Nursing care debate heats up in Japan

Main Category: Nursing / Midwifery
Article Date: 18 May 2004 - 0:00 PDT

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Debates over a Japanese government proposal to expand the age range of payers of public nursing care insurance premiums have begun, with an eye to planned reforms of the scheme to be implemented in fiscal 2006.

The Japanese Health, Labor and Welfare Ministry has proposed the integration of nursing care insurance with welfare schemes for the handicapped, in addition to expanding the age range of premium payers to all citizens aged 20 and above. But the merits of the plan have been debated, with some questioning an increase in the burden on the public.

"When people are discussing how to have nursing care services supported by the whole of society, it's contradictory to set uniform ages (to pay premiums and receive benefits)," said Keiko Hanai, deputy head of the welfare bureau of the Japanese Trade Union Confederation (Rengo).

"Younger generations won't be happy if they're required to shoulder the burden of nursing care insurance, which isn't beneficial for working generations, in addition to the burden of pension premiums," said Hironori Yano, senior director of the Japan Business Federation (Nippon Keidanren).

In discussions by the ministry's Social Security Council's nursing care insurance subpanel, which have been held since late April, the debate over expanding the age range of premium payers has been deadlocked.

Under the current system, nursing care insurance premiums are collected from those aged 40 or older, and those aged 65 or above in principle can receive the service.

However, a steep increase in the number of people talking advantage of the system--in parallel with the system's implementation--has thrown the scheme's finances into disarray. The government faces the urgent task of securing new sources of funds for the system.

Welfare services for the disabled, which are financed by taxpayers' money, are in a similar state.

A new system that started in April last year in which physically and mentally handicapped people can access various welfare services financed by state coffers, has already run short of funds.

Another under age 65 problem that has surfaced is that those suffering terminal cancer and other serious chronic diseases cannot receive the services as they are not covered by either scheme.

As a result, many ministry officials believe that the two schemes should be integrated into a single one that would cover people in need of nursing care or welfare services for the handicapped, while expanding the age range of premium payers to those aged 20 or older.

A senior ministry official said, "It should be a system in which everyone can receive the necessary service, regardless of age and handicap."

Though the ministry aimed to start debates over the issue in March, the discussions have been stalled partly because of the confusion over public pension reforms.

Local governments and other concerned entities also are divided over the issue.

Concerning the integration of nursing care insurance and services for the handicapped, the Tokyo metropolitan government has urged the ministry to speed up the discussions.

The metropolitan government also urged the ministry to ensure that the debates over the issues proceed according to a clear schedule and with sufficient preparations.

But the Japan Association of City Mayors asked the government to consider the issue "very carefully" in its letter of opinion in mid-April.

At a meeting of 20 mayors in the association, 16 voiced cautious views toward the proposal, with only four supporting the plan. The reasons they gave were that:

-- Expanding the age range of premium payers would increase the number of people in arrears on their pension premiums.

-- A nationwide, uniform insurance scheme is not suitable for welfare services for the handicapped, which widely differ among localities.

Manami Hayashi and Takeharu Yasuda Yomiuri Shimbun Staff Writers
From: http://www.yomiuri.co.jp