Find ways to maintain nursing care system while slowing cost increases

The costs of nursing care services have continued to balloon. Due to the rapidly aging population, it is necessary to speed up reforms to maintain the nursing care insurance system.

According to the Health, Labor and Welfare Ministry, the total costs of nursing care services in fiscal 2020 reached a record high of ¥10.7 trillion. This figure is more than double the figure from fiscal 2001.

With the increase in the number of elderly people, the number of people who use nursing care services rose by 100,000 from the previous fiscal year to 6.2 million.

Japan’s elderly population, aged 65 or older, is expected to reach a peak of more than 39 million by around 2040. Measures based on the assumption of increased demand for the services are indispensable.

Prime Minister Fumio Kishida has called for raising the wages of nursing care and other workers as part of realizing a “virtuous cycle of growth and distribution.”

The wage level of nursing care workers is lower than that of workers in other industries despite a serious labor shortage. It is necessary to improve the conditions for such workers, in order to enhance the quality of nursing care services.

However, a wage increase for them would increase the burden on the public.

As financial resources to support raising their wages, which methods — such as higher insurance premiums or greater tax burdens — would be appropriate? The government needs to consider the issue from a broad perspective.

At the same time, it is important to review how insurance benefits should be provided and what the burdens should be like.

One issue is whether it is appropriate for public insurance to be used to cover such everyday support services as shopping and cleaning for those with mild conditions who require low levels of nursing care services.

Those services are currently provided under the fiscal framework of the insurance system, but they will not be covered if demand increases due to an increase in the number of elderly people. With limited human and financial resources, insurance benefits should focus on supporting those with serious conditions who need high levels of nursing care services.

One idea is to transfer the treatment of those with mild conditions to the social welfare programs of municipal governments. In addition, it is desirable to implement nursing care services in close cooperation with volunteers and others, through such measures as asking high-income earners to bear a certain share of the burden.

Another point of contention is increasing the ratio of out-of-pocket expenses when using nursing care services. Currently, in principle, users of the services pay 10% of the costs of their own nursing care, with the rest covered equally by insurance premiums and tax money. Users above certain income thresholds are required to pay 20% or 30%, but users whose income is high enough to fall into those categories account for only about 8% of the total number.

The Yamato city government in Kanagawa Prefecture is conducting a questionnaire survey to assess the health of elderly people. It said that if people are concerned about not getting proper nutrition, registered dietitians could visit their houses and offer advice on how to improve their diet and do simple exercises.

The city government estimates that such efforts have produced results, such as reducing the number of people in need of nursing care and cutting the cost of nursing care insurance benefits by ¥68 million a year.

It is vital not only to improve the nursing care insurance system but also to make efforts not to increase the number of people who need nursing care.

— The original Japanese article appeared in The Yomiuri Shimbun on Nov. 19, 2021.