November 1, 2022
Tsuyoshi Masuda
President
Japan Federation of Democratic Medical Institutions

The Ministry of Health, Labor and Welfare on October 31 presented to the long-term care insurance subcommittee of the Social Security Council discussion topics related to the “review of benefits and burdens” for the upcoming revision of the long-term care insurance system. Based on the cabinet’s basic policies, the Finance Ministry’s proposal, and the government’s reform schedule, the following points were raised for discussion: criteria for determining income above a certain level and income comparable to working age (users’ burdens); benefits related to life support services for users certified as long-term care levels of 1 and 2; benefits related to care management; charges for multi-bedded rooms; and supplemental benefits.

Regarding users’ burdens, the Welfare Ministry proposes to increase the number of long-term care services users who are required to pay 20% or 30% of the cost by lowering the current standards for determining “income above a certain level” and “income comparable to the current workforce”. Even among users who are currently required to pay 10%, there is no end to cases where economic difficulties prevent them from using necessary services. It is undoubtable that another increase in fees further discourages users to access long-term care services and deteriorates their livelihoods. Our survey has received the following desperate voices: “A service user’s pension is not enough to cover the fee, so the caregiver has to bear the cost. If the fee increases to 20%, we cannot access the service, and the user cannot be cared for at home,” and, “If fees are raised with prices rising and pensions not increasing, our life becomes even more difficult.”

A proposal to incorporate life support services for those certified as long-term care levels of 1 and 2 into “comprehensive services” is expected to reduce the quantity and quality of the services and increase cases where service users will not be able to maintain in-home care. Such difficulties will be concentrated among the elderly with dementia and their families. Dementia accounts for the majority of reasons for certification as long-term care level 1 and 2 and requires professional assistance from the early stages. The proposal is unrealistic as the planning of comprehensive services has not progressed in many municipalities.

In the review of “benefits related to care management,” the ministry proposes to charge users for making care plans. Requiring payments at the “entrance” to long-term care services can prevent a large number of elderly people from accessing the long-term care insurance system as financial difficulties may not allow them to create a care plan or receive consultation support to create one.

Other proposals include: increasing facilities subject to a charge for multi-bedded rooms (not only in special care facilities but in health care facilities for the elderly and long-term care hospitals); further reviewing supplemental benefits (system to reduce costs of housing and meals for households exempt from municipal residential tax). Since asset requirements and food costs for supplemental benefits were revised in August 2021, it has become difficult for facility residents to continue using the facility.

All of these proposals are designed to increase burdens and curtail benefits, imposing further hardship on users and the elderly who are suffering under the covid pandemic and rising prices. It is grave that the proposal to raise the burdens has been made without sufficient verification of whether users and the elderly can afford them. We demand that the proposed “review of burdens and benefits” be withdrawn.

An increase in premiums for high-income earners aged 65 or over was also proposed. The average amount of long-term care insurance premiums for the elderly has more than doubled from 2,911 yen at the start to 6,014 yen at present (8th term). Amid reduced pensions and rising medical costs, burdens for long-term care insurance premiums for the elderly have already reached their limit. Under a system in which long-term care insurance premiums rise in accordance with costs of the benefits, it will become difficult to maintain financial resources. A thorough review of the finances is necessary to curb the rise in insurance premiums. We believe that drastically increasing the proportion of the national government’s contribution and reducing the elderly’s share is essential in order to make sure the premiums are payable and to ensure the sustainability of the system that can meet the increasing demand for long-term care services. We request that the government drastically review the finances (the ratio of public expenses and insurance premiums), rather than taking temporary measures to raise premiums for high-income earners.