## ☑ Major social security reform topics

## I Children and child rearing

- Quantitative improvement of childcare according to regional circumstances as a result of establishing a new system for children and child-rearing, as well as functional enhancement that will include unification of kindergartens and nursery schools

• Less waiting lists, realization of high-quality school education and childcare, expansion of clubs for after school activities for children, and improved social nursing

• Encouragement of various business entities to enter into services that will include childcare, more effective use of existing facilities, and unification of implementation systems

## I I Medical and nursing care

- A more efficient and prioritized system will be created in providing medical and nursing care services according to regional circumstances, and of enhanced functionality. Systematic reworking of remuneration for medical treatment and nursing care services will therefore take place, as well as comprehensive legislation for developing the infrastructure thereof.

- Functional specialization and enhancement of hospitals and beds, correction of the uneven distribution of doctors in different regions and departments, enhancement of preventive measures, improved medical care at home, the creation of comprehensive regional care systems, functional enhancement of care management, improved residential services, unitization of facilities, and the additional manpower required for prioritization

• Reduction in average length of hospitalization, normalization of outpatients, and reduction of duplicate treatment, duplicate examinations, or overdosing via utilization of ICT

- Prioritized benefits and enhanced functionality of the medical and long-term care insurance systems as a safety net via enhancing the functionality of the insurer

a) Wider applicability of employees' insurance and a more stable and stronger financial infrastructure for National Health Insurance and from a wider range of sources

• Broader application of employees' insurance to include short-time workers, and fiscal integration of municipal National Health Insurance into prefectural units that will result in a stronger financial infrastructure

b) Long-term care insurance will focus more on the principle of the burden being in accordance with the defrayal capacity, care for low-incomes, and prioritized insurance benefits

• Further reduction of the insurance premiums of primary insured persons to be paid by low-income earners

• Introduction of a long-term care levy in proportion to total amounts of wages, and prioritized benefits for treatment effective in preventing any aggravation

c) Measures for advanced and long-term medical care (enhanced safety-net functionality) and prioritized benefits

• Reduction of the burden via reconsideration of expensive medical care expenses, coupled with fixed-amount co-payments at the time of medical treatment, which will be implemented in accordance with the size of the reduced burden (normalization of outpatients will also be considered in view of the roles shared by hospitals and/or clinics) with consideration provided to persons with low incomes.

## d) Other

• Total aggregation system and measures for persons with low incomes that involve regressiveness will be considered.

• Further promotion of the use of generic drugs, reconsideration of co-payments for pharmaceuticals, and reconsideration of state subsidies to National Health Insurance associations will all take place.

•Reconsideration of medical care systems for the elderly (such as a more equitable and understandable mechanism for use in sharing the burden between the elderly and young generations, introduction of earnings-based payments for assistance funding, and reconsideration of co-payments) will take place.

## Amount required (public expenses) in 2015

0.7 trillion yen

* Funding of more than 1 trillion yen will be considered in the future, including from sources other than the fundamental tax reform

Amount required (public expenses) in 2015

Up to 0.6 trillion yen

Amount required (public expenses) in 2015

Up to a maximum of 1 trillion yen