Aged society and Japan’s experiences
Mechanism for healthy and vibrant society

Hiroto Izumi, Doctor of Engineering

Special Advisor to the Prime Minister(Director-General of the Office of Healthcare Policy,Cabinet Secretariat, Government of Japan)
April 14th, 2018

Long-Term Changes in Total Population and Estimates of Future Population
 The total population in Japan is expected to return to the level of 100 years ago, in the late Meiji era, by the coming
centennial. It will be an extremely rapid and extraordinary change compared with the past millennium.
(10 thousand（万人） ppl)

(2010)128,060,000 people

13,00012,000(2030)
116,620,000 people
Aging rate: 31.6%

11,00010,0009,000(2050)
97,080,000 people
Aging rate: 38.8%

End of war(1945)
71,990,000 people

8,000
7,000
6,000
5,000
Edo
Muromachi shogunate
Kamakura shogunate establishedshogunate established (1603)
established (1338)
12,270,000 people

4,000
3,000
2,000

Kyoho
Reform(1716
to 1745)s(2100) (high-end estimate)
64,850,000 people

Meiji
Restoration(2100) (moderaterange estimate)
49,590,000 people
Aging rate: 41.1%(1868)
33,300,000 people31,280,000 people(2100) (low-end estimate)
37,950,000 people(1192) 8,180,000 people
7,570,000 people

1,000

（年）
(Year)

0800

1000

1200

1400

1600

1650

1700

1750

1800

1850

1900

1950

2000

2050

2100

Source:Population to 2010: materials prepared by National Spatial Planning and Regional Policy Bureau, Ministry of Land, Infrastructure Transport and Tourism (MLIT) based on the national census resultsby Ministry of Internal Affairs and Communications (MIC) and the analysis of long-term chronological population distribution data in the Japanese islands (1974) by National Land Agency
The population thereafter: the materials prepared by National Spatial Planning and Regional Policy Bureau, MLIT based on Population Projection for Japan by National Institute of Population andSocial Security Research (estimated in January 2012)1

Comparison between medical costs, self-pay burdens, and premiums per capita
by age group (public medical insurance) (annually)(Estimated values based on the performance in 2014)(x 10,000 140yen)

Medical

医療費
costs

120Premium
保険料

Self-pay
自己負担burden

116.7 117.1
103.1

100

109.3

92.3
77.7

80

61.9

60

45.4
36.0

Medicalcosts

40
20

22.7
12.3 9.2

7.2

2.2

3.6

Self-pay burden
and premium

0

3.7

2.8

60

27.8

11.8

2040

7.4

13.9 17.2
9.4 11.0 12.3

21.9

23.3
21.9 25.9
28.9 32.4 35.8 38.5 38.0 30.3
Self-pay
自己負担
内訳 burden
Breakdown
保険料
Premium
0～4

5～9

1.7
1.9

1.7
10.0

2.2
19.8

2.5
23.4

2.8
26.1

3.2
29.2

3.9
31.9

4.9
33.6

6.1
31.9

7.6
22.7

9.1
14.2

18.5

13.9 14.3 14.6 13.2 12.5 12.0

7.5
11.0

6.4
7.5

7.4
6.9

8.0
6.6

8.1
5.1

8.4
4.0

8.5
3.5

10～14 15～19 20～24 25～29 30～34 35～39 40～44 45～49 50～54 55～59 60～64 65～69 70～74 75～79 80～84 85～89 90～94 95～99 100～2

Estimates for Future Social Security Expenses
 Outlook of benefit expenses

Benefit expenses will increase from 109.5 trillion yen (22.8% of GDP) in FY2012 to148.9 trillion yen (24.4% of GDP) in FY2025.

(Trillion yen)

160
140
120
100
8060

Simulation based on
current situation
109.5(22.8%)

8.4
35.1

40
20053.8
FY2012<<¥479.6 trillion>>

118.7(23.3%)

After reforms
119.8(23.5%)

10.539.5131.8(23.6%)

134.4(24.1%)

14.9
46.9

144.8(23.7%)

148.9(24.4%)

19.8
54.0

OtherChild rearing

Long-term careRef.) Budget sizeof Japan:¥96.3 trillion inHealthcare
FY 2015
Social Security:¥31.5trillion

56.5
FY2015<<¥509.8 trillion>>

58.5
FY2020<<¥558.0 trillion>>

60.4

FY2025<<¥610.6 trillion>>

PensionRatio of thesocial security
against the policy
expenses(*):55.0%(*) Budget excluding government debt
expenses and local allocation tax subsidies

Note 1: This outlook takes into account concrete measures, processes, and estimates expenses for social security reforms and reflects the effects of fulfillment, concentration, andan increase in efficiency.
Note 2:The above figures for child rearing include the expenses of nursery schools, kindergartens, overtime childcare, community childcare support centers, temporary childcare,cash benefits for children, childcare leave benefits, benefits for delivery, social care, and prenatal checkups provided that new systems should be carried out.
Note 3: The figures in parentheses “( )” represent the ratios against GDP. The figures in double-parentheses “<<>>” represent the amount of GDP.

3

Years Required for Aging Rate to Rise from 7% to 14%
France1865

115

Sweden

1890

1980
85

Australia

1975

1938

73

2011

United States

1944

69

Canada1944

65

Hungary

1941

Spain

1947

United Kingdom

1930

Japan

Thailand

45

1992

1970

24

1994

1994

60

2000

Projection

Sri Lanka

1994
1975

China
South Korea

2009

53
45

Kazakhstan
Singapore

2013

Vietnam

26

2054
2026

2000

19

2019

2000

18

2018

2002

24

2026

2002

22

2024

2016

18

2034

India

2023

28

2051

Indonesia

2025

25

2050

1850

1900

1950
Year

2000

2050

Note : The year to the left of the bar designates the year in which the percentage of the population aged 65 and above (aging rate) reached 7%; the number to theright of the bar designates the year when the aging rate attained 14%. The number on the bar designates the years required for that increase.
Source : Kinsella and Wan He (2009); Kazakhstan, Vietnam, India, and Indonesia calculated using UN (2015).
4

Basic structure for sustainable growth – The fundamental idea –The lost twenty years in JapanWhy did Japan lose international competitiveness andsuffer from an economic slump?
High corporate tax￥

Strong yen
Increased electricitycostIn reality thefundamental
factors are:Super-aging society with fewer children/society with a falling birth rate

Labor regulations
Restrictions onenergy/environment

EPA...

Delay in the agreement ofEPA(Economic PartnershipAgreement), etc.

Shortage of labor
Decreasing demand5Basic structure for sustainable growth – Supply side –Supply side1) Improvement of productivity (TFP) by innovations (Total Factor Productivity - TFP)
2) Promotion of capital investment＋ Absorb overseas demand3) Securing labor power (quantity, quality, and efficient utilization)
Ensure immediate effects and easily gain a nationalconsensus.

＋Quantity
More children〇The most important
but lacks immediate
effectivity

Foreign workers〇 Takes time to reachconsensus
onsomeissues such as developing
the environment to accept
foreign workers

Social participation bywomenWorking elderly〇Elderly in Japan are more eager to〇Labor force percentage of women work than those in Europe andfor 2016: 68.1% (the highest ever)America. The percentage of people※Plan to Accelerate the Elimination aged 65 or more to the whole laborof Childcare waiting lists.
force for 2016 is 11.8%, and the→Expand the capacity of childcare number of those elderly is expected
to 500,000 by 2017
to reach 7.7 million.

Infrastructure that allows as many nationals as possible to enjoy a society
with health and longevity, to continue to work if they wish, to participate in society,and to proudly lead meaningful lives

Quality

Essentially healthy

A revolution in human resources developmentex.) Recurrent education

Efficientutilization

Reforms regarding work style (Dynamic Engagement of All Citizens)ex.) Labor regulation reform6Average life expectancy and healthy life expectancy
Healthy life expectancy: period with no limitations for activities of daily living (ADL)

Males2010

2016

79.55
70.42

9.13 years

80.98
72.14

8.84 years

Females
2010

2016

Sources:- Average life expectancy:
Complete Life Table 2010, Ministry of Health, Labour and Welfare (MHLW)
Abridged Life Table 2016, MHLW
- Healthy life expectancy:
Abridged Life Table 2010/ 2016, MHLW
Vital Statistics of Japan 2010 / 2016, MHLW
Comprehensive Survey of Living Conditions 2010 / 2016, MHLW
Population Projection for Japan 2010 / 2016, MIC

86.30
73.62

12.68 years

87.14
74.79
Average life expectancy

12.35 years

healthy life expectancy* Goal of Health Japan 21 (the second project): to extend the healthy life expectancy to exceed the increase in the average life expectancy (FY2022)
Goal of Japan Revitalization Strategy and Healthcare Policy: to extend the healthy life expectancy nationally by at least one year by 2020 (FY2020)The healthy life expectancy in 2016 was 72.14 years for males and 74.79 years for females.
The healthy life expectancy was extended by 1.72 years in males and 1.17 years for females, compared with 2010.
The period with limitations for ADL was shortened by 0.29 years for males and 0.33 years for females, compared with 2010.
7Future Prospects
As The Japan Gerontological Society and Geriatrics Society propose to change the definition of“the elderly” from people aged 65 and older to people aged 75 and older, the rejuvenation of thebodily functions of the elderly and the extension of healthy life are important aspects.
Historical changes in total points of aphysical strength test

Thousandpeople40,000Elderly population (Five-year age group)

35,00030,00025,000【people over 75 years of age】
23.85 million (Approx. 25%)
(As of 2050 year)

20,000

It is expected that around 2020, thephysical strength of those aged 76-79
will improve to the level of physicalstrength of those aged 66-69 in 1998.

15,00010,000【people over 65 years of age】

29.45 million (Approx. 23%)
(As of 2010 year)

5,000
Male

Male

Male

FemaleFemaleFemale【people over 80 years of age】
15.99 million(As of 2050 year)

02010年 2015年 2020年 2025年 2030年 2035年 2040年 2045年 2050年
65～69歳

70～74歳

75～79歳

80～84歳85～89歳90歳～（Source）Made by Ministry of Land, Infrastructure, and Transportation
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

（Source）Japan Sports Agency
The result summary of the physical strength/exercise ability test in FY 2015

8

Change in the number of employed people by age groupand employment rates in major countries
The numbers of employed(x 10,000 people) people by age group
7,000
6,298
6,000

5,000

6,293

6,280

6,326

6,371

6,401

6,530

6,465

Over 65 62 (%)
years old55-64
years old561134(17.4)

1227(19.5)

58.560.4
59.7
58.4

58.0

58.2

56.6
55.3

54

45-54
years old
4,000

5852

Germany1489(22.8)

France

51.5

50
2010

1135-44years old
561458(22.3)

2,000

54519(7.9)

2010111213141516Reference) 1. Prepared from the Ministry of Internal Affairs and Communications,“Workforce survey” and OECD.stat.
2. Inside ( ) is the proportion of each age group of employed people.

17(Year)15-24
years old

14

15

16(Year)

55.2

UK

54.1

53.6

53.5
52

1124
(17.2)

492(7.8)

13U.S.
25-34
years old1247
(19.8)

12Employment rates in majorcountries (women)

(%)

1472
(23.4)

0Japan50.6
1291(20.5)

3,000

1,000

UK

U.S.

60

807
(12.4)

570(9.1)

Employment rates in majorcountries

52.8

50
48

46

49.7

46.8

Japan

Germany

48.9

France

46.8

46.3
2010

2011

2012

2013

2014

2015
2016
(Year)

9

Comprehensive healthcare industries contributing to healthy and vibrant society

Medical care
Treatment
after illness

Disease prevention andindividualized medical caree.g.) Genome diagnosis

Elderly care
Providingpersonal care

Supporting the independenceof elderly people

Prevention― Meal, exercise, etc. ―Healthy life

― Housing, society development, etc. ―10Current Situation

Desirable Direction regarding Medical & Elderly Care in Japan
ElderlyCare

MedicalHospital /Elderly Care
Facility

Intensive
Elderly Care

Rehabilitation（Recovery）（Recovery）

Home

Desirable Direction

Specialist

Long-term care Service
Demand-Supply Gaps

Functional
Recovery
Care

Functional
RecoveryCare（Recovery）

Physical Therapist, Occupational Therapist,
MedicalSpeech Therapist(Doctor, Nurse)

Hospital/
Elderly Care
Facility

MedicalCare Worker

Elderly Care
Rehabilitation

Intensive
Elderly Care
Functional
Recovery
Care

Disease Prevention（Recovery）

Frailty Prevention

Functional
RecoveryCare（Recovery）（Recovery）

Increase ofpersons living
at homeHome11

CASE: An 86yr-Old-Female, Who Has Experienced Cerebral Infarction
Jan 2016

Feb 12

 Taken to hospital
after found lying
at home fromsuffering stroke(Cerebralinfarction)

 PEG tube isinserted(Percutaneousendoscopicgastrostomy)

Feb 20April 9Oct. 2016

 Undergone
 Enter a homeOperation(Inguinal hernia)

Long-term Care Level： 5
Diagnosis:
 Hemiparesis
 Impossible toIntentionally communicate
 Tube feeding (PEG) Requiring complete assistance(Bedridden, use of diapers)

ApplicationofFRCEP

Diagnosis:
 All Bowel movement at Toilet
 Meals are served as Regular diet
 Walking with a use of circle walker

Long-term Care Level： 3*details on next slide

BEFORE

AFTER
12

Transition of Certified Rates of Cases Requiring Long-Term Care(requiring assistance) in Wako City, Saitama Prefecture This is an example of community approach which includes functional recovery care.
 Wako city in Saitama prefecture, Japan is implementing functional recovery care on community basis.
 They achieved lower ratio of population certified as being in need of elderly care than national average.
Ratio of population certified as
being in need of elderly care

JapanSaitamaWako

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Reference: Fifth period project plan of long-term care insurance in Wako-city

13The overview of the Act on Promotion of Healthcare Policy
Purpose of the Act: to contribute to the formation of a society with health and longevity through R&D that
can help to provide the world’s highest level of healthcare

Headquarters for Healthcare Policy
Healthcare Policy (Cabinet decision)(1) R&D in a medical field, arrangement of the environment, and sharing the outcome(2) Creating/activating new industrial activities that can contribute to the formation of asociety of health and longevity (e.g., international expansion) and the arrangement of theenvironment

Plan to promote R&D in the medical field (decided by Headquarters)

Japan Agency for Medical
Research and Development（AMED）
14

Asia Health and Wellbeing Initiative (AHWIN)
Target Contributing to Goal 3 of SDGs, achievement of Universal Health Coverage (UHC) Promoting comprehensive healthcare industries in Asia including society development enabling healthy life as well as medical care toachieve UHC and realize healthy and vibrant society
 Minimizing the needs of medical / elderly care and enriching necessary healthcare services
 Establishing Asia's framework for self-sufficiency and management of medical care through sharing Japan's knowledge / experiences andpromoting global activities of Japanese companies, etc.
 Realizing data-based next generation medical care in Asia and sharing Japan’s experiences of the next generation medical foundation act< Comprehensive healthcare industries contributing to healthy and vibrant society >Medical care
Elderly care

― Functional recovery care ―Prevention― Meal, exercise, etc. ―Healthy life

― Housing, society development, etc. ―Asia
 Development of healthcare services through commitment ofJapanese industries
 Skilled medical personnel and care workers trained in JapanE.g.) Development of manufacturing infrastructure for medicines with global quality

Building economic ties among
healthcare related industriesJapan Accumulating technologies and experiences of healthcare field Enriching human resources for professional health care services
 Promoting global activities of Japanese industriesE.g.) Human resouce development

15Thank you for your attention