N AT I O N A L P O L I C YO R I E N TAT I O N A N D
ARCHITECTURE
KEIZO TAKEMIM E M B E R , H O U S E O F C O U N C I L L O R S , J A PA N
CHAIRMAN, LDP POLICY BOARD IN THE HOUSE OF COUNCILLORSKEIO LONGEVIT Y CLUSTER POLICY DIALOGUE MEETINGO N S AT U R D AY, 1 4 A P R I L . , 2 0 1 8

Changes in Major Policies before introducing
the Long-term Care Insurance SystemAging rate(year)
1960sBeginning of welfare policies
for the elderly

5.7%(1960)

1970s
Expansion of healthcare
expenditures for the elderly

7.1%(1970)

Major policies
1963 Enactment of the Act on Social Welfare Services for the Elderly◇ Intensive care homes for the elderly created◇ Legislation on home helpers for the elderly1973 Free healthcare for the elderly1982 Enactment of the Health and Medical Services Act for the Aged
◇ Adoption of the payment of co-payments for elderly healthcare, etc.

1980s
“Social hospitalization” and“bedridden elderly people”
as social problems

9.1%(1980)

1990s
Promotion of the Gold Plan

12.0%
(1990)

Preparation for adoption ofthe Long-Term Care Insurance
System14.5%(1995)

2000s
Introduction of the Long-TermCare Insurance System

17.3%(2000)

1989 Establishment of the Gold Plan (10-year strategy for the promotion ofhealth and welfare for the elderly)◇ Promotion of the urgent preparation of facilities and in-home welfareservices
1994 Establishment of the New Gold Plan (new 10-year strategy for thepromotion of health and welfare for the elderly)◇ Improvement of in-home long-term care1997 Enactment of the Long-Term Care Insurance Act

2000 Enforcement of the Long-Term Care Insurance System23Asia Human Wellbeing Initiative（AHWIN）

Population aged 65 and over(in million)

1950

2015

2050

56148

1410153

53
9856
44130

331

7195

ASIA

AFRICAEUROPE

N.AMERICALAC

OCEANIA

41

ASIA

AFRICAEUROPE

N.AMERICALAC

OCEANIA

956
146

ASIA

AFRICAEUROPE

N.AMERICALAC

OCEANIA4

Population by Age Group
Asia and Pacific Region Total

54

0.3

0.4

0.5

0.6 0.7

0.8 0.8 0.9 1.0 1.1

1.1 1.1

1.2 1.2

1.2 1.2

0.3

1.2 1.3

Population (billions)

0.2
0.2
0.2

3

0.1
0.10.10.1

2

0.1
0.1
0.1

1

0.8

0.1

0.9

0.1

0.9

1.0

0.7
0.5 0.6 0.6

1.1

1.3

1.5

1.7

0.8 0.9 1.0 1.0

1.9

2.1

2.3

2.8
2.5 2.7

3.0 3.1 3.1 3.2 3.2 3.2 3.1

1.0 1.1 1.1 1.0 1.0 1.0 1.0 1.0 1.0 0.9 0.9 0.9 0.9

3.1 3.065+
3.0 2.92.9 2.8

2.7 2.7

15-64
2.6 2.6

0.8 0.8 0.8 0.8 0.8 0.7 0.7 0.7 0.7

0-14

0.7

1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
2055
2060
2065
2070
2075
2080
2085
2090
2095
2100

Year

Note : Asia and Pacific region includes East, Southeast, and South-Central Asia, and Oceania
Source : United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population
5Prospects: The 2015 Revision (DVD edition).

Dependency ratioof selected Asia and Pacific economies
110

Dependency ratio = Pop. aged 0–14 + 65～Pop. aged 15–64

100

AFPPD

90

China
India

80

Indonesia
Japan

70

Philippines
60

VietnamThailand50

South Korea
Kazakhstan

40
301950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100

Source : United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population
6Prospects: The 2015 Revision (DVD edition).

Speed of aging—Years required for aging rate to rise from 7% to 14%
France1864

115

Sweden

1887

1979
85

United Kingdom

1972

1929

46

1975

Australia

1939

Hungary

1941

United States

1942

72

Canada

1945

65

Spain

1947

Japan

73
53

1970

Sri Lanka

Projection

China

2014
2010
1992

24

1994

1994

South Korea

Thailand1994

45

Kazakhstan

Singapore

2012

60

1999

18

2017

1999

20

2019

2002

2020222002

232025

2007

Vietnam

2054

20

2016

2027
182034

India

2023

282051Indonesia

2025

252050

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 the right 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 : Hungary by Kinsella and Wan He (2009); Kazakhstan, Vietnam, India, and Indonesia calculated using UN (2015) and others by IPSS (2016) 7The １st impact ofaging

GROWING DANGER OFNON-COMMUNICABLE DISEASES

9Aging and Cancer in Asia

Source : WHO International Agency for Research on Cancer

10Cases & Proposals: Future Vision of Cancer Genomic Medicine Promotion in Japan
Cancer Genomic Medicine Promotion Consortium

Medicalsocieties, etc.

Regulator
yagencies•••

Liaison Council
Scientific assessments of cancer genomic medicine from a third party’s perspective
Decision of directions based on assessments and submittal of proposals to MHLW
Opinion gathering from the public and activities for diffusing cancer genomic medicine(4) R&D Organization such asuniversities• Strategic development andpromotion of liquid biopsies*1,effective immune therapies*2and others(2) Organization to manage information related to cancer
genomic medicine (National Cancer Center)）•Standardization, collection and management of data•
Conclusion of contracts with medical institutions, R&D
organizations and enterprises•
Management of patients’ data and consultation

Database of genome
analysis information(3) Private entities
engaged in genomicanalysis•

Genomic analysis
assuring high-quality
and efficiency
Outsourcin
g contract

HAiC
Service forestablishingenvironmentfor developingAI*1: Cancer genomic diagnosis using blood insteadof cancer tissue*2: Treatment to attack cancer cells by activating
immune function of living body

Determination offuture direction of
the Consortium

Informationregistration••••

Technical support
Outsourcin
g contract

Quality-assured NGS examination (outsourcingpermitted)
Providing explanations on assay results
Provision of and support for genetic counseling
Referral to and execution of clinical trials
Collection, management and registration ofadequate information on clinical trials

Referral of patients anddelivery of specimen andinformationCollectionandmanagemen
t of data

Information
on clinicaltrials, etc.

(1) Central medical institutions for cancer genomic medicine(designate 10-12 hospitals)•Patients &Public

Sending of results andsupport for diagnosis

Central medical institutions for cancer treatment(about 400 hospitals)(3) Private entities tosupport cancer
genomic medicine
Database ofcancer-related
knowledge

Enterprises, etc.
• Medicine
development• Medical
equipment
development

Schedule for Implementing Cancer Genomic Medicine in Japan

Central medical
institutions forcancer genomicmedicine(designate 1012 hospitals)

Expansion offacilities to adopt
cancer genomic
medicineassaysPosition cancer
genomic medicine(panel assays & wholegenome assays)as anadvanced medicine

Approval of andgain healthinsurancecoverage forgenomic assays

2019 or later

Second half of 2018

First half of 2018

2017

Establish
Select central
Revise basic planrequirements
and propose
medicalfor公募
selectingconcept on central
institutions
facilities
medical
診療報酬上の評価を検討（中医institutions for協）
cancer genomic
Prepare guidance for medical
medicine based onsocieties to review the scope ofthe opinions of thediseases to be subjected to panel
Consortium

Implement a new advanced
medicine using panel assays

Gain healthinsurancecoverage forpanel assays
winning
approval

Implement anewadvanced
medicine

Prepare for
implementing a new
advanced medicine

Positioning
and review
forimplementation ofwholegenome
assaysWin approval
for panelassays ASAP

Center for
managing cancer
genomic
information(National CancerCenter) ）Prepare database of integrating clinical genome
information

Accumulating data on database

Prototyping
Prepare for operation of cancer genomic
information center (includes unification ofclinical information

Launch operation of cancer genomic information
centerPrepare for whole genome analysis

Promotion ofR&D

Cancer genomicinformation
centerWhole genomeanalysis

12

Strategic R&D promotion(Promotion of investigator-initiated clinical trials and advanced medicine, as well as development ofinnovative drugs, effective immune therapies, liquid biopsies and others)

The 2nd impact ofaging
SUSTAINABILITY OF MEDICAL CARE

Proportion of population 60 years or overliving independently, alone or with spouseMale(%)

Female(%)

Germany

91.5

88.7

USA76.8

73.8

Japan

51.5

46.9

China39.734.1

Vietnam

29.8

26.8

Indonesia

24.1

24.1

Thailand

21.3

16.8

India

17.3

15.8

Sources: Japan data based on 2010 Population Census; all other data based on United Nations, DESA, Population Division,
14“Population Ageing and Development 2012.”

Health and welfare services for elderly in Japan—
Impact of introduction of Long-Term Care Insurance System (2000)
Place of deathYear

Hospital

ClinicSenior citizen
healthfacilities

NursinghomesHome

1951

9.1

2.6

--

82.5

1970

32.9

4.5

--

56.6

1990

71.6

3.4

0.0

-

21.7

2009

78.4

2.4

1.1

3.2

12.4

Number of nursing homes
Year

Number offacilities

Change

1990

2,260

2000

4,463+2,203

2011

6,254+1,791

3,994 nursing homes were newly
established in a period of 20 years.
There was a 277% increase infacilities.
15

Trends and the Future Prospects of Long-Term Care Benefits and Premiums○ The municipal governments formulate a Long-term Care Insurance Service Plan, which designates 3 years as one term and is reviewed every 3 years.
○ As ageing proceeds, premiums estimated to rise to 6,771 yen in 2020 and 8,165 yen in 2025. In order to maintain sustainability of the long-term careinsurance system, it would be necessary to establish Integrated Community Care System, and to make services more focused and efficient.

The sixthphase

The fifthphase

Thefourthphase

The thirdphaseThesecondphase

The firstphase

Operation period
FY２０００
FY２００１
FY２００２
FY２００３
FY２００４
FY２００５
FY２００６
FY２００７
FY２００８
FY２００９
FY２０１０
FY２０１１
FY２０１２
FY２０１３
FY２０１４
FY２０１５
FY２０１６
FY２０１７
FY２０２０FY２０２５Benefits（Total Cost）
3.6 trillion
4.6 trillion

5.2 trillion

Insurance premiums(national average per month)

2,911yen

5.7trillion
6.2 trillon
6.4 trillion

3,293yen

6.4 trillion
6.7 trillion
6.9 trillion

4,090yen

7.4 trillion
7.8 trillion
8.2 trillion
8.9 trillion
9.4 trillion
10.0 trillion

10.1 trillion

4,160yen
4,972yen
5,514yen
6,771yen
8,165yenEstablishing ‘Integrated Community Care System’○By 2025 when the baby boomers will become age 75 and above, a structure called ‘Integrated Community Care System’ will be created thatcomprehensively ensures the provision of health care, nursing care, prevention, housing, and livelihood support. By this, the elderly could live
the remainder of their lives in their own ways in environments familiar to them, even if they become heavily in need for long term care.
○As the number of elderly people with dementia is expected to rise, creation of Integrated Community Care System is important to support
community life of the elderly with dementia.
○The progression status will have regional differences; large cities with stable total population and rapidly growing population of over 75, andtowns and villages with decrease of total population but gradual increase of population over 75.
○It is necessary for the municipalities and prefectures that serve as insurers to create Integrated Community Care System based on theregional autonomy and independence.

.

In case of illness:

Health Care

Integrated Community Care System Model When care becomes
necessary...

Nursing Care

Hospitals:
Acutephase, recoveryphase,chronicphase

Outpatient/ inpatientcare

Regularhealthcare:
・PCP, clinics with in-patient facilities
・Regional affiliate hospitals

Visits / Moving in・Dental care, pharmacies

Home Community GeneralSupport Center Care manager
Handlesconsultationand service
coordination.

 One’sown residence Seniorresidencesofferingservices,etc.

Livelihoodsupport/preventinglong-termcare
Sothatseniorscan continueactive,healthyliving

 In-homeservices:
・Home-VisitLong-TermCare,Home-VisitNursing,OutpatientDayLong-TermCare・Multifunctional(Long-TermCareina)SmallGroupHome
・Short-TermAdmissionforDailyLifeLong-TermCare・EquipmentforLong-TermCarecoveredbyPublicAid・24-hourHome-VisitService
・CombinedMultipleService(MultifunctionalLong-Term
CareinaSmallGroupHome＋Home-VisitNursing)■Facility/Residenceservices: Nursingcarehomes
 Geriatrichealthservicesfacilities
 Communal-livingcarefor
dementiapatients
 Livingcareforpersonsat
government-designatedfacilities
etc.

■PreventiveLong-TermCareServices* Integrated Community Care System isconceived in units of every-day living areas(specifically equivalent to district divisions forjunior high-schools) in which necessary
services can be provided withinapproximately 30 minutes.

17
Senior clubs, residents’ associations, volunteer groups, NPOs, etc.

The 3rd impact of aging

AGING POOR

Recipients of Public Assistanceby Age1,000,000
967,552

65 yrs and older

900,000

45.5%

800,000700,000
600,000
500,000
400,000

０～１９

５０～５９300,000

271,896

４０～４９265,846
231,119

３０～３９200,000

213,982

６０～６４117,581

100,000
２０～２９59,865

01995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Source: Ministry of Health, Labour and Welfare “National Survey on Public Assistance Recipients”

19The 4th impact of aging
SHORTAGE OF CARE WORKERSAsia Health and Wellbeing Initiative（‘AHWIN’）〇‘AHWIN’ aims to amass bilateral and regional cooperation,business and projects on aging-related challenges in the Asian region.
〇The goal of the initiative is to create a vibrant and healthy society where people can enjoy
long and productive lives, and to contribute to the economic growth.

Training for professional
elderly care service such as
Functional Recovery Care

Asia

Building economic ties amongindustries related to elderly care

Career Development

Japan
Training

Enrichment of human resources for
professional elderly care service
such as Functional Recovery CareFirst approach image suggested by Japan

22

Asia Health and Wellbeing体制（案）Initiative Promotion System in JapanPRIVATE SECTOR

COORDINATION
Keizo Takemi
Chair, Special Committee on International
Health Strategy, LDP

Private Sector ConsortiumofAsia Health and Wellbeing Initiative［Chair］ Shuichi Nakamura

Hiroto Izumi
Chair, Asia Health and Wellbeing
Initiative Promotion Council

Shuichi Nakamura
Chair, Private Sector Consortium(Chairman, Medical Care and Welfare
Policy Research Forum)

Minister of ‘MHLW’
Policy dialogue and dissemination

Working groups

Japan Center for international Exchange

Review of systems of care and services in Japan

Special Committee on International HealthStrategy, Liberal Democratic Party of Japan

LDP［Chair］ Keizo Takemi
Asia Health and Wellbeing Initiative
Promotion Council (WG)

GOVERNMENT OF JAPAN［Chair］ Hiroto Izumi
Office of Healthcare Policy, Cabinet Secretariat［Members］
Ministry of Justice (MOJ)
Ministry of Finance (MOF)
Ministry of Foreign Affairs (MOFA)
Ministry of Economy, Trade and Industry (METI)
Ministry of Health, Labour and Welfare (MHLW)
Ministry of Agriculture, Forestry and Fishery (MAFF)
Ministry of Land, Infrastructure, Transport andTourism (MLIT)
Ministry of Education, Culture, Sports, Science andTechnology (MEXT)

Training and movement of elderly care workers
Building economic ties among industries related to elderly care industryEconomic Research Institute for
ASEAN and East Asia (ERIA)

INTERNATIONALORGANIZATIONＷＨＯ
Kobe Centre23

Councils and Working groups for Asia Health and Human Well-Being Initiative

Councils
Information dissemination
Policy dialogues

Conceptualization ofElderly Care in Japan Working Groups

Development of teaching andtraining method Working Groups

Government support foroverseas market cultivation Working Groups

Support for overseas
business development

Organization and Management for
Rehabilitation① Human resource development in Asia

①Development methods for Needs② analysis, Care and evaluation② Support for the livelihoods of foreignworkers② Large-scale projects(Clark Green City Project )①③ Medical cooperation for Care Services
for Independent Living for Elderly④ New technology, Robot and ICT③ Networking in Asia
④ Home Care

⑤ Private Service provider⑥ Dementia

23

United Nation
The High-level Commission on Health Employment and Economic Growth
Recommendations of the Commission
1. Job creation
2. Gender equality and rights
3. Educations, training and competencies
4. Health service delivery and organization
5. Technology
6. Crises and humanitarian settings
7. Financing and fiscal space
8. Partnership and cooperation
9. International Migration
10. Data, Information and Accountability2