75: International Perspectives in Geriatric Care

Geriatric Care in Japan

Sandra Y. Moody, MD, BSN, AGSF &Miwako Honda, MD

Japan has the highest life expectancy, at nearly 87 years, and faces the most rapidly aging society in the developed world. This likely has been achieved through a convergence of several factors, but most importantly a decline in infant mortality since the 1920s, an economy that grew rapidly over 2–3 decades beginning in the late 1950s, and the introduction of universal health insurance coverage in 1961, which allowed equal access to health care across the population. Commensurate with the growing proportion of older adults in Japan, the total fertility rate has decreased drastically, and continues to do so, leading to a crossover effect—a rapid growth in the proportion of older adults, with a declining proportion of younger people.

The proportion of adults age 65 years and older has grown substantially from 4.9% in 1950 to 22.7% in 2010. As of March 2012, Japan’s total population was estimated to be 127,650,000, with approximately 29,487,150 individuals who were age 65 or older. Furthermore, it is estimated that by 2050, a full 40% of Japan’s population will be age 65 years and older. Assuming Japan’s total population will decrease during the next 50 years, by 2060, nearly 41 million individuals (40.5% of the population) will be age 65 years or older.

In addition to having the longest life expectancy, Japan also has been noted to have the best healthy life expectancy in the world as of 2007, which is partly attributed to a national health insurance plan that encourages annual health checks and preventative care. For example, on average, Japanese men live in a healthy state for 73 years and women for 78 years. These successes put Japan in a position to serve as a model to other nations as they address similar aging-related issues, including the United States.

Challenges of an Aging Society

Japan faces several challenges given its aging society. These challenges include: (a) how to continue to support and maintain its national health insurance system, and (b) how to prepare a health care workforce that can care for a society that is aging rapidly.

Health Care Expenditure in Japan

Japan’s national health insurance is a social insurance plan to which all citizens must contribute. Broadly speaking, the health care payment structure consists of insurance premiums and state subsidies. According to the KEMPOREN (the National Federation of Health Insurance Societies), for those who are fully employed, insurance premiums are drawn from their “monthly salary, bonuses, allowances, and all other forms of compensation for work received by the insured person from the employer.” ...