## Chapter 3: Reviewing the outcome of Japanese social security, with a focus on the universal insurance and universal pension systems

## (1) Improvements in social security to date

• Japan's social security has been expanded, with social insurance in particular.

Pensions and nursing care have shifted from being "private support between family members" to being "what should be shared by the whole of society".

• Universal insurance has reduced the mortality rate and life expectancy has reached the highest level in the world.

• Pension payments have been repeatedly improved, thus improving the economic conditions of elderly households.

• Long-term care insurance provides comprehensive services in the areas of health care, medical, and welfare, which the user can choose from.

## (3) Response to change in social security environment

- Changes in economic conditions and a rapidly aging society have had the impact on social security of payments not always being improved.

- Changes in the industrial structure require a response. Originally, most National Health Insurance and National Pension policyholders were farmers, forestry workers, fishermen, or self-employed. But most National Health Insurance policyholders are now elderly people and hence reconstruction of the system is underway.

- Changes in the disease structure and increasing proportion of elderly people to total deaths necessitate measures such as improved medical care at home.

• Measures also need to be taken according to advances in medical technologies and improved living standards.

## (2) Improvements in the infrastructure used to provide services

• Universal insurance has resulted in the number of medical institutions and their employees having increased.

In particular, the development of private medical institutions has been facilitated via systems that include the "free general practitioner system", "free access", which enables patients to be cared for by any medical institution using just the one insurance certificate, and a "fee-for-service system of remuneration for medical treatment".

However, problems have also arisen that include "social hospitalization" or "a three hour wait for three minutes of medical treatment". In addition, in some areas, although mostly rural, there are not enough doctors, especially pediatricians and obstetricians, to meet demands. These problems are being taken care of via the functional differentiation of medical institutions and then cooperation between them.

• Long-term care insurance has resulted in the number of care workers having increased with the entry of various entities, including joint-stock corporations.

## (4) Insurance premiums and public expenses

• Increased benefits due to improvements and aging have resulted in insurance premiums for the working generation rising due to their increased proportion of the imposed pension and contribution scheme of adjustments between the systems and in order to support medical care for elderly people in the case of medical insurance.

• However, the receipt rate of insurance premiums for National Pension has been gradually decreasing over time.

• Addressing the different financial strengths of the various insurance systems and the policy of preventing increases in insurance premiums will require public expenses to be accordingly expanded. Social security related costs are projected to increase to more than one trillion yen every year in the future.