Index / Back / Next

2.The Long-term care Insurance System

(1) Aims for introducing the system

(2) Outline of the System

1) Insurers

2) The insured, beneficiaries and premiums

  Category 1 insured persons Category 2 insured persons
Eligible persons Persons aged 65 or over Persons aged 40 to 64 who are insured by health care insurance
Persons requiring long-term care (bedridden, dementia)
Persons requiring support (frail)
Those who have become bed-ridden, dementia, and/or frail be- cause of specific age-related diseases such as early-stage dementia, cerebro-vascular disorder, etc. (*)
Premiums Collected by municipalities Collected with premiums for health care insurance by health care insurers and paid in lump sums
Method of levying and collection
Fixed premiums per income bracket (premiums for persons with low incomes shall be reduced)
Premiums shall be deducted from pension benefits above a given amount (180 thousand yen per year),otherwise they shall be collected directly by municipalities
Employees' Health Insurance
The amount of premiums is decided based on standardized amount of salary multiplied by long-term care premium rate (Employers bear part of the cost)
National Health Insurance:
The amount of premiums is decided based on the amount of income as well as fixed per-capita amount. (The government bears part of the cost)
(*)For the time being, public funds will be used to provide young disabled persons with comprehensively programmed long-term care services, etc. in accordance with the Government Action Plan for Persons with Disabilities.

(3) Procedures for use

  1)Municipalities shall provide long-term care requirement certification and support requirement certification based on the screening judgement results of the long-term care approval board.

The long-term care approval board will investigate the mental and physical condition of the insured person and make a screening judgement based on the opinions of a regular doctor. (The screening judgement can be entrusted to prefectures.)
*Standards for long-term care requirement certification shall be uniformly and objectively determined nationwide.
 Benefits which correspond to the level of long-term care required (a limit for benefits to be paid for home long-term care) will be determined.
In-home benefits will be determined depending on the level of long-term care required (6 levels including Support-required).
For home-visit outpatient services: 62,000 to 358,000 yen per month. (Amount differs with regions.)
For short-stay service: 7 to 42 days every 6 months.
From January 2002, the limit for both services will be unified.
Facility benefits will also be determined in accordance to facility types, depending on the level of long-term care required.

Limit for benefits paid for home long-term care services (To be unified in January 2002)
commuting service
Short-stay service
(Not replacable) (Replacable)
Support required 6,150 unit/month 1 week / half year 6 days / 1 month
Care level 1 16,580 unit/month 2 week / half year 16 days / 1 month
Care level 2 19,480 unit/month 2 week / half year 18 days / 1 month
Care level 3 26,750 unit/month 3 week / half year 24 days / 1 month
Care level 4 30,600 unit/month 3 week / half year 27 days / 1 month
Care level 5 35,830 unit/month 6 week / half year 30 days / 1 month
*1 unit = 10 - 10.72 yen (Differs with regions and services)
*'Replacement' of 'Short stay service' is a measure for people who are having difficulty in in-home care due to advanced age, etc. and who live in municipalities which have, to some extent, room for bed usage. They can replace the remainder of each month's home-visit and outpatient service benefits with the limit of days for short-stay. (The limit for consecutive usage is 30 days. Except in cases when replacement of service is particularly required due to mental and physical conditions, approximately one half of the certified period can be replaced.)

  2)From the standpoint of providing comprehensive and planned service to accommodate the policyholder's demands, it is fundamental that a long-term care service plan (care plan) is decided.

(4) Insurance benefits

  In-home service Services at facilities
Persons requiring long-term care
Home-visit/Day Services
home-visit long-term care, home-visit bathing, home-visit rehabilitation, day rehabilitation (day care), home-visit nursing care, day service, welfare devices leasing
Short-stay service, short-stay care
In-home medical care management counseling
Care service with mutual support for the elderly with dementia
Care service provided in for-profit private homes for the elderly, etc.
Allowance for purchase of welfare devices
Allowance for home renovation (handrails, removal of level differences, etc.)
Long-term care welfare facilities for the elderly (Special nursing homes for the elderly)
Long-term care health facilities for the elderly
Long-term care medical facilities for the elderly
-Sanatorium-type wards
-Sanatorium-type wards for elderly patients with dementia
-Hospitals with enhanced long-term care service provision (for three years after implementation)
Persons requiring support Same as above (excluding care service with mutual support for the elderly with dementia) N/A

(5) Costs

1)Out-of-pocket payment at a fixed rate (10% of the cost of the insured services) and a standard charge for meals imposed on users of facility services (such as special nursing homes for the elderly).
2)There is an upper limit of the above out-of-pocket payment.
3)The upper limit of the out-of-pocket payment and standard charge for meals is set lower for people with low income.

<High-cost long-term care service and standard charges for meals>
  Upper limit of 10% charge covered by high long-term care service cost Standard charges for meals
Non-low income persons 37,200 yen/month 23,400 yen/month(780 yen/day)
Municipal tax-exempted households 24,600 yen/month 15,000 yen/month(500 yen/day))
Old-Age Welfare Pension recipients, etc. 15,000 yen/month 9,000 yen/month(300 yen/day))
*Reduction and exemption measures for costs during the 5-year period following implementation, for persons resident in special nursing homes for the elderly at the time of implementation, shall be negotiated in response to their ability to pay

(6) Expenses


*1Percentage based on the population ratio of category 1 and category 2 insured persons.
*2The government will be provided 5% to make adjustments for differences in municipalities' financial capabilities.
(Percentage of subsidies are differ from each municipalities)
(Reason for adjustments)(1)Differences in membership percentages of latter stage elderly persons.
(2)Differences in elderly persons abilities to bear costs (income standards)
(3)Special cases such as reduced and exempted premiums at times of emergencies

Intermittent financial management shall be introduced, and premiums for category 1 insured persons will be revised once every 3 years.

(7) Insurance Premiums

(8) Preparation of the basis for provision of long-term care services

1)In order to promote infrastructure of a long-term care service to progress in a systematic manner, municipalities must determine their plans for long-term care insurance services and prefectures must decide on their long-term care services and benefits respectively, based on fundamental policies decided by the government.
2)When municipalities are to plan or to change the municipal long-term care insurance service plan, measures to reflect insured persons' opinions shall be taken.
3)Municipalities that have difficulty securing the standard levels of benefits for home services determined by the government, can fix a standard level that is lower than the appropriate level, and raise this gradually to the level determined by regulations 5 years after implementation.

(9) Considerations for stabilizing system operations

<Considerations of financial aspects>
  1)The government will provide subsidies equivalent to 50% of the administrative expenses incurred for the newly added matters of long-term care requirement certification etc.
  2)Finance stabilizing funds shall be granted or loaned to prefectures, (the government, prefectures and Category 1 premiums shall each provide one third of the revenues), to make good financial deficits caused by increased payments resulting from benefits surpassing estimates, and declined rates of premium payments.

<Considerations of business implementation aspects>

(10) Implementation

April 1, 2000

(11) Considerations

Outline of the Long-Term Care Insurance System


Present situation of the elderly

The ratio of elderly persons increases from "one out of six people" to
"one out of four people"


The number of bedridden elderly / suffered from
dementia are rapidly increasing


Over 50% of care takers are
over 60 years old.

85% of care takers
are women


Outline of the Long-Term Care Insurance System

Procedures for the use of service


Difference between the previous system and
long-term care insurance system from the users' point of view

Previous system Long-term care insurance system
(1)Apply at the administrative office window, and municipalities determine the service.
Users can choose the type of service and facilities they want to use.
(2)Apply separately for medical care and welfare.
Users will make a long-term care service usage plan (care plan) and use medical care and welfare services comprehensively.
(3)Service provided mainly by municipalities and public organizations (Council of Social Welfare, etc.).
Services provided by various organizations such as private companies, agricultural cooperatives, livelihood cooperatives, and volunteer organizations, etc.
(4)For middle and high income persons, services are hard to use due to expensive cost to bear.
e.g.In the case of the householder's annual income is 8 million yen, and his or her elderly parent receives a pension of 200,000 yen per month:
 ・Special nursing home for the elderly will cost 190,000 per month
 ・Home helper service will cost 950 yen per hour.
Users will pay 10% charge for the service regardless of their income.
e.g.In case of the householder's annual income is 8 million yen, and his or her elderly parent receives a pension of 200,000 yen per month:
 ・Special nursing home for the elderly will cost 50,000 per month
 ・Home helper service will cost 400 yen every 30 to 60 minutes.

Cost sharing percentages for long-term care insurance

Finance stabilizing fund (source of revenue → Government: prefecturers:
Category 1 premiums - 1: 1:1)
Loan etc. from fund as a result of financial deficit incurred from
increased expense of benefits and non-payment of premiums


Notes: 1.The ratio of category 1 insured persons: Category 2 insured persons was assumed for FY 2000.
2.Adjusted subsidies will be provided in relation to the percentage of latter stage elderly persons in each municipality, and their incomes, etc.
Nationwide, this will amount to approx. 5% of the overall subsidy.
However, subsidy adjustment rates are examples.

Return To Top
Index / Back / Next