Explore Japan’s health and care strategies for its ageing population, from universal coverage to dementia care, and the lessons other nations can learn.
Japan has the oldest population in the world. In fact, as of September 2024, government data indicates that around 30% of its current population is over 65. As life expectancy rises and birth rates decline, Japan has pioneered health and care strategies to support its ageing society. While its approach is often seen as a model for other countries, it also presents financial, workforce, and systemic challenges.
In this blog post, we’ll explore Japan’s health and care strategies for its ageing population, along with the associated benefits and challenges. We’ll also look at what other nations can learn from its experience.
This post is the first in an ongoing series that focuses on health and care strategies for ageing populations across the globe.
Japan has developed a multi-faceted approach to elderly care, focusing on universal access, financial sustainability, and community integration. Some of its key policies include:
Introduced in 2000, the LTCI system provides universal coverage for those aged 65 and above, as well as individuals aged 40-64 with age-related conditions. It is financed through mandatory contributions from individuals aged 40 and older, general taxation, and co-payments. The system allows users to choose their care providers, fostering competition and service diversity for ageing care.
To reduce reliance on institutional care, Japan promotes home and community-based care. This system, officially known as the Community-Based Integrated Care System, is set to be established this year (2025). Local governments are setting up support centres, while interdisciplinary teams (including healthcare professionals and social workers) coordinate services. The goal is to help elderly individuals remain independent in their homes for as long as possible. Japan’s Ministry of Health, Labour and Welfare (MHLW) has published an illustrative summary of the system model here. It also emphasises that the roll-out process and speed will vary in different regions of the country.
As a super-aged society, Japan is also seeing a rise in the number of people living with dementia. In fact, a research group from Kyushu University estimates that by 2025, one in five people aged 65+ in Japan will live with dementia. To deal with this, Japan has introduced early detection programmes, caregiver support networks, and community engagement efforts to reduce isolation.
In 2015, it also introduced the Orange Plan, a rounded system that supports those living with dementia. The Orange Plan’s goal is to foster dementia-friendly communities and keep those living with dementia in familiar environments. It is characterised by seven pillars:
1. Raise awareness and promote understanding of dementia
2. Provide healthcare and long-term care services in a timely and appropriate manner as the person receiving care progresses through the stages of dementia
3. Reinforce measures for early-onset dementia
4. Support dementia caregivers
5. Build communities that are friendly to elderly people, including those with dementia
6. Promote the research and development of prevention, diagnosis, cures, rehabilitation models, and care models for dementia and disseminate the results
7. Prioritise the perspectives of people with dementia and their families
Awareness campaigns also aim to create dementia-friendly societies, and there are ongoing efforts to destigmatise the condition. For example, the Japanese government changed the term for dementia in 2004 to avoid the previous term’s derogatory connotations. This blog post, published on the Alzheimer’s UK website, also highlights what Japan’s dignity-focused dementia care looks like in practice.
Japan's Long-Term Care Insurance (LTCI) system employs a tiered premium structure based on income levels to ensure affordability. Co-payment rates are set at 10%, 20%, or 30%, depending on the individual's income, with caps in place to prevent excessive out-of-pocket expenses. Additionally, government subsidies assist low-income seniors with housing and meal costs, further reducing the financial burden on families.
Facing a caregiver shortage due to a declining working-age population, Japan has implemented measures such as increasing wages for long-term care workers and opening opportunities for foreign caregivers. To enhance caregiving efficiency, the country has invested in robotics and artificial intelligence (AI). For instance, AI-driven robots like AIREC are being developed to assist with tasks such as patient mobility and daily chores.
The LTCI system undergoes a review every three years, allowing for necessary adjustments to funding, service fees, and eligibility requirements. This adaptability helps Japan respond to emerging challenges and a changing economic environment.
Japan’s ageing strategies have led to several positive outcomes, making the nation a global reference point for elder care.
The universal coverage system ensures that all elderly citizens, regardless of income, have access to necessary care. By spreading costs through a multi-tiered premium structure, Japan reduces the financial strain on individuals and families.
By prioritising home and community-based care, Japan enables older adults to live independently for longer. This has had a marked improvement on mental and emotional well-being. Preventative healthcare measures also reduce severe disabilities, further promoting autonomy.
Japan has enacted policies focusing on dementia care, such as the Basic Act on Dementia, which aims to create an inclusive society for individuals with dementia. Community-based interventions, including dementia-friendly cafés and support programmes, help reduce stigma and social isolation.
The quasi-market LTCI system balances government oversight with private-sector participation, ensuring efficiency and service diversity. Technological advancements also enhance caregiving efficiency and reduce workload stress on healthcare workers.
Traditional caregiving responsibilities in Japan have historically fallen on women. The public LTCI system reduces reliance on family-based care, alleviating the burden on female family members and enabling greater workforce participation.
Despite its success, Japan’s elderly care system faces several challenges that threaten its sustainability.
Japan’s long-term care expenditures surged from JPY 3.6 trillion in 2000 to JPY 10.8 trillion in 2020. With continued population ageing, costs are expected to rise further, potentially leading to increased premiums, higher taxes, or service reductions.
The country requires 2.8 million LTC workers by 2040, yet the shrinking workforce makes recruitment difficult. Japan has increased foreign caregiver recruitment but still faces ethical concerns about wage disparities and job conditions.
Rural areas experience shortages of LTC facilities and professionals, leading to unequal access to services. Additionally, while some private providers offer high-quality care, others face issues of inefficiency or financial instability.
Due to low co-payment requirements, some individuals overuse LTC services, straining resources. Fraud and inefficiencies in the private LTC market also remain concerns.
Japan’s medical and LTC systems often operate independently, making care transitions complex. Improving coordination between hospitals, nursing care facilities, and home-based services is essential for better patient outcomes.
As more nations face ageing populations, Japan’s strategies offer valuable insights:
Countries with ageing populations should consider a social insurance model like Japan’s. This would ensure universal access while distributing costs across society.
Japan’s emphasis on home and community-based care over institutionalisation helps maintain elderly independence while controlling costs. Countries can develop similar systems to reduce hospital dependency.
Governments should consider Japan’s approach of wage increases, foreign workforce integration, and technology-driven caregiving solutions to mitigate staff shortages.
Japan’s dementia-friendly communities and early detection programmes improve quality of life. Countries can adopt similar measures to support patients and caregivers alike.
As ageing populations increase financial expenditure, nations should implement multi-tiered premium systems, co-payment caps, and regular policy reviews to sustain LTC funding.
Japan’s struggle with integrating healthcare and LTC highlights the need for better coordination between medical institutions and long-term care services.
Japan has built one of the world’s most advanced elderly care systems, balancing universal coverage, financial sustainability, and community-driven support. While its strategies have significantly improved quality of life for older people, challenges such as funding pressures, workforce shortages, and service accessibility disparities remain.
For other countries facing similar demographic shifts, Japan offers a blueprint for addressing the challenges of an ageing society. By adapting its best practices, we can better prepare for the future and ensure dignified ageing for all citizens.
But of course, each culture is different. Each nation’s economic situation is unique, and so are some of the challenges they face. As this case study demonstrates, there are many moving parts to effective health and care solutions for ageing populations.
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