Social Security
In
Japan

March 2001

Preface
This booklet aims to provide foreign researchers with an introductory explanation of
aspects of the social security system in Japan: pensions, health insurance, public
assistance, long-term care and employment insurance. The booklet was first publishedin March 2000, and this is the updated 2001 version.

The booklet is mostly

descriptive and kept at a minimum level in outlining the current system and thechallenges facing it. Researchers are advised to refer to further readings at the end of
this booklet. As Japan’s social security system is undergoing a series of reforms, wewill update this publication from time to time.

Dr. Makoto AtohDirector-General
National Institute of Population and Social Security ResearchContents

1.

Overview of Social Security System22.

Pensions

7

Outline of Pension System

16

Health Insurance

18

Outline of Health Insurance System

26

4.

Public Assistance28

5.

LongLong-Term Care

40

6.

Employment Insurance
Insurance

44

Outline of Employment Insurance System

48

References

50

3.

Chapter 1
Overview of Social Security System
I. General Characteristics

1. Social security
As with other countries, the source of social security in Japan could be found incharity-oriented communal activities for the poor in a pre-modern era.

In the modern

era, while legislations such as Indigent Person’s Relief Regulation (1874) and Poor Relief

Law (1932) 1 were enacted, the modern social security system based on the state’s
responsibility in sharing and mitigating social risk of the population did not start until
after the World War II with the inclusion in the Constitution of the Article 25:“(1) All people shall have the right to maintain the minimum standards ofwholesome and cultured living. (2)The State must make efforts to promoteand expand social welfare, social security and public health services to cover
every aspect of the life of the people”.
Starting with the urgent need to relieve the war-stricken people, the system of “social
security” has gradually extended its reach.

The term “social security” means in Japan arange of social policy that is the task of a welfare state, from income security to the publichealth.

Table 1.1 shows the list of major schemes defined as social security in Japan.

The main organ responsible for overseeing and carrying out these schemes is the
Ministry of Health, Labour and Welfare (MHLW).

Table 1.2 shows its organization

chart.

2. Universal health insurance and universal pension
The year 1961 was memorable in the history of Japanese social security. Two laws
for universal health insurance and pension were enacted in 1958 and 1959, respectively,
and enforced in 1961.
system.

Law

They have become the two main pillars of Japanese social security

Together with the Public Assistance Law (1946) and the Employment Insurance(1974), they are the main institutions of social policy to mitigate the risk ofsickness, accidents, unemployment and old age.

1 The English names of law and schemes are in consistent with official documents, in order to avoid
the confusion.

2

Table 1.1

Schemes of Social Security

Health insuranceManagement of health care delivery system
Prevention of diseases such as TB, AIDS and cancer
Long-term care insurance
Public pension
Income assistance(Public assistance)*
Services for the elderly(Welfare for the elderly)*
Assistance for the disabled(Welfare for the disabled)*
Benefits for children(Welfare for children)*Public health
Employment insurance
Work-related accident insurance* Terms in italics are official ones used by the government

3. Social insurance and tax
Social security systems such as those for health care, long-term care, public pension,
employment and work-related accident take the form of social insurance.

The public

insurance system provides in-cash and in-kind benefits to insured persons (and theirfamily) in case of downfalls within their life cycle.

The participation for these schemes ismandatory to all citizens and their employers in case they are employed.

The

contribution to the schemes is shared by all insured, in most cases, according to theirability to pay (income).

Thus, the function of social insurance is to share the risk among

insured persons, and at the same time, to redistribute income among them.
On the other hand, measures identified as social welfare, such as public assistance(meaning income maintenance for the poor, in Japan) and services and benefits for theelderly, children and the disabled are mostly paid out of the general budget of thegovernment (tax).

There is a continuing debate, especially on the pension schemes,

between those who claim converting some of the insurance-based schemes to thetax-based schemes and those who prefer to maintain the link between the contribution
and benefit through an insurance system.

3

Table 1.2 Organization Chart of the Ministry of Health, Labor and Welfare
Minister’s Secretariat
Statistics and Information Dept.
Health Policy Bureau

Health Service Bureau
Dept. of National Hospitals
Pharmaceutical and Medical
Safety Bureau
Dept. of Food Sanitation
Labour Standards Bureau
Industrial Safety and Health Dept.
Worker’s Compensation Dept.
Ministry ofWorker’s Life Dept.

Health, Labourand Welfare
Employment Security Bureau

Employment Measures for the Elderly
and Persons with Disabilities Dept.

Human Resources Development Bureau

Equal Employment, Children and Families Bureau

Social Welfare and War Victims’ Relief Bureau
Dept. of Health and Welfare for Persons
with Disabilities
Health and Welfare Bureau for the Elderly
Health Insurance Bureau

Pension Bureau
Director-General for Policy Planning and
Evaluation4

4.

In-cash and in-kind assistanceKinds of benefits provided through the social security system are either in-kind orin-cash.

Table 1.3 lists major types of benefits by in-kind/in-cash classification.

Table 1.3 Major Types of Service by InIn-kind or InIn-cash Classification
Classification

To whom

In-kind

The sick

Health care services

The elderly

At-home services
Institutionalized services

In-cashAssistance for households which takecare of its own elderly (limited)
Old-age and survivor’s pension

The disabled
The children

The poor
The unemployed5.

Institutional service for thedisabled
Institutions for special children

Health care services

Disability pension
Child allowanceChild rearing allowance forsingle-mothers
Livelihood (income) support
Unemployment benefits

Service providers
Service providers of social security, such as hospitals and clinics for the health care,

day-care centers and institutions for the elderly long-term care, rehabilitation centersand support centers for the disabled, and so forth, can be both public or private. For
example, there are public hospitals and private hospitals, and from the view point of theuser, there is no difference.

They both operate under the supervision of the Ministry of

Health, Labour and Welfare (MHLW) and the prefectures.

II. Revenues and Expenditure of the Social Security
Figure 1.1 shows a breakdown of social security revenue and expenditure as definedby the International Labor Organization. Insurance premium accounts for 60% of thetotal revenue and government contributions and others for the rest.

The expenditure forthe public pension takes up nearly a half of the entire expenditure, and for the healthinsurance, a little more than one third.

5

Employment insurance

Contribution from
employers
28.6

0.5(0.8)

Administrative costs,
etc.
4.1
Balance of payments
13.0

Balance of payments
13.0

Welfare and others
8.3(11.5)

Administrative costs,
etc.
4.1

Gratuities, support
1.8(2.4)

Public healthFamily allowance,social
welfare,public assistance
5.3(7.3)

10.2

Health and medical
services for the aged

1.0

Accident compensation

32.2(44.7)

0.2(0.2)

Balance of payments
13.0

Administrative costs,
etc.
4.1

Housing

Social assistance andothers1.6(2.2)
Employment injury
1.1(1.5)

Family benefits
1.9(2.7)
Invalidity benefits
1.8(2.5)

Unemployment
2.7(3.7)

Survivors 5.6(7.7)

Sickness and health25.2(34.9)

Old age

Function

2.4

Balance of payments
13.0

Administrative costs,
etc.
4.1

Child, family

Other medical
care
15.3

Other expenditure24.3(33.7)

Pension benefits
36.2
Medical care
10.1
Welfare services
1.4

SOCIAL
EXPENDITURE
FOR THEELDERLY
47.8(66.3)

Target individuals

Notes: 1. “Child, family” refers to medical insurance in the form of a lump sum maternity allowance and child-rearing allowance, employment insurance inthe form of parent leave allowance, day-care facilities administration costs and single parent family and disabled child allowance.
2. FY1998 social security revenues amounted to 89.2 trillion yen (excluding transfer from other systems). The figure in square brackets represents[ ] the ratio of social security revenues total.
3. FY1998 social security expenditure amounted to 72.1 trillion yen. The figure in parentheses represents ( ) the ratio of social security
expenditure total.
4. Arrows have been omitted from “Revenue” to “Administrative costs,” and “Balance of payments” in “Scheme.”

Income from capital,other
12.3[13.7]

Central government
17.2
Local government
4.8

General revenue
22.0[24.6]

Medical insurance
14.4
Pension benefits
36.2

Contribution frominsured persons
26.3

Medical care25.4(35.2)

Pensions
38.4(53.2)

SOCIAL
INSURANCE
64.5(89.5)

INSURANCEPREMIUM55.0[61.6]

2.7

Category

SchemeRevenue(Unit: Trillion of yen, %)Social security
expenditure

Figure 1.1 Revenue and Expenditure of Social Security: Fiscal Year 1998

Note: Figure 1.1 Revenue and Expenditure of Social Security: Fiscal Year 1998
1998
: (units: hundreds of millions of yen, figures in brackets, %)FY1998 social security revenue amounted to 89.2 trillion yen (excluding transferfrom other systems). The figure in square brackets represents the ratio to the totalsocial security revenue.
FY1998 social security expenditure amounted to 72.1 trillion yen. The figure inparentheses represents the ratio to the total social security expenditure.
Arrows to “Administrative costs” and “Balance” in the Scheme column are omitted.

6Chapter 2
Pensions
I. General Characteristics
1.

ThreeThree-tiers of pension system
The Japanese pension system is multi-tiered, consisting of public and private pension

schemes (Fig.2.1). In this booklet, the distinction between public and private pensions isdefined to be whether the insurer of pensions is the government or not. The first tier is the

Basic Pension (Kiso Nenkin), which provides the flat rate basic pension of a universal
coverage.

As a non-income-related pension, it aims to provide a basic income guarantee forthe old age, and the participation is mandatory to all residents.

The second tier, theEmployees’ Pension Insurance (Kose Nenkin Hoken) covers the most of employees andprovides an income-related payment.

It is mandatory to all firms over a certain size, andpremium is shared by employers and employees.

The first and the second tier pensions areboth operated by the government and thus are public. The third tier is an optional scheme.
It is provided either by private firms (employers) for their employees, or by collective
national pension funds for the self-employed with the government as the insurer.

The

Employees’ Pension Funds is operated by employers, but has a large portion of the
Employees’ Pension Insurance and thus has a quasi-public character.

On top of the threetiers, purely private, individual-based pensions, such as those offered by the life insurancecompanies, provide the additional coverage for those who wish to purchase the plans.

The schemes in the first and the second tiers for employees are jointly operated and asingle contribution rate covers contributions for both schemes.

Thus, in many cases, theterm “Employees’ Pension Insurance” refers to both of them jointly.

The Employees’ Pension

Insurance covers both employees and their spouses (Categories No.2 and No.3.

See Fig 2.1).

Similarly, the Basic Pension for the self-employed, farmers and other non-employed(Category No.1) is called the National Pension(Kokumin Nenkin), which are operated, bymunicipalities (and thus called regional-based pension).

The civil servants have a separate

scheme on their own called Mutual Aid Pensions, which covers both the Basic Pension
portion and the income-related portion.

Thus, the entire adult population, in principle, is7insured either by the Employees’ Pension Insurance, the National Pension or the Mutual Aid

Pensions.
Fig 2.1 Pension System

Employees' Pension
Tax Qualified
Funds (12 million) Pensions (10 million)

National

Survivor's Pension

PensionFunds

Mutual Aid
Pensions(5 mill.)

Employees' Pension Insurance(33 million)( 0.7 million)(National Pension)

Basic Pension
No.1

No.3

(20 million)(12 million)

No.2 (38 million)(private sector employees)(civil servants, etc.)

Note: Numbers in ( ) are number of subscribers. No.1, 2, & 3 denotecategories of subscribers: No.1 is self-employed, farmers, students,
etc., No.2 is employees, and No.3 is spouse of No.2.
(All numbers are as of March 1999)
Slopes in the diagram indicate income-related pension schemes.
Source: Kose Hakusho, MHW, 2000

2. Universality of the basic pension
The coverage of the Basic Pension is universal, i.e. it extends to all residents 20 years oldor above in Japan including foreigners.

For the National Pension, the eligibility to receive

pensions requires a minimum of 25 years of premium payment.

3.

Mixture of public and private schemes
The insurer of the National Pension and the Employees’ Pension Insurance is thegovernment.

They form the two pillars of Japan’s public pension system.

According to asurvey, more than 60% of the elderly households entirely depend on the public pension for
their income.
Other schemes are occupational pensions.

The Employees’ Pension Funds, the Tax

Qualified Pensions and the Mutual Aid Pensions, the third tier for the Category No.2
insurers (employees), are run by each private firm or the government in the case of the
Mutual Aid Pensions where the government is the employer, and not all of the employees arecovered by them.

The National Pension Funds, which provide the third tier coverage for theCategory 1, are run by local and occupational funds.
of the Category 1 is participating.
8

It is also optional, and only a fraction

4.

Insurance premium
For the Employee’s Pension Insurance (the public pension for the Category No.2, i.e.

employees), the premium is paid by both employees and employers, and is set at a fixed rateof the salary.

The same rate covers the premium for his/her spouse who does not makemore than ¥1.3 million/year (called the No.3 Category).

For the National Pension (thepublic pension for the Category No.1, the self-employed), the premium is paid by the insured
only, and is a flat rate for all.

Both the Category No.1 and his/her spouse, if he/she is notworking as employees, have to pay the premium.

The premium for occupational pensions differs from scheme to scheme, but mostly is
paid by the employers for the Category No.2 and by the insured for the Category No.1.

5.

Government subsidy for the public pensions
For the first tier (Basic Pension), one third of the benefits and all of administrative costs

are paid from the general budget of the government.
half by the year 2004.

This rate is planned to increase to one

For the second tier (Employees’ Pension Insurance) and mutual aid

association pensions for central and local civil servants, the administrative costs are paid by
the central government.

6.

For the third tier, there is no subsidy from the government.

Mixed retirement package
Japanese firms traditionally offered to its employees a retirement allowance in the formof a one-time lump-sum payment. Since the introduction of public pension schemes, firms
started to offer private pensions to attract employees.

Currently, most firms provide a

mixture of a lump-sum payment and a pension scheme.

Since the two types of scheme areinterchangeable in many instances, the entire retirement package is seen as the income
security for the retired.

7.

Mostly DefinedDefined-Benefit
The National Pension, the Employees’ Pension Insurance, and other public andoccupational schemes are all defined-benefit schemes.

However, a law to introduce a

Defined-Contribution scheme in the private sector has just passed in 2001, and will be
introduced shortly.

9II. Types of Pension Scheme
1.

The National Pension
As described above, all residents in Japan between ages of 20 to 60 are eligible andrequired to become a subscriber of the Basic Pension. Whereas employees automaticallyenroll in the Basic Pension when they subscribe to the Employees’ Pension Insurance, theNational Pension is for those who are not employees. A fixed amount (¥13,300 per month in2001) is levied on each subscriber as a premium.

However, low-income persons (about

19.9% of all No.1subscribers in 1998) and non-working spouses of employees are exempt frompaying premiums, partially or entirely.

Current benefits are paid out of currently collected

premiums (pay-as-you-go system), but as much as one third (to be raised to one half by 2004)of the benefits are subsidized from the general budget of the government.

The benefit isflat rate to all, and the scheme is a defined-benefit scheme.

F i g . 2.2 Subs cri bers of the B a s i c Pens i on ( 1999)
Category 3
17%

Category 1
29%

Category 2
54%

Category 1: All residents who are not Category 2 or 3, i.e. self-employed, farmers, students, etc.
Category 2: All employed persons whose workplace has more than 5 employees
Category 3: Non-working spouses of Category 2
Source: MHW, 2000

Currently, 1.4%1 of the eligible persons fail to participate in the Basic Pension, and 96%
of all persons aged 60 and over receive the Basic Pension, thus its scheme has achieved near
perfect universality.

The average monthly benefits for the old age are ¥49,000.

1 One minus the number of subscribers (70.50 million) divided by population aged from 20 to 59 (71.47
million).

10

2.

The Employees’ Pension Insurance
The Employees’ Pension Insurance forms the core of the income security for retirees.

All workplaces with more than 5 employees and their employers are required to participate
in this scheme.

Both employers and employees contribute 8.675%2 of employee’s monthly

salary as premiums (including a premium for the National Pension), and the pension benefit
is income-related.

There is no discount system for low-income persons/household (or his/her

employer), but employers of those who are on maternity leave (up to 1 year) are exempt frompaying a premium3.

However, the ceiling of the premium is set at the premium rate

multiplied by ¥620,000 (the maximum category of monthly salary).
to the employee’s salary.

The benefits are related

The average monthly benefit for the old age is ¥177,000, whichamounts to 56% of the average monthly salary of subscribers (1999).

3.

Corporate pensions and retirement allowance
90% of all Japanese firms offer retirement packages for their employees.

A retirement

package can be either a one-time lump-sum retirement allowance, or a life-long or limited
duration pension, or both.

In 1997, about a half (52.5%) of firms with some kind of

retirement package offered a pension scheme, while nearly 90% provided a lump-sum
allowance.

Even though the pension is gradually spreading its share, the traditional styleof the lump-sum allowance is still the main stream and most employees choose to take a partor the entire amount of the retirement money as the lump-sum payment.

Thus, the public

pension, private pension and lump-sum retirement allowance, all together make up the total
income maintenance support for a retiree.

2 The premium rate applies only to monthly salary, and the premium rate for seasonal bonus payments(usually 3.5 months worth of salary) is 0.1% shared equally between employers and employees.
3 Employees who are on maternity leave typically do not receive salary, except unemployment benefits(40% of their pay), and thus do not need to pay a premium. The duration of maternity leave is counted
as insured months in calculating a benefit level.

11Fig. 2.3 Share of firms with retirement allowance scheme
and/or private pension scheme (1998)
Retirement

PrivateAllowance

Pension47.5%

11% - has neither

32.2% 20.3%
89% - has either

Source: H12 Kigyo Nenkin Hakusho

There are three types of corporate pension schemes: 1) the Employees’ Pension Fund, 2)
the Tax (Exempt) Qualified Pension (scheduled to be phased out in 10 years), and 3) eachfirm’s individual pension scheme.
in Fig. 2.4.

The breakdown of different retirement packages is shown

In addition, a defined-contribution private pension is now under the debate in

the Diet, and is likely to pass in near future.

Fig. 2.4

Share of different private pensions by number of firms (1997)

Tax Qualified & Own
Pension0.4%
Tax Qualified &Employees' Pension
Fund
11.2%

Tax Qualified, Own& Employees'
Pension Fund
0.3%

Own Pension
1.7%
Employees' Pension
Fund and Own
Pension0.8%

Tax Qualified
Pension only
27.5%
Employees' Pension
Fund only
10.7%

Retirement
Allowance only
47.5%

Source: “H11 Kigyo Nenkin Hakusho ”(a) The Employees’ Pension Fund
Firms of more than 500 employees are allowed to set up an Employees’ Pension Fund.
Currently, about one third (36%) of all employees participate in this scheme.

A fund is set

up to top off the public pension to ensure a higher level of benefits, and is based on the12contributions from both employers and employees of 1.6 to 1.9% each of the employee’s salary.
The Employees’ Pension Insurance and the Employees’ Pension Fund are closely related, andsome portions of the Insurance are managed by the Fund on its behalf.

Thus, even though

the Fund is a corporate pension scheme, it has a quasi-public nature and enjoys atax-favored treatment, but at the same time, is regulated closely by the government.

(b) The Tax (exempt) Qualified Pension
Another type of private pension is the Tax Qualified Pension scheme.

Under thisscheme, employers are allowed to exempt its contributions from corporate tax.

About one

third (31%) of all employees are currently participating in this scheme.

Compared to theFund, this scheme is fairly free from regulations of the government, and is the second mostpopular form of private retirement package next to the lump-sum retirement allowance.
Most of the pensions under this scheme are fixed-term (typically 10 years), different fromother pensions with a life-long term.

Average monthly benefit is ¥58,499.

However, this scheme is scheduled to be phased out in 10 years.

(c) One-time lump-sum retirement allowance
One-time lump-sum allowance is still the most preferred form of retirement money, as
seen from the fact that 47.5% of total workplaces have only this type of retirement benefits.
The benefit level depends on each workplace, but is usually 39 to 46 months worth ofmonthly salary for employees, who have worked a full-term (38 years for college graduates,and 42 years for high-school graduates).

13

III. Current Issues of Pension System
1. Financial crisis of public pension
Aggravated by rapid aging, low rate of economic growth, and near-zero interest rates,
the National Pension and the Employees’ Pension Insurance are facing a difficulty to secure
enough funds to meet the future requirements for pension payments.

Various reforms to

restrain the payments, including cutting back of future benefits and raising of premiums
have taken place in order not to put too much burden on the future generations.

Delayingof the pensionable age for the Employees’ Pension Insurance from 60 to 65 years old
gradually is another example of the reform. In addition, an increase in the government
subsidy seems inevitable, but securing financial sources (for example, an increase in the
consumption tax) has been politically difficult.

2. NonNon-compliance and default in the National Pension
One of the biggest problems of the National Pension is that there are a growing numberof eligible and required persons who have not become participants or have not paid thepremium in full.

According to the last official survey (1998), 4.9% of would-be participantsof the National Pension have not participated.

However, there is no non-compliance in

Category No.2, as they automatically become subscribers when they become subscribers of
the Employees’ Pension Insurance, so that overall non-compliance rate is 1 to 2%.

Even larger problem is the default rate of premiums among the Category No.1
subscribers.

In 1998, the ratio of monthly premiums actually paid to fully expected

premiums was 76.6%.

In addition, 19.9% of the Category No.1 is legally exempt frompaying the premium, making the financial situation of the National Pension even worse.
Every effort is being made at central, prefectural, and municipal government levels todecrease the default rate.

The default and non-compliance of the National Pension is worse

in younger generations.

3. Introduction of the defineddefined-contribution scheme
In the private sector, firms are realizing a huge burden of future pension payments,
which is now labeled as liabilities under the new accounting system.

14

Together with

low-returns on their funds due to the recession of the economy, an interest has been
increasing in converting their defined-benefit pension schemes to defined-contribution
schemes, in which future payments are related to the investment performance of funds, as
opposed to the current system in which future payments are fixed at the beginning.
Recently, a new law for the Defined-Contribution corporate pensions has passed and such
schemes will be introduced.

4. Changing employment patterns and life cycles
Another motivation behind the introduction of a defined-contribution pension is thechanging employment patterns.

The traditional Japanese pattern of a life-long employment

has gradually been disintegrating.

Thus, firm oriented pension schemes based on along-term employment at a fixed workplace must be changed to fit the new situation.

Oneof the advantages of the defined-contribution pension, mentioned above, is that it is portablefrom a firm to another.

15

Outline of the Pension System

Public Pension
Basic Pension

Employees' Pension
Insurnace

Type of Insurance

Basic
1st Tier
Mandatory

Supplemental
2nd Tier
Mandatory

Insurer

Government

Government

All residents(categories 1-3)

Category 2 privatesector workers under 65
who work at workplaces
with more than 5

70.50
99%
99%
19.09
27%
66%

32.96
46%
100%
8.22
25%
29%

Flat rate

Fixed % of salary

-None

8.68%
8.68%

\13,300 (for Category
1 & 2), \0 (Cat.3)
Not Available(including premium for
National Pension)

Employee
Employer% of subscribers who are exempt(1998)
Default rate (as % of expected premium) (1998)

ExemptExempt5.7%
23.4%

ExemptExempt1.6%(1997)

Benefit (Old Age) Type

Flat rate

Income-related

Note

Eligible persons
Number of subscribers (millions)% to all residents(20-59years)% to all eligible persons

Number of current pension recipients% to all subscribers% to all residents (60&older)

①
②
②/pop
②/①
③
③/②
③/pop

Premium Type
Average contribution (% to salary) Employee
Employer
Average contribtion (\)

Average monthly salary of subscribers⑤⑥

Tax exemption

0%\804,200 x ((insured (Monthly income * 0.71%* insured months * slide
months + 1/3 xrate)+ dependants
exempt months)/480)
allowance

Calculation method
Average monthly benefits
Replacement ratio (average)
Starting age
Benefits (Disability)
Calculation method
Average monthly benefits (2000)
Benefits (Widow/Widower)
Calculation method
Avg monthly benefits\315,000(2000)

⑦
⑦/⑥
years

\49,000
Not available

65\177,000
56.2%
65Flat rate
Income-related
1st&2nd degree:\1,005,300 (1st(Monthly income * 0.71%
degree) or\804,200(2nd degree) * insured months * sliderate)+ dependants+ dependents
allowance
allowance\76,888\106,116

Flat rate\804,200 + children
allowance for wives
w/children

Income-related
3/4 of old age pension
for spouse or closefamily\83,444\91,470

Source:Shakai Hosho Tokei Nenpo (2000), Kose Hakusho (2000), MHW HP, Kigyo Nenkin Hakusho (2000)

16

(All numbers are as of March 1999, unless otherwise noted)

Semi-Private Pension
National Pension
Funds
Supplemental
3rd Tier
Optional

Government

Category 1
0.73
1%
4%

PrivatePensionRetirement
Allowance
SchemeSupplemental
Supplemental
Supplemental
3rd Tier
1/2/3 Tier Combined
3rd Tier
Optional
Mandatory
Optional
Employers of more than 500
employees
Mutual Aid Associations Firms (employers)
National and local civil
Employees of above servants, teachers, etc. Employees of above

Supplemental
3rd Tier
Optional

Employees' Pension
Funds

5.30
7%
100%
2.13
40%
7%

Subscriber's choice

Fixed % of salary

Fixed % of salary-None

1.6 ～ 1.9%
1.6 ～ 1.9%

9.20%
9.20%
(including premium for
National Pension)\19,000 ('00.3)
Not Available

Exempt up to\68,000

Payment

Tax Exempt
Mutual Aid Pension Qualif'd Pension(1997)

12.00
17%
36%
2.76
23%
10%

0%

Private Lump-Sum

Firms (employers)
Employees of above

10.30
14%
31%

None
Depending oneach firm

Depending oneach firm\333,622
Life insurance
premium exempt
ExemptExemptExemptExemptExemptPremium-related

Income-related

Income-related

Depending on
premium & age at
the time of entry

Average monthly salaryduring insured months *fixed rate + alpha(Monthly income * 0.9%
* insured months* sliderate)+ dependants
allowance

Depending on eachfirm

\56,000 (1996)
16.8%
60

\223,000(1997)\58,499(1997)

Not available

17.11%(1997)

65

39 to 46 months
worth of monthly
salary for employees
who have worked fullterm (38 to 42 years)

60
Income-related
1st degree old age
pension * 1.25 +dependents allowance,
2nd degree: old age
pensionIncome-related
3/4 of old age pension
for spouse or closefamilyNot available

Not available

17Chapter 3
Health Insurance
I. General Characteristics
1.

Universal health care and public insurance
Japan’s medical services are financed through a public mandatory health insurance

system, which is composed of two types of schemes: occupation-based and region-based.
The former is called the Health Insurance.

Employers and employees of firms of a certain

size and over form a health insurance society and thus these are called the Society-managed

Health Insurance.

There are more than 1,800 such societies.

For those who work at

smaller firms, the government provides a collective health insurance, which is called theGovernment-managed Health Insurance.

In addition, special professions such as civil

servants, day laborers and seamen form separate nation-wide professional associations.
Those who are not covered by the Health Insurance are required to participate in aregion-based insurance, called the National Health Insurance, for which the municipalities(numbering more than 3,300) act as independent insurers.

(See Fig 3.1)

Mostlyself-employed, farmers, workers of smaller firms and their family join the National Health

Insurance, thus its participants more or less overlap those of the National Pension.
Fig. 3.1 Public Health Insurance System
Occupation-based health insurance(Employees' Health Insurance)
Health Care Insurances

Health Insurance
Government-managed Health Insurance
Association-managed Health Insurance
Day-Laborers Health Insurance
Seamens’ Insurance
National Government Employees' Mutual Aid Association
Local Government Employees' Mutual Aid Association
Private School Teachers and Employees' Mutual Aid Assoc.

Region-based health insurance
National Health InsuranceLong - Term Care Insurance

The public health insurance with a universal coverage was established in 1961
concurrently with the universal public pension schemes.1

The share of each scheme isshown in Fig. 3.2. The Government-managed Health Insurance, the Association-managed
1 Those who are receiving public assistance are not covered by health insurance, since their medical
needs are met by the welfare payments.

18

Health Insurance, and the National Health Insurance each account for about one third of
the total population.

Fig 3 . 2 Sh ar e o f Diffe r e n t Pu blic He alt h In su r an c e Sc h e m e s
by Nu m be r o f Pe r so n s C o ve r e d (1 9 9 9 )
0.3%
29.8%
36.1%

Gov't-managed Health
Insurance
Association-managed Health
Insurance
Mutual Aid Association
National Health Insurance

8.0%

25.8%

Other

Source: MHW, “Kose Hakusho (2000)”

2.

Financing of health insurance
All the public health insurance schemes are financed by premiums, subsidy from thegeneral budget of the government, and co-payment from patients.

For the Health

Insurance, the premium is a fixed percent of employee’s salary, which is shared equally by
the employers and the employees.

For the National Health Insurance, the premium differs

among local governments and is usually levied on the basis of income, property, and numberof insured within a household.

A substantial government subsidy is given to the National

Health Insurance. For all Japanese medical insurance systems combined, the contribution
by government subsidy, insurance premiums, and patient co-payment are 32.2%, 52.9%,
14.9%, respectively (1998).

3.

Free to choose any medical facility
Because Japanese health insurance systems are universal, there is no distinction

between public and private hospitals from the viewpoint of the user.

In fact, users are free

to choose any medical service providers without constraint in terms of hospital type, locationor other factors such as having referral or not.

19

4.

Equal coverage of services at equal price
price
The coverage of health insurance and the prices of medical services are standardized bylaw, and thus, all persons receive the same medical service at equal price.

The area coveredby the insurance is shown in Fig. 3.3.

Fig. 3.3

Medical Services Covered
Covered by Health Insurance
Advanced medical research

Advanced medical
Medical checkup
Cash benefits(sickness andinjury, childbirthallowance, etc..)
Prevention/HealthMaintenance

Medical Servicescare
Hospital facility fee

Specialroom fee

Meal expense
duringco-payment
hospitalization

Special meals

Massage, acupancture, etc.

Uninsureddental care,etc.

OthersNon-prescription

Health service facility fordrugs

the elderly, Medical cost

Facility fee

Co-payment
At home medical services

NursingLong-termcare

Nursing AttendantsLong-Term Care/Welfare= Medical costs covered by health insurance= Other medical costs

Source:5.

Rising health care cost for the elderly
As the aging of the population proceeds, the share of the health care costs for the elderly

in total medical costs has increased.

However, because the composition of subscribers

differs among insurance schemes, some insurance schemes, such as the National Health

Insurance, have a larger number of elder subscribers than others and had to bear a bigger
financial burden.

To equalize the burden of the health care costs for the elderly among

insurance schemes, a new system was introduced in 1983.

Under the system, the healthcare costs for those aged 70 (See page 22 for details) and over in all schemes are separated
from that for under age 70, and it is divided by all insurance schemes.

20High Quality
Environment

6.

Introduction of the Long
Long--Term Care Insurance
Even with such a cost-sharing system, the cost of the long-term care included in thehealth care for the elderly has become a burden on the health insurances.

Recognizing thespecial nature of the long-term care and the need to separate the long-term care from othermedical services, the Government has introduced a mandatory Long-Term Care Insurance,
which started in April 2000.

The new system requires additional contribution from those

aged over 40 and covers a variety of at-home and institutional services for those aged 65 orover who are judged as in need of long-term care.

II. Types of the Health Insurance
Health Insurance (Occupation(Occupation-based insurance)

1.

People covered under this type of insurance are employees and their dependents.

Allemployed persons are required to join the association, except those who are employed byprivate firms with less than five employees and self-employed.

Depending on theoccupation and size of employers, there exist several programs as described below.
(a)Society-managed Health InsuranceThis scheme is operated by health insurance societies organized by large firms for theiremployees.

Sometimes more than one firms form a single society.

Currently, there are

1,813 such associations (as of April 1999).
(b)

Government-managed Health InsuranceThis is for the employees of small and medium scale firms, which cannot form a healthinsurance society on its own.

The Government provides a collective health insurance forthem, with contributions from the employers and employees.
(c) Day-Laborers Health InsuranceThis is for day laborers, i.e. those who are employed on a day-to-day basis, those employed
for a fixed term of less than two months, those are employed for seasonal work and those
who are employed at temporary workplaces.

Because of their unstable relationship withthe employer, the Government provides a collective health insurance, for which
contributions are collected on a day-to-day basis from both employers and employees.

21(d) Other Occupation-based health insurance

•
•
•
•

Seamen’s Insurance
National Government Employees’ Mutual Aid Association
Local Government Employees’ Mutual Aid Association
Private School Teachers and Employees’ Mutual Aid Association

The first is operated by the Government, and the other three, by each mutual-aid
associations.

2.

National Health InsuranceThis program covers all those who are not covered by the Health Insurance, i.e.

self-employed, farmers, students, and so forth.

The insurers are municipalities in mostcases, except for special professionals such as medical doctors who form National Health

Insurance Societies on their own.

Retirees who previously subscribed to the Health

Insurance are insured under the National Health Insurance. However, the health care costfor the retirees of age 60-70 are financed by the transfer from the Employees’ Health

Insurance, i.e. retiree’s former insurer.
The National Health Insurance is financed by the government subsidy as well as theinsurance premiums collected from its subscribers on a household basis.

The premium canbe discounted up to 60% for low-income households.

3.

Health Service System for the Elderly
Previously, health insurance for the elderly was covered under the National Health

Insurance, except when they are financially dependent on their family and are covered by
the Health Insurance of their family as their dependents.

However, as a result of anincreasingly aging population and rising cost, this arrangement led to an unbearably heavy
burden on the National Health Insurance.

Thus, a special program was created for those

aged 70 and over, and for those between 65 and 70 years old who are bed-ridden or havesevere disabilities.

Under this program, the health care costs are mostly met by the subsidy

from the central and local governments (30%) and the transfer of contributions from the

National Health Insurance and the Health Insurance (70%) with minimal co-payments fromthe elderly.

22(See Fig 3.4)

Fig. 3.4 Sources of Financing in Health Insurance
Insurance Schemes, 1998
(in trillions of yen )Employees' Health Insurance
Co-payment
2.0
1.0
3.9
Premium
7.2

total premium 12.1

Goverment
subsidy

total subsidy 0.8

0.5

0.3

Transfer

Retiree Health Insurance
Co-payment 0.3
Premium
0.4
0.1
Transfer
0.9

Transfer 0.1
Transfer
4.3

National Health Insurance
co-payment
1.2
Premium

1.6

0.8

total premium=2.5

Goverment
subsidy

1.6

1total goverment
subsidy=3.0

Subsidy frommunicipalities

0.4

0.2

total municipality
subsidy=0.6

Transfer 2.1
Contribution

4.

Health Insurance for the elderly 10.4
Co-payment
0.9
Receipt of Transfers
6.4(4.8 premium, 1.6 subsidy)
Goverment subisidy
3.2(govt 2.1, municipalities 1.1)

transfer

Medical benefits
Under the Health Insurance, the insured pays 20% of cost of all care, and dependents

pay 30% of the cost (20% if inpatient). For both of them, the maximum of co-payment is
63,600 yen a month or the 22% of the average monthly salary, plus 1% of the cost over acertain amount for one illness.

There are a lower threshold for low-income families and ahigher threshold for the high-income families.
Under the National Health Insurance, the insured pays 30% of medical costs. The
maximum of co-payment is same as for the Employees’ Health Insurance.

The co-payment for the elderly had been fixed low, but due to financial problems
mentioned earlier, a reform was undertaken in 2000.

Now, outpatients pay 10% of the costof the drugs, as opposed to a rather low nominal fixed price before.

The in-patients also

bear 10% of the hospital fee, with a ceiling of up to ¥37,200 per month.

23

III. Current Issues of Health Insurance
1. Health care cost for the elderly
elderly
The share of health care costs for the elderly has risen continuously, reaching to about
34.6% of all medical costs (FY 2000).

Since the contribution and co-payment of the elderly

had been very limited, their medical costs are mainly met by the younger population’scontributions in the health care system.

However, due to rising medical costs anddecreasing premiums caused by stagnant number of employees, many insurers in the Health

Insurance Associations and the National Health Insurance have faced financial difficulties.
More than a half

(53.85% in 1998) of the Health Insurance schemes were in red, and it will

be difficult for them to pay the required amount for the Health service for the Elderly, whichtakes up as much as 40% of their income from the premiums.

One of the reasons that the medical costs for the elderly are high is so called “the Social
Hospitalization”, meaning frail elderly are kept in hospitals for extended time of period, notnecessarily because their conditions require medical attention in hospitals, but rather, theylack appropriate care at home or at a care facility.

The introduction of the Long-Term Care

Insurance in April 2000 is expected to reduce the high medical costs for such hospitalizationby providing appropriate care at home and at lower-cost care facilities.

The verdict on the

success of the new scheme is not yet to be seen.

2. Reform of Drug Pricing

Drug tariff schedule sets the official price for each medicine on the basis of the weighted
average of market price.

Since a medical provider can obtain medicine at a bulk price which

is lower than the official price, there exists an incentive for a medical provider to prescribe
more medicine, and this is one of the reasons for high consumption of the drugs.

A debate ison going to abate this incentive and to design a new system.

3. Reform of medical fee System
Under the current systems of fee-for-service payments, medical providers are paid, inprinciple, for whatever services and medicine they provide.

Thus, there is an incentive for

medical providers to over-examine and over-prescribe medicine, creating a tendency to24higher medical costs. In addition, there has been a gradual shift from acute to chronic
diseases.

This has led to a debate on a reform of the fee schedule to fixed prospective

payments so that doctors are paid a fixed amount depending on the type and severity of thedisease, sometimes called DRG (Diagnosis Related Groups) method.

This system has been

experimentally introduced to about 10 hospitals.

4.

Restructuring of medical providers
In Japan, beds for general illness compose 3/4 of total beds, while the rest goes totuberculosis, mental illness and other special illness. Patients of both acute and chronic
conditions use beds for general illness.

This poses a problem of bed management because

chronic patients occupy beds for a long period of time. Currently, it is under consideration
to divide the general beds into acute and chronic uses, in order to manage beds more
efficiently.

Moreover, classifying and demarcating the hospitals according to types of

diseases and conditions is also considered.

Also under consideration is to promote information sharing between doctors andpatients, such as opening of medical files to the patients, informed consent practice, andmore generally, protection of patients’ rights.

25

Outline of the Health Insurance System

Employees' health insurance systems (EHIs) - Profession-based
Health Insurance1) Name2) Eligible subscriber3) Number of subscriber(millions) Dependents% of population

4) Insurer (number oforganizations)5) Premium rate:
Subscriber
Employer

Gov't-managed Health
Insurance
Employees of SmallMedium firms
19.95
18.02
30%
Government

4.25%
4.25%

Seamens' Insurance

Association-managed Day-Laborers
Health Insurance
Health Insurance
Employees of Large
Day-Laborers
firms
15.81
0.04
17.28
0.02
26%
0.05%
Health Insurance
Government
Associations (1,813)

Seamen
0.10
0.18
0.2%
Government

3.691% (avg)
4.769% (avg)\55～1050/day\85～1700/day

4.40%
4.40%

All
13%
16.40%

All\10.3 billion
--

All
13%
16.40%

All\3 billion
--

20%

20%

20%

20%

1.0% (Special Premium)

6) Gov't Subsidy to:7)

Administrative cost
Medical costelderly
Co-payment:
Subscriber
Dependents
Out-patient medicine

20% for inpatients 30% for outpatients(Internal medicine)\0(1 kind), \30(2-3kinds), \60(4-5kinds),\100(>6)/day,

Inpatient meal expense
Maximum\760/day (for low-income family \650/day for first three months, \500/day after\63,600 (for low-income person \35,400)

8) Allowance:
Childbirth allowance
Funeral expense
Fun.exp. for dependents\300,000
1 month of avg. salary(min. \100,000)\300,000\300,000
Avg. monthly wage 2 months of salary(min.\100,000)(min. \100,000)
1.4 month ofsalary (min.
\100,000\100,000

9) Unemployment benefits:
Due to sickness

60% of avg. wage

Due to childbirth

Up to 18 months
60% of avg. wage
42 days before birth, 56
days after

Due to unemployment

Same as the left
column2% of Avg monthly
wage/dayUp to 6 months(except for TB 18

60 % avg. wage

Up to 3 years
60% of avg. wage
Unemployed days
42 days before
before birth, 56
birth, 56 days afterdays after--10) Disaster Relief:
For deathFor death of a family
memberFor disaster

26

--

--

--

---

---

---

March-98

Source: Shakai Hosho Tokei Nenpo, 2000, Shakai Hosho Nenpo, 2000

Regional Based Insurance
National Govt
Private School
Employees' Mutual Aid Local Govt Employees' Teachers &Association
Mutual Aid Association Employees' MAA

National Govt Civil
Servants

Local Govt Civil
Servants

1.14
2.98
1.52
3.75
2%
5%
Mutual Aid
Mutual Aid
associciation of each associciation of eachministry (24)local govt (54)

Private School
Teachers &Employees
0.44
0.38
0.6%

2.46 ～ 5.00%
2.46 ～ 5.00%

4.26% (avg)
4.26% (avg)

4.23%
4.23%

National Health Insurance

Self-employed, farmers,etc.

39.81
0
31%
Municipality(3,249)Retired

4.52
4.43
0
0
4%
3%
National
Municipality
Health(3,249)Insurance
Associations(166)

Avg.premium per family \156,952--(1997)All

All (by local govt)

Partial

All

All

---

---

---

50%

32～52%

--

--

All
---

20%

20%

20%

30%

30%

20% inpatient, 30%
outpatient

--

--

--

(External medicine)\50(1 kind),\100(2kinds),\150(>3)

3 months, or for low-income family receiving elderly pension \300/day)standard amount\300,000
1 month of
avg.salary (min\100,000)
70% of avg.salary(min \100,000)

standard amount\300,000

65% of avg.salary

80% of salarystandard amount\300,000
1 month of
1 month of salary
avg.salary (min(min \100,000)\100,000)
70% of 1 month of
70% of avg.salarysalary (min \100,000) (min \100,000)

80% of avg.salary
Up to 18 months
Up to 18 months
Up to 18 months(except for TB 3
(except for TB 3 yrs) (except for TB 3 yrs) yrs)
80% of avg. wage
80% of avg. wage
42 days before birth, 42 days before birth, 42 days before
56 days after
56 days after
birth, 56 days after
50% of avg. wage
60% of avg. wage
60% of avg. wage
1 month of avg.
salary1 month of salary
70% of monthly avg. 70% of monthly avg.
salarysalary0.5 to 3 months of 0.5 to 3 months of
avg. salary, due to avg. salary, due tosevernessseverness

1 month of avg.
salary70% of monthly avg.
salary0.5 to 3 months of
avg. salary, due toseverness

standard amount \300,000
Set according to the law-Standard not set

Standard not set

-----

27

Chapter 4
Social AssistanceI. General Characteristics
1. Explanation of terms
The social assistance in Japan can be divided into: (1) Income assistance for the poor and(2) Social services and assistance for socially disadvantaged people.

The former is called the

Public Assistance, while the latter includes Welfare for the Children, Welfare for the
Disabled, Welfare for Single-Mother Households, and Welfare for the Mentally Disabled
People depending on the specified target group.

The Public Assistance includes bothin-kind and in-cash assistance to the poor household, while the latter includes mostly
services such as at-home and institutional services, but sometimes in-cash assistance.
Thus, the term welfare is used widely to indicate various social assistance programs andinstitutions that fall within the above-mentioned areas.

Most of these programs,

institutions and services are provided from the general budget of the government andmunicipalities.

Until the Long-Term Care Insurance was introduced in 2000, the services for the elderly
were also termed the “Welfare for the Elderly”.

However, many services for the elderly are

now covered by the Long-Term Care Insurance, and thus, it will be discussed in Chapter 5.

2. Means test and universality
universality
The Public Assistance Law stipulates a principle that every citizen has a right to claim
public assistance without discrimination, regardless of reasons for falling into hardship.
However, the Public Assistance is provided with fairly strict means and asset tests, whichmight be a reason for low percentage of population receiving the public assistance.

The

Child Allowance is also provided with a means test, but the threshold is much higher thanthat for the Public Assistance.
On the other hand, most of the services provided at institutions for the disabled andchildren are provided to all, even though there is a difference in fee depending on the incomeof the recipient.

28

II. Assistance Schemes
Here, main features of the following three categories of the social assistance will be
described. Income assistance, rather than services, will be the main focus of the discussion.

1.

Public Assistance for the poor

2.

Welfare for Children (including Single-Mother Households)

3.

Welfare for the Disabled

1. Public Assist
Assistanceance for the poor
The root of Japan’s public assistance goes back to the Indigent Person’s Relief

Regulation (1874) and the Poor Relief Law (1932). However, a modern version of the public
assistance started in the midst of the confusion after the World War II with the Public

Assistance Law (1946), followed closely by its total revision in 1950. The Revised Public
Assistance Law (New) constitutes a backbone of the public assistance today.

The Law

stipulates four fundamental principles: (1) public assistance to the people in need is a
responsibility of the state, (2) all citizens1 have a right to claim public assistance without
discrimination of sex, social background and reasons for falling into hardship, and only the
economic condition is the criteria of receiving assistance, (3) the state guarantees to all
citizens a minimum level of healthy and cultural life, and (4) public assistance is a
supplement to all resources available to and the best efforts exerted by the applicant.

The public assistance is provided upon a receipt of an application from a household in
need and after a careful examination of the application.

The assistance is calculated bysubtracting the household’s final income from the minimum cost of living.

In case theminimum cost of living exceeds the final income, the difference is given as the assistance.
The minimum cost of living is calculated from seven categories of expenses: livelihood,housing, educational, medical, maternity, occupational, and funeral expense.

The

calculation of the minimum cost of living takes into consideration the differences in living
costs among different regions of the country, and household members’ age.

All assistance isprovided as cash transfers, except a few such as medical costs, which are provided as in-kind.

1 The Public Assistance Law (New) excludes foreigners from this right, but currently, by order, legal
foreigners are given “equal treatment as citizens”. Illegal foreigners are not covered.

29

(a) Means test
The principle (4) of the Public Assistance states that the Public Assistance must be a
supplement to the person’s best efforts and available resources.

In other words, the person

is required to use all available resources, including assets, ability to work, as well as
assistance from those who are required to support the person by law.

Assets such as land,houses and farms must be sold, except in the case where the person is actually living or
utilizing it and the value of the assets is higher when it is utilized than when it is sold.
Household goods such as TV are allowed if the diffusion rate of the goods is more than 70%
in the region.

As for the utilization of the ability, the person will not be able to receive assistance if
he/she is judged as capable to work.

If the person has a will and ability to work, but isunable to find work, it is unlikely that he/she would be given assistance.

The civil law states that certain relatives and family members are required to support a
person in need.

Thus, the public assistance is given only after it is judged that this support

is not available. In practice, spouses and parents of a minor (less than 20 years old) havestrong responsibility to support the person.

(b)

Statistics
In 1998, 663 thousand households or 947 thousand persons (0.75% of the population)

received some types of public assistance.

Among them, the share of elderly household is thelargest, accounting for 44.5% of all recipient households, and has been increasing for someyears.

The share of the household with a disabled or sick is also large, at 40.4%.

are single-mother households and others.

The rest

The large share of households with the elderly,

disabled or sick may be the reason that the most of recipient households (87.7% in 1998) do
not have any working member.

30

Table 4.1 Persons Receiving Public Assistance by Types of Aid

Number of Households
Number of persons
Livelihood aid
Housing aid
Educational aid
Medical aid
Other types of aid(Monthly average, 1998)
Unit
Number(1000 households)
631(1000 persons)906(1000 persons)784(1000 persons)669(1000 persons)
84(1000 persons)716(1000 persons)
3

%
100.0
86.5
73.8
9.3
79.0
0.3

Table 4.2 Percentage of Household Receiving Aid by Types of Household
Type of Household
Elderly households
Single-mother households
Household with disabled or sick
Other

%
44.0
8.3
41.0
6.7

Source: MHW, 2000

Fig 4.1 Duration of Receiving Public Assistance by Household(1998)
Less than 6months5.8%
More than 10
years
36.2%

5-10 years
19.0%

Source:6 months to 1
year
6.4%
1-3 years
19.3%

3-5 years
13.3%

http://www..ipss.go.jp/Japaanese/seiho/seiho.html

31

F i g 4.2 Work i ng /N on-work i ng H ous ehol ds R ecei v i ng Publ i c
A s s i tance ( 1998)
Day-Laborer
Working household1.3%
At-home sidejobs
member
1.0%
2.5%
No working
household member
87.7%

他
9.8%
Employee
5.9%

Source: Shakai Hosho Tokei Nenpo,2000

32

Others
1.6%

2. Welfare for Children (including Single
Single--Mother Households)(a) Child Allowance and Special Child Allowance
This is an area where there have been significant reforms within past year or so.

The

new interest in reforming the Welfare for Children is spurred mainly due to the concern thatthe number of children is decreasing.

First, in the past, the Child Allowance is granted toparents (or guardians) who are raising children less than 3 years old and whose income isless than a specified amount.

Since June 2000, the age limit was raised to 6 years old andthe income threshold was also raised.

(See Table 4.3 for income threshold).

The amount of

the Child Allowance is ¥5,000 per month for the first two, and ¥10,000/month/child for otherchildren.

The financial burden of the Child Allowance for children 0 to 3 years old is bornby employer, central, prefectural and municipal governments at 70%, 20%, 5%, 5% for arecipient who is employed, and by the central, prefectural and municipal governments at
66%, 16% and 16% for a recipient who is not an employee.

For children 3 to 6 years old, theentire financial burden is born by the government (central 66%, prefectural 16%, municipal
16%).

In addition, for a parent who is either employee or a public servant, a higher income
threshold was set for receiving the Special Child Allowance.

The amount of the Special

Child Allowance is same as the Child Allowance, but the entire financial burden is born by
his/her employer.

Table 4.3 Income Threshold for Child Allowance
Number of Dependents

Threshold for Child
Allowance*

None
170
1 person208
2 persons246
3 persons284
More than 4 persons+38.0/person* Annual Income of previous year (unit:\10,000)

Threshold for Special
Child Allowance*
361
399
437
475
+38.0/person

33

Table 4.4 Number of Child Allowance Recipients and Expenditure,
Expenditure, 1998
Number of Recipients Number of Children
coveredTotal
1,981,265
2,209,515(of which SCA)
(1,281,193)(1,422,037)
Employee
1,445,505
1,607,383(of which SCA)
(1,130,115)(1,251,874)
Non-Employee
378,524
424,901
Public Servants
157,236
177,231(of which SCA)
(151,078)(170,163)

Expenditure(unit: million yen)
148,434(93,954)
107,989(82,850)
28,881
11,564(11,104)

Source: Kose Tokei Kyokai, 2000, , MHW, 2000

Note: SCA = Special Child Allowancesingle--mother households)(b) Child Rearing Allowance (for single
As part of measures for single-mother households, Child Rearing Allowance is given to amother or other persons having custody of, and rearing a child less than 18 years old, whodoes not share a common household income with father and whose earnings for the previous
year is less than the threshold.

For mothers and others with less than ¥2,048,000 of annual

earning, monthly allowance of ¥42,370 in case of one child, ¥47,370 in case of two children,and for third child and up additional ¥3,000 for each child is granted.

For similar persons

whose earnings of the previous year was more than ¥2,048,000 but less than ¥3,000,000,
monthly allowance is reduced by ¥14,020.

(c) Child Care Facilities (Day-care centers, etc.)
Municipal governments are required by the Child Welfare Law to provide day-care
centers for children whose parents are not capable of taking care of them for reasons such as
work, illness, and care of other members of the family. Day-care centers provide 8 hours ofcare, but demand to extend the hours has been increasing.
measures are tightly regulated by the state.
municipality.

34

The staffing and other quality

Fee for day-care centers depends on

3. Welfare for the Disabled
The measures for people with disabilities are divided into (1) those for people withphysical disabilities, (2) for people with mental disorders, (3) for children with mental andphysical disabilities and (4) adults with intellectual disability.
institutional services and in-home services.

Measures are mainly

Tables 4.5 and 4.6 list services provided.

Table 4.5
Measures for People with Physical Disabilities
Community Service
Rehabilitation
Provision of medical rehabilitation service
Home visiting examination and rehabilitation counseling
Provision of goods
Provision of technical aids for daily life
Provision of daily life appliances
In-home care
Allowance for people with special disabilities
Home-help service
Short term stay program
Health care
Health checkup
Social participationCounselingDay-service programs
Sheltered day workshops
etc.
Institutionalized Service
Rehabilitation
For persons with disabilities of limb or bodyfacilities
For the blind
For the deaf
For people with internal disorders
For people with severe disabilities
Residential facilities Custodial care homes
Welfare homes
Work facilities
Sheltered workshops
Sheltered workshops for people with severe physical disabilities
Sheltered Day workshops
Welfare factories
Community
Welfare centers (health care and relaxation activities)
facilities
Day service centers
Recreation centers
Facilities for braille publication and Braille libraries
Information center for the deaf
Source: MHW, 2000
Facilities for production of prosthetic appliances
Homes for the blind
Measures for People with Mental Disorders
Medical services
Psychiatric hospitals and clinics
Community services Day-care
Visiting guidance for user groups
welfare counselingSocial rehabilitation Dormitories(for those unable to carry out
services
Short-term residency
daily lives on their own)
Welfare homes(for those who can carry out daily
lives on their own, but have no place to live)
Welfare factories(provide workplace)
Sheltered workshops(those who can work, but have no place
to live)
Group homes
Small workshops(work training)
Source: MHW, 2000
Social rehabilitation programs
Counseling

Table 4.6

35

As for the income assistance, disability pensions under the National Pension, theEmployees’ Pension Insurance schemes, and the Allowance for Special Disabled Persons are
granted for eligible persons with disabilities who are over 20 years of age.

For households

who are raising children with disabilities under age 20, the Family Allowance for Special

Children and the Welfare Allowance for Disabled Children are applicable. If the sum of
eligible allowances and any other income is under the minimum cost of living, the Public

Assistance, as discussed in section II.1, is granted to secure the minimum standard of living.
Amount of each allowance is summarized in Table 4.7.

Table 4.7
4.7
Allowances

Amount (monthly)
Eligibility

Pensions
Type

Income Assistance for the Disabled,
Disabled, 1999
Allowance ffor
or Special
Disabled Persons

Welfare Allowance for
Disabled Children

Family Allowance forSpecial ChildrenChildren\26,860\14,610\51,550 (1st degree)\34,330 (2nd degree)
Those raising disabledchildren and is notreceiving disability
pensionDisabled persons over 20 Those raising mentally
years old requiring
disabled children requiring
special care and living at special care and living at
home
home

National Basic Pension

Employees' Pension Insurance

Flat rate

Income-related

Amount (Annual)\1,005,300 (1st degree) or\804,200(2nd degree) + dependents
allowance

Average Amount\76,888

Monthly income * 0.75% * insured
months * slide rate * (1.25 for 1st
degree, 1.0 for 2nd degree)+ dependants
allowance\106,116

Eligibility

Over 20 years of age, who have paid For those who have become disabled
2/3 of premium period and those who during insured months (for those underare under 20 at the time of becoming 300 months of insurance period, 300 is
disabled and who have turned 20
applied)Source: Kosei Tokei Kyokai, 2000, Shakai Hosho Tokei Nenpo, 199936

III. Current Issues
1. Basic Structural Reform of Social Welfare
The 1945-55 conception of public relief for the poor still remains in the basic frameworkof social welfare in Japan.

However, there is a growing awareness of the necessity torespond to the diverse welfare needs of people and to provide them with high quality services.
With such an understanding, the government is carrying forward some reforms.

First, in1990, the Social Welfare system was revised to (1) place more emphasis on the at-homeservices, and (2) the services are standardized to be provided at municipality level.

Since

1997, the government is carrying forward the Basic Structural Reform of Social Welfare.
The reform aims to establish a system that ensures the choice of individuals.
Previously, specifically in case of services requiring institutionalization, the welfare offices
assessed the need of the person in question and ordered appropriate measures.
a system, the user could not choose the service or the institution.

Under such

Under a new system, anindividual selects his/her own services and uses them based on a contract with suppliers.
(Fig. 4.3) The reform has established the vision for the new social welfare, but concretemeasures and programs are still being debated.

2. Need to create a society favorable to child rearing
Japan has faced a rapid aging of the population, which is caused by both a decrease in
the fertility rate and an increase in the life span.

In order to stop the trend toward a society

with a few children, it is necessary to create an environment favorable to child rearing.
However, many Japanese working parents rely much on mothers staying at home or
grandmothers taking care of children.

As the number of working mothers rises, there has

been a severe shortage of day-care centers, especially for 0 to 2 year olds, within
metropolitan cities.

In 1999, the Government has allocated a special supplemental budget

to reduce the number of waiting children for day-care centers.

Yet, more efforts in this field

are needed to increase the number and diversify the kind of day-care centers and othermeasures to help working parents.

Measures to help not only working parents but also

non-working mothers, who are feeling stress of bringing up children in the absence ofextended family and community ties, will work to create a child-rearing easy society.

37

Fig. 4.3 Diagram Representation of the Welfare Reform
Before the Reform

Local Government

5.Payment
4.Placement
7.Co-payment(fee)
2.Placement
request3.Acceptance

1.Application

Recipients

After the Reform

Consigned service
6. Services

suppliers

Municipalities

7.Subsidy (on be half of user)

3.Acceptanceof subsidy

6.Invoice2.Application
for subsidy

1.Application

Users

Designated Service
4.Service
5.Payment

38

forsuppliersChapter 5Long--Term CareLong
I.

General Characteristics

Introduction of the Long
Long--Term Care Insurance
Starting in April 2000, Japan introduced the Long-Term Care Insurance.

The insurance

system will cover the long-term care of the elderly, which was previously provided partly
through the health insurance system and partly by the welfare measures.

The maindifferences between the Long-Term Care Insurance and long-term care provided by the priorsystem are shown in Table 5.1.

The new system grew out of the recognition that, due tochanges in the society such as weakened community ties, increase in small-sized families,
and increase of working women, financial and psychological burden of family facing the carefor the elderly has become unbearably large.

The Long-Term Care Insurance is designed toshare the burden of caring for the elderly among all members of the society and lessen theburden of the family.

In other words, it aims to establish a system that responds to society’s

major concern about aging, and to assure the citizens that they will receive care, if necessary,and be supported by society as a whole.

Furthermore, it is expected to alleviate thefinancial pressure placed by the care need of an aging society on the health insurance
system.
Table 5.1

Differences between New and Old Care Systems
Old
Welfare for the Elderly

New
Long-Term Care Insurance
Those aged 65 years old andThose aged 70 years old and over
over and those between 40and those between 65 and 70 with
64 who are subscribers of
disabilities
medical insurance
Insurance for the Elderly

Service Target

Low-income, living alone orother requirements

Eligibility for Service

Care needs and conditions offamily structure, income, etc.

Care needs

Co-payment

According to ability to pay\530/visit, \1,200/day of
hospitalization

Service Providers

Public welfare facilities

Medical facilities

No

Yes

Freedom of choice by user
Source: Nihon Iryo Kikaku, "Iryo Hakusho, 1998"

40

Care needs
10% of service fee
Public or private carefacilities, medical faicilities
Yes

II. LongLong-Term Care Insurance Systema)

Insured
The insured persons are those who are aged 65 and over (Category 1) and those between

ages of 40 to 64 and are subscribers of health insurance (Category II).

The premium iscollected through municipality and deducted from pensions for the Category I, and throughadditional premium to be paid to health insurance for the Category II.

Premium amount isdetermined by each municipality, and thus differs depending on available facilities, in-homeservices provided, and demand for care services.

Premium is income-related, and there will

be measures to moderate the burden for low-income persons.

b)Service provided
A list of care services is shown in Table 5.2.

The services are provided both at home andat institutions depending on the care required by user.

The user is free to choose the kind ofcare and its providers, which can be either public or private.

c) Source of financing
The cost incurred in the Long-Term Care Insurance is financed by premiums,
government subsidy and co-payment of users.

A part from the co-payment of the users, thecost is financed 50% by premiums (17% by Category I, 33% by Category II in FY2000) and
50% by government subsidy.

Within this framework the municipality can determine therate of premium for the insured of Category 1.
average (FY2000).

It is estimated about 3,000 yen per month on

For the Category 2 insured the rate will be 0.95% of salary in the

Government-managed Health Insurance and 0.88% in the Society-managed Health
Insurance (FY2000).

Co-payment for the services is 10% of the cost, plus, for those in a

hospital or an institution, a part of the meal expense.

d) Assessment of the care-needs
The users are classified into 6 categories (“Assistance Required” and ”Care Required
Level 1 to 5”), depending on the severity of the care need.
provided is determined according to this category.

The upper limit of services

The user must be assessed by themunicipality into one of the categories before applying for the services.

41

Table 5.2
Care under Long-Term Care Insurance
Service for those staying at
Service for those who arehomeinstitutionalized
Home-help
Special nursing homes for the elderly
At-home bathing
Long-term care at health facilities for
the Elderly
At-home nursing
At-home rehabilitation
Long-term care at medical carefacilities for sanatorium (sanatorium
Out-patient rehabilitation
words, etc.)
At-home medical caremanagement counselingDay-service
Short-stay service
Group home for elderly withdementia
Long-term care at private
homes for the elderly
Provision or subsidy for careequipment
Subsidy for home alteration
to meets care needs
Source: Kenko Hoken Kumiai Rengokai, "Shakai Hosho Nenkan 1999"

Fig. 5.1

Diagram Representation of Long-Term Care Insurance

Service Providers

InsuredPublicandprivatecare
providersCategory 1(over 65 yrs),
22 million(FY 2000)

premium

Service20%
Collected
bymunicipality
80%
Taken out
frompensions

co-payment

Municipalities
Assessment ofof careneededCategory 2(40-64 yrs),
43 million(FY 2000)

premium

Source: Kenko Hoken Kumiai Rengokai, 1999, MHW, 1999

42

Collected
by healthinsurances
Fund

Budget(Municipality)
Premium
fromCat. 1(17%)

Premium
fromCat. 2(33%)

Govt.
Subsidy(50%)(State 25%,
Prefecture
12.5%,
Municipality
12.5%)

III. Current Issues
1. Shortage of care providing facilities
One of the concerns in introducing the Long-Term Care Insurance is uneven distributionof care facilities throughout Japan, resulting in a shortage of care providing facilities, bothprivate and public, in some regions.

The anxiety is expressed, “Insurance, but no Service”.

The government has formed a plan to increase the public care facilities and to encourage
private sector to enter into the field.
At the same time, there is also a concern about the quality of care provided by theprivate sector.

2.

The quality control measures need to be set.

Response to the rise of insurance premium and the coco-payment
Another issue is the amount of premium.

For the insured of the Category I, thepremium is deducted from pensions or collected separately by the municipality, and for theCategory II the premium of the Long-Term Care Insurance will be added on top of the healthinsurance premium.
municipalities.

There is also a considerable variation in the premium among

There has been a considerable out-cry from low-income households who

cannot bear the premium or/and the co-payment, and as a response some municipalities have
reduced the premium or the co-payment for the low-income users.

3.

Determination the Category
Assessing the true requirement of the elderly, and categorizing into 6 categories is very

hard.

Especially in case of dementia, there have been reports that they are likely to beclassified in a lower category.

43

Chapter 6
Employment Insurance
I.

General Characteristics
Japan uses the term “Labor Insurance” to mean both the Labor Accident Insurance andthe Employment Insurance. The two are independent schemes, but in some respects, suchas the collection of the premiums, are treated together. In this Chapter, the focus of the
discussion is the Employment Insurance.

Employment Insurance has two functions.
case he/she loses the job.

One is to provide employees cash benefit in

The other is to support employers to prevent them from laying off

The former is called the Unemployment Benefits, and the latter consists

their employees.

of three components, namely: Services for employment stabilization, Services for developing

human resources, and Services for employees’ welfare. The Unemployment Benefits also
include a variety of benefits such as the Job Applicants’ Benefits, the Study and Training

Benefits, and the Employment Continuation Benefits. The entire scheme is shown in Fig.
6.1.

II. Employment Insurance
Insurance System
1.

The Basic Allowance for the Job ApplicantsThis is the most commonly referred to as the “Unemployment Benefits”.

For generalemployees, it is necessary to have been insured for at least 6 months within one year prior toleaving the job.

The duration of the benefits ranges according to the age of the beneficiaryand the years of being insured.

Since April 2001, the duration of the benefits also depends

on the reason of the unemployment, i.e. whether the termination was voluntary (including
retirees) or involuntary and without enough time period to arrange re-employment (due tolay-off or bankruptcy of the firm).

The Tables 6.1 to 6.3 show the number of days for eachkind of recipients.
2.

Old Age Continuous Employment Benefits
This is a scheme for old employees who are between ages 60 and 65 and continue to workat a salary lower than 85% of their salary at age 60.
years before receiving the benefit.

44

They have to be insured for at least 5

Fig. 6.1 Employment Insurance

Job Applicants’ Benefits
General employees

Basic Allowance
Skill Acquirement Allowance

Employment Insurance

Unemployment Benefits, etc.

Lodging Allowance
Injury and Sickness Allowance
Old-Age Employees

Old-Age Job Applicant Benefit

Short-term emp.

Special Lump-sum Allowance

Daily Labor.

Day-Labor Job Applicant Benefits.

Study & Training Benefits
Employment Promotion Benefits

Re-Employment Allowance
Moving expense, etc.

Continuous Employment Benefits
Old Age Continuous Employment Benefits
Child Care Leave Benefits
Family Care Leave Benefits

Services

Service for Employment Stabilization
Service for Developing Human Resources

Service for Employees’ Welfare

45

Table 6.1

Duration of Basic Allowance (General Employees)(unit: days)
Years of being insured
Less than 5<= and 10<= and More than
5 years<10 years <20 years 20 years

GeneralShort-term

90
90

120
90

150
120

180
150

Data is effective starting April 1, 2001.

Table 6.2

Age ofbeneficiaryLess than 30

Duration of Basic Allowance (Involuntary terminated Employees)(unit: days)
Years of being insured
Less than 1<= and 5<= and 10<= and More than
1 year<5 years <10 years <20 years 20 years

90
(90)

30～44
45～59

90
(90)

60～64

90
(90)
180
(90)
150
(150)

180
(150)
210
(180)
270
(240)
210
(180)

180
(150)
240
(210)
180
(150)

--240
(210)
330
(300)
240
(210)

For those difficult to get employed(disabled, etc.)
Less than 45
150
300
360
45～64
150
(240)
Less then 30
(150)
30～64
(150)
(270)
* numbers in ( ) are for part-time workers
Data is effective starting April 1, 2001.

Table 6.3 Duration of Old-Age Job Applicant Benefit(unit: days)
Years of being insured
Less than 1 1<= and <4 More than 5
year
years
years
Continuously older workers
Short-term workers

46

30
30

60

75
50

3.

Rise of PartPart-time and temporary employment in the young and the women
Partly due to high unemployment, and partly due to changing employment preferences(both by employees and employers), the number of part-time and temporary workers is rising,
especially among young and women.
Employment Insurance.

Many of them do not or cannot participate in theThis is due to the system’s underlying concept that the

Employment Insurance is security for livelihood for those who make their living with thewages received for their own labor, at the time they lose their jobs.

In response to the changing job market, the 2001 Reform of the Employment Insurance
abolished some criteria for part-time and temporary workers to subscribe: the main one ofthem is the yearly income threshold (¥900,000/year).

Now part-time or temporary workers

working at least 20 hours per week, and works (or sent to work from temp agency) at a same
workplace for more than 1 year are eligible to subscribe to the Employment Insurance.

III. Current Issues
1.

High unemployment rate and financial crisis of the Employment Insurance
Now a legendary low unemployment rate until the 1980’s had left a healthy financialbalance of the Employment Insurance, and with this surplus, the system was extended toinclude services to prevent a lay-off and measures for the old age continuous employees.
However, a rapid increase of the unemployment since the 90’s has resulted the financialbalance of the system to turn into red.

The 2001 Reform has tackled the problem in somerespects by separating the recipient of the Insurance by reasons of the termination.

The

effects of the Reforms are yet to be seen.

2.

Treatment of elderly employees
However, the current system still favors old age employees in many respects (Forexample, the Old Age Continuous Employment Benefits and the insured period
categorization of the Unemployment Benefits).

The assumption of the Employment

Insurance was that young people are hired easily and will continue to work full-time for theentire duration of their career.
market.

Some researchers believe these schemes distort the labour

The treatment of old age employees must be re-examined closely in relation withthe labour market and also other social security systems such as pensions.

47

Outline of the Employment Insurance System

Employment Insurance1) Eligible subscriber

General Employees

2) Number of subscriber **3) Insurer
4) Premium rate: (as of April
Subscriber
Employer

2001)

Short-term special
employees
33.45 (million)
Government(for Agro-Forestry)(General )
0.60%
0.95%

0.70%
1.05%

5) Gov't Subsidy:
Administrative cost
Benefits paidAll
1/4 of benefits, 1/8 of Employment Continuation benefits6) Unemployment Benefits(A) Job Applicant Benefits① Basic Allowance
Requirements
AmountDuration② Skill Acquirement Allowance③Lodging Allowance

Insured for at least 6 months in one year prior
to leaving the job
60 to 80% of pervious wage
See Table 6.1 below

Special One-time
Allowance: 50 day
worth of the Basic
Allowance(1) \590/day for course fee, (2) \2,000/mo for special training, (3)up to\42,500 of transportation cost
\10,500/mo④Injury & Sickness Allowance
Same as the day rate of the Basic Allowance--(B) Employment Promotion Benefits (1) Re-employment allowance: 15～120 days of Same as left, except（Ｃ Study & Training Benefits）
Requirements
AmountBasic Allowance(1)
disabled, etc.)、moving expenses, job seeking
expensesThose who have completed the study & training
designated by the Minister with more than 5
years of insured period
80% of expense (up to \300,000)(D) Continuous Employment Benefits①Old Age Continuous Employment Benefits
Those aged 60 to 64 year olds who have been
Requirements
insured for at least 5 years, and whose wage isless than 85% of the wage at 60.
25% of the wage after 60 (in case the current
salary is 80-85% of the wage at 60, the rate is
Amountreduced gradually)
Until the 65th birthday (In case re-employed
after receiving unemployment benefits, 2 years
Duration
if the remaining days of unemployment benefit
is more than 200 days, 1 year, if 100 days.)②Child Care Leave Benefits
Those who has taken a child care leave to raisea child of less than 1 year old, and who haveworked more than 11 days in a month for more
Requirements
than 12 months in the past two years
AmountDuration③Family Care Leave Benefits
Requirements
AmountDuration

48

40% of wage before the leave (30% during theleave, 10% after returning to work)
During the child-leave
Those who has taken a family care leave andwho have worked more than 11 days in a monthfor more than 12 months in the past two years
40% of wage before the leave
Up to 3 months

---

---

---

Schemes are as of April 2001.

Seamen's' InsuranceContinuously Employed Older
Persons(for Construction)
0.70%
1.15%

Day-Laborers

Seamen0.05
Government

0.07
Government

Left and\48～88/day\48～88/dayAll
1/3 of benefits

1.00%
1.00%
All
1/5 of benefits, 7% of Employment
Continuation benefits

Paid 26 days of
Insured for at least 6 months in one
premium in the past
year prior to leaving the job
2 months

Has been employed since before
turning 65, and till after 65, andinsured for 6 months in the year
before termination
50 to 80% of previous wage

\7,500～\4,100/day

60 to 80% of pervious wage

See Table 6.3.

13～17days

50～180days general, and 50～
330days for involuntary terminated(1) \590/day for course fee, (2) up to\42,500 for transportation cost

---

---

---

Same as left,
except (1)\10,500/mo
60 to 80% of pervious wage
(1) Re-employment allowance: 20～70
days of above rate(2) Moving expenses

Continuous Employment Benefits:
25% of monthly wage---

(1) Child-Leave Basic Allowance
25% * 30*Basic daily wage-----(2) Child-leave Returnee Allowance
5% * 30 * Basic daily wage

---

---

(1) Child-Leave Basic Allowance
25% * 30*Basic daily wage
(2) Child-leave Returnee Allowance
5% * 30 * Basic daily wage

49

References
Relevant Organizations
National Institute of Population and Social Security Research
http://www.ipss.go.jp
Ministry of Health, Labor and Welfare
http://www.mhlw.go.jp/english/index.html
Statistics Bureau & Statistics Center, Management and Coordination Agency
http://www.stat.go.jp/english/1.htm
The Japan Institute of Labor

http://www.jil.go.jp/index-e.htm

International Medical Center of Japan

http://www.imcj.go.jp/imcj2.htm

National Institute of Health Services Management
http://www.nih.go.jp/byoken/index.html
Organization of Economic Cooperation and Development
Reform Monitor, Bertelsmann Foundation

http://www.oecd.org/

http://www.reformmonitor.org

References available in English
Health and Welfare Statistics Association (1998) Health and Welfare Statistics inJapan. HWSA.
Japan Aging Research Center (1997) Statistical Abstracts of Aging in Japan., ARC.
Japan International Corporation of Welfare Services (1999) Social Welfare

Administration in Japan (Textbook for the 17th Study Programme for the
Asian Social Welfare Administrators). JICWS.
Japan International Social Security Association (1999) Outline of Social Insurancein Japan. JISAA.
Ministry of Health and Welfare (1999)

Annual Reports on Health and Welfare.

MHW.
National Federation of Health and Insurance Societies (1999) Health Insuranceand Health Insurance Societies in Japan. NFHIS.
National Institute of Population and Social Security Research (1999) The Cost of50

Social Security in Japan. NIPSSR.
Takanashi, A. et al. (1998) Employment Insurance Law, The Japan Institute ofLabour.
Journals

Review of Population and Social Policy, National Institute of Population and Social
Security Research.

51

AuthorAya AbeNational Institute of Population and Social Security ResearchInternational Cooperation and Research Division

EditorTetsuo Fukawa

National Institute of Population and Social Security ResearchHead, Department of Theoretical Social Security Research

Acknowledgement
The author and the editor thank the many researchers both inside and outside
the National Institute of Population and Social Security Research for valuablecomments.

We would like to give the special thanks to Dr. Yuichi Shionoya who

has reviewed the material extensively for the last year’s edition.

Also we would

like to thank the International Affairs Division of the Ministry of Health, Laborand Welfare.

We invite comments and suggestions to be reflected in future editions of thispublication.

Please send all comments to below or by e-mail: somuka@ipss.go.jp

PUBLISHED BY NATIONAL INSTITUTE OF POPULATION AND
SOCIAL SECURITY RESEARCH
2-2-3 Uchisaiwai-cho, Chiyoda-ku, Tokyo 100-0011 JAPAN
Tel: 03-3595-2984 (Direct)
国立社会保障・人口問題研究所〒100-0011

東京都千代田区内幸町２―２−３日比谷国際ビル６階

Tel: 03-5253-1111(厚生労働省代表) 03-3591-2984 (総務課)
URL: http://www.ipss.go.jp

March 2001

(071101)