90 120 170 230 Total (elderly needing long-term care etc.) 200 280 390 520 Population of elderly persons (aged 65 or over) 1,690 2,170 2,770 3,240

1) Breakdown of care takers by their relationship to bedridden persons aged 65 or over	2) Breakdown of main care takers living with bedridden persons aged 65 or over by age group
3) Breakdown of caretakers of bedridden persons aged 65 or over by sex
3) Breakdown of caretakers of bedridden persons aged 65 or over by sex

"The Comprehensive Survey of the Living Conditions of People on Health and Welfare" by Statistic and Information Division, Minister's Secretariat, the Ministry of Health and Welfare (1995)

Requires assistance to leave home	Lives independently indoors but requires assistance to go out. 1) Goes out with assistance, stays out of bed most of the day 2) Seldom goes out, has several rests in bed during the day
Nearly bedridden	Requires some assistance living indoors and spends most of the day in bed but keep sitting up. 1) Uses a wheelchair to move about, but gets up for meals and to go to the toilet. 2) Moves about in a wheelchair with assistance.
Completely bedridden	Spends all day in bed and requires assistance to urinate/defecate, and with meals and dressing. 1) Can turn over in bed unassisted. 2) Cannot turn over in bed unassisted.
Bedridden	Includes both nearly bedridden and completely bedridden.

Percentage of persons requiring long-term care (including bedridden persons who require long-term care)	1.5%	3.5%	6.5%	11.5%	24.0%
Percentage of persons requiring long-term care including elderly suffering from dementia	4.0%	6.5%	13.0%	23.0%	44.5%

Percentage of persons requiring long-term care: 5.3 million/32.4 million =

16%

Percentage of persons requiring long-term care (including bedridden persons who require long-term care)	1.5%	3.5%	6.5%	11.5%	24.0%
Percentage of persons requiring long-term care including physically weak elderly persons	4.0%	6.5%	13.0%	23.0%	44.5%

Looking at the entire lives of people, approximately 45% will be expected to require long-term care.