Population ageing and wellbeing: Lessons from Japan's long-term care insurance policy

Nanako Tamiya, Haruko Noguchi, Akihiro Nishi, Michael R. Reich, Naoki Ikegami, Hideki Hashimoto, Kenji Shibuya, Ichiro Kawachi, John Creighton Campbell*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

395 Citations (Scopus)


Japan's population is ageing rapidly because of long life expectancy and a low birth rate, while traditional supports for elderly people are eroding. In response, the Japanese Government initiated mandatory public long-term care insurance (LTCI) in 2000, to help older people to lead more independent lives and to relieve the burdens of family carers. LTCI operates on social insurance principles, with benefi ts provided irrespective of income or family situation; it is unusually generous in terms of both coverage and benefi ts. Only services are provided, not cash allowances, and recipients can choose their services and providers. Analysis of national survey data before and after the programme started shows increased use of formal care at lower cost to households, with mixed results for the wellbeing of carers. Challenges to the success of the system include dissatisfaction with home-based care, provision of necessary support for family carers, and fi scal sustainability. Japan's strategy for long-term care could off er lessons for other nations.

Original languageEnglish
Pages (from-to)1183-1192
Number of pages10
JournalThe Lancet
Issue number9797
Publication statusPublished - 2011
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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