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
Institute for Health Economics and Policy, Tokyo, Japan

3. Graying population in Japan20 40 60 80
100
120
140
1920
1931
1942
1953
1964
1975
1986
1997
2008
2019
2030
2041
2052
2063
2074
2085
2096
65yo-
15-64yo
0-14yo
Current
（Mio）
Population (≧65yo)
4.16 M ( 4.9%) in 1950
21.19M (16.7%) in 1999
33.12M (27.4%) in 2025
Institute for Health Economics and Policy, Tokyo, Japan

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)
Institute for Health Economics and Policy, Tokyo, Japan

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.
Institute for Health Economics and Policy, Tokyo, Japan

6. Expenditure for long-term care in Japan for 1999
Items of Health Data
Estimate
(Million Yen)
% of THE
Total expenditure on health (THE)
38,011,356 -
Total expenditure on long-term nursing in-patient care
2,908,176
7.7%
Total expenditure on long-term home health care
91,400
0.2%
Institute for Health Economics and Policy, Tokyo, Japan

7. Financing of long-term care in Japan for 1999
(Million Yen)
Total
Public
Private
Expenditure on health
38,011,356
29,669,720
(78.1%)
8,341,636
(21.9%)
Expenditure on
long-term in-patient nursing care
2,908,176
2,549,317
(87.7%)
358,859
(12.3%)
long-term home health care
91,400
89,100
(97.5%)
2,300
(2.5%)
Institute for Health Economics and Policy, Tokyo, Japan

8. Nursing care facilities
Expenditures for long-term care by function of care and provider industry in Japan of 1999
(SHA table 2)
(Million Yen)
HP.1.1
General Hosp.
HP.2.1
Nursing care facilities
Total
HC.3
Services of long-term nursing care
2,057,493
942,083
2,999,576
HC.3.1
In-patient long-term nursing care
1,966,093
2,908,176
HC.3.2
Day cases of long-term nursing care
HC.3.3
Long-term nursing care: home care
91,400

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 elderly　to 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
Institute for Health Economics and Policy, Tokyo, Japan

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
－private expenditure on long-term health care
Institute for Health Economics and Policy, Tokyo, Japan

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 LTC Persons 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 2000 Consistency should be needed before/after introducing LTCI.
Institute for Health Economics and Policy, Tokyo, Japan

12. Trend of National Medical Expenditure
50,000
100,000
150,000
200,000
250,000
300,000
350,000
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
100Mio Yen
introduced LTCI
Institute for Health Economics and Policy, Tokyo, Japan

13. Before and after enforcement of LTCI
Official statistics about LTCI
No available data
Data sources
Total expenditure for long-term care, defined by SHA
National medical expenditure
National medical expenditure
Institute for Health Economics and Policy, Tokyo, Japan

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
Institute for Health Economics and Policy, Tokyo, Japan

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

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
Institute for Health Economics and Policy, Tokyo, Japan

18. Facility services
Long term care welfare facilities for the Aged [ LTCW ]
(Special Nursing home for the Aged) NA
Long term care health facilities for the Aged [LTCH]
(Facilities of health care services for the aged)
HP2.1
HC3.1
Long term care medical treatment facilities [LTCM]
Medical treatment beds
Beds for treatment of senile dementia
LTC strength building Hospital
HP1.1
HC1.1
Institute for Health Economics and Policy, Tokyo, Japan

19. Benefits　of LTCI
Persons requiring long term care or support will receive benefits in the following services.
- In-home services
- Facility services
Institute for Health Economics and Policy, Tokyo, Japan

20. In-home services Home-visit/ commuting care service
Home-visit care (Home help service)
HC 3.3 ?
HP 3.6?
Home-visit bathing services
Home-visit nursing
HC 3.3
Home-visit rehabilitation
Commuting for care (Day services, at day care centres)
HC 3.2
Commuting rehabilitation (Day care)
Welfare equipment rental service X
Short-term stay service
Short-term stay at a care facility
HC 3.2?
Medical care service through a short-term stay
Others
Daily life care in communal living for the elderly with dimentia
Daily life care for residents in a special facility
Management guidance for in-home care
Allowance for purchasing welfare equipment
Allowance for modifying house
Institute for Health Economics and Policy, Tokyo, Japan

21. Degree of Need of LTC Needing Assistance
Condition
Yen
/Month
Needing Assistance
Not deemed LTC but needing assistance in everyday life
61,500
Needing LTC 1
Needing some LTC
165,800
Needing LTC 2
Needing small degree of LTC
194,800
Needing LTC 3
Needing medium degree of LTC
267,500
Needing LTC 4
Needing large degree of LTC
306,000
Needing LTC 5
Needing highest degree of LTC
358,000
Institute for Health Economics and Policy, Tokyo, Japan

22. SHA application of LTC LTCM TBD LTCH LTCW Home care Need 5 Need 4
Assi.
Increase of medical
provision →
Intensity of medical need →
= Include in HHA
Institute for Health Economics and Policy, Tokyo, Japan

23. Conclusion
Pilot Study to estimate LTC will start beginning of 2003, when all relevant data will be published.
Institute for Health Economics and Policy, Tokyo, Japan

24. Japan SHA Team Koki HAYAMIZU Tastuo IHARA Yoshiyuki OZAWA
Hiroyuki　SAKAMAKI
Manabu　YAMAZAKI
Institute for Health Economics and Policy, Tokyo, Japan