Elderly Welfare in Japan

The percentage of the Japanese population that consists of elderly citizens (older than 65 years old) is among the highest in the world, and it continues to grow. Problems concerning elderly welfare are no longer only on a local level, but rather is a national concern. In light of this problem, reform of the taxation system, medical treatment system, and social security is a major political task of the Japanese government.

As a social countermeasure to the growing elderly population in Japan, "The basic law on measures for the aging society" was established in November 1995 in order to better their environment. However, Japanese aged suicides are among the highest in the world, and it is continuing to increase. Approximately 1/3 of all the suicides in Japan are people over 60 years old. One of the major reasons cited for the cause of these suicides is "pain of sickness", in other words, the feeling of worthlessness due to their debilitating age.

It is important to first analyze the problems associated with the current social welfare system in order to understand the reforms that need to be made for the long term future of the elderly welfare system in Japan. The following points are principle issues concerning the current status of elderly welfare.

The increasing elderly population in Japan.

The Junior population (ages 0 to 14 years old) was 16% of the total Japanese population in 1995, but it continues to decrease. By the year 2000, it will become 14.3%, and by the year 2030, this age group will become 12.7% of the total population. The Working population (ages 15 to 64 years old) was 69.5% in 1995. However, it will decrease to 67% by the year 2000, and then decrease further to 56.6% in 2030. On the other hand, the Elderly population in Japan (ages over 65 years old) was only 14.6% of the total population in 1995. However, it has been increasing every year and is expected to reach 17.2% of the total population by the year 2000. Alarmingly, the population of the elderly will reach 29% in 2030. Until the year 2000, the Elderly population is expected to increase 0.52% per year. Then, it will increase approximately 0.4% per year until 2030. Figure 1

Medical treatment insurance

After the collapse of the "bubble economy" in Japan, the citizen income has only been increasing approximately 1% per year. However, medical treatment expenses have been increasing 6% per year, and in 1995 these expenses became 7% of the total citizen income. This ratio of one s income relative to medical expenses can show the burden of these disproportionately increasing medical expenses on the social system in Japan. Of the total medical expenses, a large percentage is spent on medicine. In the United States, 11.3% of total medical expenses is spent on medicine, however, 29.5% is spent on medicine in Japan. In more detail, 3.9% (of the 11.3%) is spent on hospitalized medicine in the United States, and 7.2% (of the 29.5%) is spent on hospitalized medicine in Japan. More importantly, 7.4% (of the 11.3%) is spent on outpatient medicine in the United States, while 22.3% (of the 29.5%) is spent on outpatient medicine in Japan. Thus, the Japanese spend three times more on outpatient medicine than the United States. Figure 2

Problem of caregiving

The population of the elderly people in Japan who needs caregiving will increase from 1.8 million in 1994 to 3.2 million in 2025. Further, 50% of the elderly who have died were bedridden patients 6 months before they died. Of these patients, 50% had been bedridden for more than 3 years. In the case that they were taken care of by their family, 90% of their caregivers were women. Further, since more and more women are entering the workforce, over 50% of the women who were caring for the elderly patients were over 60 years old. In short, the elderly have been taking care of the elderly in Japan.

Moreover, a recurrent problem has been that nursing homes, daycare facilities, and housing treatments have been insufficient for elderly people hoping to be taken care of outside of the hospital. Further, caregivers, home care specialists, and trained social care workers have also been insufficient to take care of elderly patients in Japan.

According to a report from Hiroshima Mental and Social Worker Organization, "Although patients reports used at conferences have had the names and addresses of the patients hidden, workers at public day care facilities and nursing homes have been able to obtain this information as well as personal information about the patient [translated from Japanese]." In other care facilities, "Access to the patient s bank accounts and personal records (e.g. senility and/or dementia) have in some cases led to the patient being overcharged for certain treatments [translated from Japanese]." These are serious problems encroaching on the basic human rights of the patients.

Underdevelopment of computer networking and technology

The establishment of a computer networking system for welfare is necessary in order to provide effective treatments and services for elderly people in Japan, especially since many elderly people live outside of metropolitan areas where hospitals are located. This networking will allow elderly patients to receive proper treatments regardless of where they are living. However, compared with the United States, present Japanese information system technology is lacking, especially when applied to the field of social welfare. Two current advances in technology, fiber optics and imaging technology, will be important and useful in the further development of the welfare system in Japan. When put into use in Japan, these two technologies should greatly enhance the effectiveness of computer networking relating to caregiving of the elderly.

In light of the problems mentioned above, it is apparent that elderly welfare in Japan is in need of reforms to become more effective. People in Japan utilizing the social welfare system are few. Many people still believe that it is the responsibility of the family to take care of the elderly patients in Japan. According to public tolls, men hold this position more than women do. However, people in Japan must realize that Japanese society is changing: the numbers of children are decreasing and the number of working women is increasing. Not only are there are less people at home to care for elderly patients, but the current social welfare system in Japan is not sufficient to care the increasing numbers of elderly patients. Therefore, it is important to change the views in Japan. Japanese must realize that they should not only be dependent on their families, but should also be dependent on the social welfare system. In order to improve the Japanese social welfare system, there are various plans to increase its effectiveness.

Medical treatment insurance and caregiver insurance.

First of all, it will be important to make a distinct difference between medical treatment and social welfare. In order to make a system that will support an increasing aging society, treatments must be made more financially reasonable for the elderly in Japan. This will insure that the financial burden is not placed upon other family members or the government. Further, the public health system that provides people with information regarding health, and hygiene needs to become more accessible and provide more complete information for elderly people. Preventative measures are important to decrease the number of elderly people needing treatment and care.

Regarding the public healthcare system in Japan, more involvement is needed in elderly medical treatment. By helping elderly people become healthier, it will be possible to decrease the cost of "social hospitalization". There are two reasons for social hospitalization in Japan. The first is that since no one will pay for treatments, public insurance covers their expenses. Because of this, the government is spending too much money on hospitalized elderly patients, which can become quite a burden. Secondly, the hospital makes more money when elderly patients are hospitalized longer. Thus, the result of social hospitalization is that money is shifting from the government to the hospitals. Another financial burden besides hospitalization is medicine. As mentioned earlier, a large percentage of the total medical expenses in Japan is spent on medicines. Thus, the cost and administration of medicines should be more controlled in Japan. Not only should the prices be more financially reasonable, but also the prescriptions should be for only required medicines. Often, doctors in Japan will prescribe a number of medicines for a particular illness, even if not all of them are necessary. This, along with high medicinal prices, also contributes to the high medical expenses in Japan. Regardless, by improving the public healthcare system and the health of elderly people in Japan, the financial burden of hospitalization and medicine can be lessened.

Regarding caregiving welfare, an insurance plan should be constructed for elderly people. Similar to the elderly insurance plans in the U.S., elderly people would be able to make periodic payments for an insurance plan that would help pay for their medical expenses. Currently, the working population is paying for many of the costs of treating elderly patients. However, this population is decreasing while the elderly population is increasing. Thus, it would be helpful for the elderly population to have an insurance plan that would assist in paying for their caregiving expenses. Further, care facilities and day care services should be increased and more sufficient for treating the increasing numbers of elderly patients. In terms of home caregiving, families that are caring for elderly patients should receive tax breaks in order to lessen the financial burden medical treatments may cause.

These laws should be approved this year by the Japanese government and are planned to be enforced by the year 2000.

Computer networking

Two plans are currently being developed in this area: the medical treatment welfare card system and elderly navigation systems.

The medical treatment welfare card system is planned for all citizens in Japan. These technologically advanced cards (fiber optics, IC, etc.) will contain personal medical treatment information and welfare information about the individual. Thus, all data regarding medical examinations and treatments will be placed on these cards, and this data will become available to healthcare professionals when they need this information about the person. Further, it will be possible to integrate medical treatment information with the patient s welfare information. This will be important for elderly patients, since social workers and caregivers will also have access to the medical history and current medical treatments of the patient even at the patient s home.

The navigation system, like those used for automobiles, will be developed for elderly patients using imaging technology. Thus, by using satellites, elderly patients will be able to determine their location if they become lost. This is especially important in senile elderly patients who may not remember their location or the location of their home. Further, this technology will allow family members and police to locate the elderly patient if the unfortunate case arises. Since this technology has many applications to a variety of fields, many companies will work on the improvement of these navigation systems and they should become more effective with time.

Private organizations

Many private organizations financially support social welfare and medical treatment systems in Japan. This is important since the working population in Japan is decreasing and the elderly population is increasing. Thus, these private organizations will help support the increasing financial burden of caring for elderly patients. While these organizations support many areas of social and healthcare systems, the majority of their support is for healthcare facilities and welfare services. For example, they financially help bedridden elderly patients as well as public healthcare systems to improve the health of the elderly population. This is again important since the dynamics of the Japanese family are changing. While four or more generations used to live under one household, presently there are usually only two (parents and children) or sometimes three. Further, the numbers of working women are increasing. Thus, day care facilities are not only important to care for the elderly population, but also for children whose parents work. Support from private organizations will further improve the necessary healthcare and day care facilities in Japan.

Japanese aging problems are become more serious year by year. There are various countermeasures to these problems that are currently being developed. The future public care system in Japan is only comparable to a few Western countries, like England, Germany, and Canada. While the medical management care system in the U.S. is quite precise, it is dependent on private companies and organizations as well as the particular state. Comparatively, the long-standing caregiving system in England is very effective, while medical management care systems do not exist. Therefore, there is not an effective model system from which Japan can base their developing public care system. While some countries have effective medical management systems (like the United States), other countries have effective caregiving systems (like Great Britain). However, there are currently no countries with an effective medical management system and caregiving system. Driven by the pressures of increasing aging problems, the development of an effective, comprehensive public care system is the one of the most important tasks for Japan. As the junior and working populations decrease and the elderly populations increase, it is essential that Japan establish an effective system soon for its citizens.

Reference

"Pablic Policy and the Old Age Revolution in Japan" by Scott A. Bass, Ph.D, Robert Morris, DSW, Masato Oka, MSC

Ministry of Health & Welfare in Japan

National Institute of Population & Social Security Research in Japan

Social Welfare and Medical Service Corporation in Japan