Estimating Expenditure on Long-Term Care (LTC) in Japan

1. Estimating Expenditure on Long-Term Care (LTC) in Japan SAKAMAKI, Hiroyuki, MBA Institute for Health Economics and policy (IHEP) Tokyo,Japan 10th Oct, 2002, OECD Paris

2. Presentation Outlines • Estimates on Expenditure for LTC • Estimation Processes and Issues until 1999 • Public Long Term Care Insurance (LTCI) in 2000 • Estimation Strategy after 2000

3. （Mio） 140 Current 120 100 65yo- 80 60 15-64yo 40 20 0-14yo 0 2019 2052 2063 2074 2096 1920 1931 1942 1953 1964 1975 1986 1997 2008 2030 2041 2085 Graying population in Japan • Population (≧65yo) • 4.16 M ( 4.9%) in 1950 • 21.19M (16.7%) in 1999 • 33.12M (27.4%) in 2025

4. Expenditures including for long-term care in Japan until 1999 Expenditure on long-term in-patient nursing care (HC.3.1) -Expenditure for health service facilities for the elderly (HP.2.1) -Estimated expenditure for meal service for inpatients in hospitals for the elderly (HP.1.1) -Estimated expenditure for inpatient care in hospitals for the elderly (HP.1.1) Expenditure on long-term home health care (HC.3.3) -Expenditure for home-visit nursing care for the elderly (HP.1.1)

5. Facility services providing LTC • Long term care welfare facilities for the aged [ LTCW ] : special nursing home for the aged • Long term care health facilities for the aged [LTCH]: facilities of health care services for the aged • Long term care medical treatment facilities [LTCM]: medical treatment beds, beds for treatment of senile dementia, LTC strength building hospital.

6. Expenditure for long-term care in Japan for 1999

7. Financing of long-term care in Japan for 1999 (Million Yen)

8. Expenditures for long-term care by function of care and provider industry in Japan of 1999 (SHA table 2) (Million Yen)

9. Estimation process (1) Total expenditure on long-term nursing care (HC.3.1) = sum of following 3 items Expenditure for health service facilities for the elderly(HP.2.1) ＝National health expenditure for health facilities for the elderly (Public) + Fee for health facilities for the elderly (private) Estimated expenditure for meal service for inpatients in hospitals for the elderly (HP.1.1) =National health expenditure for meal services during hospitalisation related to hospitals × Proportion of the number of working beds for the elderlyto the total number of working beds Estimated expenditure for inpatient care in hospitals for the elderly(HP.1.1) =National health expenditure for inpatient care in hospitals for the elderly × Estimated proportion of amount of inpatient care in hospitals for the elderly,on the basis of official statistics

10. Estimation process (2) Total expenditure on long-term home health care (HC.3.3) = Expenditure for home-visit nursing care for the elderly (HP.1.1) Private expenditure on long-term home health care = total expenditure on long-term health care × patients’ payment about home-visit nursing care for the elderly. Public expenditure on long-term home health care = total expenditure on long-term health care －private expenditure on long-term health care

11. Issues of estimation ●Date source necessary for estimates of expenditure items that conceptually exist are not available. This may cause underestimate.For example, expenditure for day cases of long-term nursing care (HC.3.2) ● Boundary of LTCPersons who need long-term care (NOT health services) were covered by the Medical Insurance due to insufficiency of the Long-term Insurance system before 2000. ●Introducing Long Term Care Insurance System (LTCI) in 2000Consistency should be needed before/after introducing LTCI.

12. 100Mio Yen 350,000 introduced LTCI 300,000 250,000 200,000 150,000 100,000 50,000 0 1954 1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Year Trend of National Medical Expenditure

13. Before and after enforcement of LTCI After Before Official statistics about LTCI No available data Data sources Total expenditure for long-term care, defined by SHA Nationalmedical expenditure Nationalmedical expenditure

14. Public Long Term Care Insurance System (LTCI) ● Established in April 2000. ● Insurer: the municipalities ● Insured: people aged 40 and above ● Eligible: - People aged 65 or older in need of care or support - People aged from 40 to 64 who are participants of medical insurance, in need of care or support due to a disease caused by aging such as;presenile dementia or cerebrovascular disorders, etc

15. Integration of Health and Welfare Welfare for the Aged Medical services for the Aged Under Health Insurance Long LoS Not equiped for LTC From gov. budget The municipalities driven Means tested April 2000 ～ Long term care insurance Social insurance

16. Financing of LTCI Public Expenditure (HF.1.1) ●2001 budget 4,770 billion yen co-pays 560 billion yen Provision 4,210 billion yen Apart from co-payment of the users. The users pay 10% of the benefit amount.

17. Estimating Strategy for LTCI • Discrimination b/w LTC and Healthcare services • by Providers • by Function of Services • by Degree of Need of LTC

18. Facility services

19. Benefitsof LTCI Persons requiring long term care or support will receive benefits in the following services. - In-home services - Facility services

20. In-home services

21. Degree of Need of LTC

22. Intensity of medical need → Assi. Need1 Need2 Need 3 Need 4 Need 5 Home care Increase of medical provision → LTCW LTCH TBD TBD TBD TBD LTCM SHA application of LTC = Include in HHA

23. Conclusion • Pilot Study to estimate LTC will start beginning of 2003, when all relevant data will be published.

24. Japan SHA Team • KokiHAYAMIZU • TastuoIHARA • YoshiyukiOZAWA • HiroyukiSAKAMAKI • ManabuYAMAZAKI