HEALTH & WELFARE

REFORMING THE SOCIAL SECURITY
SYSTEM TO CREATEFAIRNESS AMONG
GENERATIONS“Social Security Reform for All Generations” to contain the increased burden of an aging society
and address the declining birthrate.

The combination of a declining birthrate andan aging population is a major issue in developed
countries. In Japan, where the two trends arose sooner
than elsewhere, social security is an area urgently
in need of reform. While Japan boasts a worldacclaimed system that includes universal healthcare,by which all citizens gain reliable access to medicalcare, the number of the system’s beneficiaries hasgrown in recent years due to the graying of society.
By contrast, the number of contributors to the system
has decreased, thus steadily increasing the burden on
younger generations.
In response to the issue, in December 2020, threemonths after the Suga administration’s inauguration,
the government released its final report on “SocialSecurity Reform for All Generations,” spelling out
reforms that show its determination to address
challenging issues that have thus far proven too
difficult to overcome. By reforming the current
social security structure, under which the benefits
are provided mainly to the elderly, with the working
generation taking on the burden, the government
aims to create a system where people of all generations
support each other equally.
Gakushuin University Professor of Economics
ENDO Hisao, an expert involved in formulating thereform policy, says, “It’s very significant that the final
report clearly demonstrates that the government—
while asking people with the financial wherewithal tobear the burden—is responsible for offering security
to those people who are truly struggling, regardlessof their generation.” The healthcare reforms willraise the patient’s copayment ratio for medical careexpenses borne by seniors of 75 or older, and whoearn above a certain level of income, from the current
10% of the total to 20%, in the aim of reducing theProfessor ENDO Hisao in the facultyof economics at Gakushuin University(Tokyo), and a specialist in social
security and health economics. He has
held various key public positions,including president of the Japan Health
Economics Association, president ofthe National Institute of Populationand Social Security Research, andchairman of the Social Security
Council. Since 2019, he has served asa member of the Council on Social
Security Reform for All Generations.

national medical care expenditures devoted to theelderly.
The reforms will also involve reducing theconcentration of patients at large hospitals, and suchmeasures will help create a system that optimizes
medical resources. As for measures dealing withthe declining birthrate and childcare assistance,
the reforms incorporate a number of actions, suchas expanding insurance coverage include fertility
treatment, establishing more day nurseries andchildcare facilities, and encouraging men to takepaternity leave.
Above all, measures to deal with the declining
birthrate are of great importance, since they form
the basis for not only maintaining the social security
system but also keeping the economy growing.
Professor Endo says, “We absolutely must avoid
producing an atmosphere that may coerce people tohave children. We should continue with policies thatcreate an environment where young people who want
children can fulfill their hopes.” The government’s
assistance in funding fertility treatment has gradually
led to an increase in the number of children born
thereby. According to the Japan Society of Obstetrics
and Gynecology, approximately 6% of all births
nationwide were assisted by in-vitro fertilization in2018.
With the treatment to be covered by insurance, notonly will the financial burden be further reduced, butmore medical institutions will offer fertility treatment,
thus making it more accessible. The resulting benefits
will be numerous, including progress in developing
more effective and safer technology. The policy ofinsurance coverage for fertility treatment symbolizes
the Japanese government’s commitment to fully
supporting young people who want to have and raisechildren.
Professor Endo says, “Two decades from now, thechildren who were born today will be supporting oursociety. Though we need to be patient enough to wait
until we see the outcome of those policies, we must
implement them now.” Having worked out forwardlooking reforms, Japan will continue to review andenhance them while moving ahead to guide thecountry into becoming a truly affluent society in thefuture. 