Eldercare policies in Japan and Scandinavia : aging societies in East and West

Norway's experience? And what can these two models, with very different ideational roots, learn from each other? These are some of the larger themes that this volume addresses. Although this book's subtitle is eldercare in Japan and Scandinavia, in fact it only focuses on Norway, with only a few limited references to one other Scandinavian country, Sweden. Nonetheless, Norway is a good representative of Scandinavia and its other welfare states. There are of course important differences between these states when it comes to the provision of eldercare, but these are by and large outweighed by the commonalities. For example, the centrality of municipalities in providing eldercare in Norway is largely paralled in Sweden, 2 and both stand in contrast to Japan, where the central government's role is more pronounced. The editors and I would like to sincerely thank the Japan Foundation, and especially its intellectual exchange program, for very generous support of the seminar and this project. We would offer special thanks to Kristin Løkke, for her stimulating presentation during the Japan Seminar. Furthermore, we would like to thank Christine Hassenstab, Professors Anne Saetnan and Ola Listhaug of the Department of Political Science and Sociology, NTNU, for valuable comments on several of the early chapter drafts contained in this volume. ## I n t r o d u c t i o n J o h n C r e i g h t o n C a m p b e l l a n d P a r t I L o n g -T e r m C a r e f o r t h e E l d e r ly i n J a pa n a n d N o r way C h a p t e r 1 J a pa n's L o n g -T e r m C a r e I n s u r a n c e S y s t e m J o h n C r e i g h t o n C a m p b e l l Japan's mandatory, public Long-Term Care Insurance (LTCI) program, or Kaigo Hoken, provides care for frail older people in institutional settings or in the community. By world standards it is generous in both its coverage and its benefits. The program is universal. Everyone from age 40 is insured under LTCI and pays premiums. People 65 and over are eligible whatever the cause of their disability, and regardless of income or whether family help is available (a few aged 40-64 with an aging-related condition are eligible as well). Certification is by an objective test (See Chapter 7 by Noriko Kurube in this volume); the threshold is low and few applicants fail-17 percent of the 65+ population has been certified as eligible (far higher than the 11 percent in Germany's somewhat comparable LTCI program). Or specifically, although only 4 percent of "young-old" people aged 65-74 are certified, over 30 percent of the true elderly who are 75 and older have been certified. As for benefits, depending on the extent of disability (with seven levels of need), the program allows from $500 to $3,500 per month for community-based care (with 10 percent paid by most recipients). These benefits are 70-160 percent higher than in Germany at comparable need levels (Germany has no co-pay). The level of services available may be exceeded by some Scandinavian nations and the Netherlands, but is certainly among the highest in the world. Front Matter....Pages i-xi Introduction....Pages 1-5 Front Matter....Pages 7-7 Japan’s Long-Term Care Insurance System....Pages 9-30 Eldercare in Norway: Content, Organization, and Financing the Care System: A Brief History, Current Status, and Future Prospects....Pages 31-48 Front Matter....Pages 49-49 Care Providers in Japan: Before and After the Long-Term Care Insurance....Pages 51-69 Formal Providers of Eldercare in Norway....Pages 71-89 Front Matter....Pages 91-91 Changes in Family and Informal Care in Japan....Pages 93-118 Changes in Family and Informal Care in Norway....Pages 119-156 Front Matter....Pages 157-157 Assessment Instruments and Allocation of Services in Japan....Pages 159-175 Assessment Instrument and the Allocation of Care Services in Norway....Pages 177-195 Front Matter....Pages 197-197 Quality of Care Services in the Japanese System of Long-Term Care....Pages 199-223 Quality of Care Services in Norway....Pages 225-249 Conclusions: The Salience of Eldercare....Pages 251-261 Back Matter....Pages 263-273 These essays by no means cover all areas of interest in long-term care programs, but they offer new insights (and intriguing questions for future research) about how differently policies in this important area can be carried out in different countries.