Reforming social care – what can we learn from the world’s oldest country?

A new Nuffield Trust report examines how radical reforms in Japan provided universal coverage to older people at a time of major financial constraints.

Press Release

Published: 27/11/2013

As an ageing population and funding cuts squeeze social care in England, a new Nuffield Trust report examines how radical reforms in Japan provided universal coverage to older people at a time of major financial constraints.

Grappling with the world’s highest level of public debt and the oldest population, the Japanese Government introduced a system of long-term care insurance in 2000 which offers access to social care to all those over the age of 65 on the basis of need alone.

The system is partly funded by a national insurance fund that all over 40s pay into and partly funded out of general and local taxation. Emerging out of a national debate about neglect and vulnerability among older people, the system helped many who were not getting the care they needed.

The report considers how Japanese society and government have tried to address the issues of isolation and co-ordination of care for older people. Dementia group homes support independence and social interaction while ensuring safety and security, while a national campaign has focused on eliminating the stigma previously linked to the condition.

This is not a perfect solution – it has led to high costs, and a standardised national system which is still trying to improve the amount of personalised care individuals receive Holly Holder, report co-author and Fellow in Health Policy, Nuffield Trust

A campaign to train dementia supporters exceeded expectations, attracting 1.5 million people in just four years. The Government is now supporting a similar scheme in England. Care managers support the arrangement of services for each individual, a system with important lessons on risks and opportunities for England as we look for ways to join up care provision.

With reform of social care in England high on the political agenda ahead of a key debate in the House of Commons expected later this year, the findings provide useful learning points for policy-makers in England.

The Government’s planned reforms in England will see the cost that individuals have to pay for care in their life-time capped at £72,000 in 2015/16. This policy will protect those incurring the highest costs (about one in eight of those who need care) but still leave many paying significant sums out-of–pocket.

In the meantime, for those who cannot afford to pay for their own care, cuts to local authority budgets have led to more areas giving help only to those who face the heaviest difficulties with everyday life, leading to concern over unmet need.

However, Japan’s experiences also demonstrate the problems that the Government may encounter when reforming social care services. As Japan’s population continues to grow older, the cost of the reforms has risen rapidly above expectations.

Those whose social care is funded by the insurance scheme are required to pay 10 per cent of fees, and there is a debate over whether the wealthy should pay more than this in order to address rising costs.

Report co-author and Nuffield Trust Fellow in Health Policy, Holly Holder, said:

“The trends that now shape how we see social care in England – an older population, greater isolation, and high Government debt – have been faced for decades in Japan. They led to care for the elderly becoming an urgent national issue as appalling stories and statistics about the condition of older people began to spread.

“The public conversation led to new ways of supporting those who needed care, and the development of a comprehensive system which tackled their unmet needs. This is not a perfect solution – it has led to high costs, and a standardised national system which is still trying to improve the amount of personalised care individuals receive.

“As these issues become more and more pressing in England, though, there are lessons to learn from how Japan confronted them as a society.”

Notes to editors