Estimating Expenditure on Long-Term Care (LTC) in Japan SAKAMAKI, Hiroyuki, MBA Institute for Health Economics and policy (IHEP) Tokyo,Japan 10th Oct, 2002, OECD Paris

Presentation Outlines Estimates on Expenditure for LTC Estimation Processes and Issues until 1999 Public Long Term Care Insurance (LTCI) in 2000 Estimation Strategy after 2000 Institute for Health Economics and Policy, Tokyo, Japan

Graying population in Japan 20 40 60 80 100 120 140 1920 1931 1942 1953 1964 1975 1986 1997 2008 2019 2030 2041 2052 2063 2074 2085 2096 65yo- 15-64yo 0-14yo Current （Mio） Population (≧65yo) 4.16 M ( 4.9%) in 1950 21.19M (16.7%) in 1999 33.12M (27.4%) in 2025 Institute for Health Economics and Policy, Tokyo, Japan

Expenditures including for long-term care in Japan until 1999 Expenditure on long-term in-patient nursing care (HC.3.1) -Expenditure for health service facilities for the elderly (HP.2.1) -Estimated expenditure for meal service for inpatients in hospitals for the elderly (HP.1.1) -Estimated expenditure for inpatient care in hospitals for the elderly (HP.1.1) Expenditure on long-term home health care (HC.3.3) -Expenditure for home-visit nursing care for the elderly (HP.1.1) Institute for Health Economics and Policy, Tokyo, Japan

Facility services providing LTC Long term care welfare facilities for the aged [ LTCW ] : special nursing home for the aged Long term care health facilities for the aged [LTCH]: facilities of health care services for the aged Long term care medical treatment facilities [LTCM]: medical treatment beds, beds for treatment of senile dementia, LTC strength building hospital. Institute for Health Economics and Policy, Tokyo, Japan

Expenditure for long-term care in Japan for 1999 Items of Health Data Estimate (Million Yen) % of THE Total expenditure on health (THE) 38,011,356 - Total expenditure on long-term nursing in-patient care 2,908,176 7.7% Total expenditure on long-term home health care 91,400 0.2% Institute for Health Economics and Policy, Tokyo, Japan

Financing of long-term care in Japan for 1999 (Million Yen) Total Public Private Expenditure on health 38,011,356 29,669,720 (78.1%) 8,341,636 (21.9%) Expenditure on long-term in-patient nursing care 2,908,176 2,549,317 (87.7%) 358,859 (12.3%) long-term home health care 91,400 89,100 (97.5%) 2,300 (2.5%) Institute for Health Economics and Policy, Tokyo, Japan

Nursing care facilities Expenditures for long-term care by function of care and provider industry in Japan of 1999 (SHA table 2) (Million Yen) HP.1.1 General Hosp. HP.2.1 Nursing care facilities Total HC.3 Services of long-term nursing care 2,057,493 942,083 2,999,576 HC.3.1 In-patient long-term nursing care 1,966,093 2,908,176 HC.3.2 Day cases of long-term nursing care HC.3.3 Long-term nursing care: home care 91,400

Estimation process (1) Total expenditure on long-term nursing care (HC.3.1) = sum of following 3 items Expenditure for health service facilities for the elderly(HP.2.1) ＝National health expenditure for health facilities for the elderly (Public) + Fee for health facilities for the elderly (private) Estimated expenditure for meal service for inpatients in hospitals for the elderly (HP.1.1) 　=National health expenditure for meal services during hospitalisation related to hospitals × Proportion of the number of working beds for the elderly　to the total number of working beds Estimated expenditure for inpatient care in hospitals for the elderly 　(HP.1.1) =National health expenditure for inpatient care in hospitals for the elderly × Estimated proportion of amount of inpatient care in hospitals for the elderly,　on the basis of official statistics Institute for Health Economics and Policy, Tokyo, Japan

Estimation process (2) Total expenditure on long-term home health care (HC.3.3) = Expenditure for home-visit nursing care for the elderly (HP.1.1) Private expenditure on long-term home health care = total expenditure on long-term health care × patients’ payment about home-visit nursing care for the elderly. Public expenditure on long-term home health care －private expenditure on long-term health care Institute for Health Economics and Policy, Tokyo, Japan

Issues of estimation ●Date source necessary for estimates of expenditure items that conceptually exist are not available. This may cause underestimate. For example, expenditure for day cases of long-term nursing care (HC.3.2) ● Boundary of LTC Persons who need long-term care (NOT health services) were covered by the Medical Insurance due to insufficiency of the Long-term Insurance system before 2000. ●Introducing Long Term Care Insurance System (LTCI) in 2000 Consistency should be needed before/after introducing LTCI. Institute for Health Economics and Policy, Tokyo, Japan

Trend of National Medical Expenditure 50,000 100,000 150,000 200,000 250,000 300,000 350,000 1954 1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 Year 100Mio Yen introduced LTCI Institute for Health Economics and Policy, Tokyo, Japan

Before and after enforcement of LTCI Official statistics about LTCI No available data Data sources Total expenditure for long-term care, defined by SHA National medical expenditure National medical expenditure Institute for Health Economics and Policy, Tokyo, Japan

Public Long Term Care Insurance System (LTCI) ● Established in April 2000. ● Insurer: the municipalities ● Insured: people aged 40 and above ● Eligible: - People aged 65 or older in need of care or support - People aged from 40 to 64 who are participants of medical insurance, in need of care or support due to a disease caused by aging such as; presenile dementia or cerebrovascular disorders, etc Institute for Health Economics and Policy, Tokyo, Japan

Integration of Health and Welfare Welfare for the Aged Medical services for the Aged From gov. budget The municipalities driven Means tested Under Health Insurance Long LoS Not equiped for LTC April 2000 ～ Long term care insurance Social insurance Institute for Health Economics and Policy, Tokyo, Japan

Financing of LTCI Public Expenditure (HF.1.1) ● 2001 budget 4,770 billion yen co-pays 560 billion yen Provision 4,210 billion yen Apart from co-payment of the users. The users pay 10% of the benefit amount.

Estimating Strategy for LTCI Discrimination b/w LTC and Healthcare services by Providers by Function of Services by Degree of Need of LTC Institute for Health Economics and Policy, Tokyo, Japan

Facility services Long term care welfare facilities for the Aged [ LTCW ] (Special Nursing home for the Aged) NA Long term care health facilities for the Aged [LTCH] (Facilities of health care services for the aged) HP2.1 HC3.1 Long term care medical treatment facilities [LTCM] Medical treatment beds Beds for treatment of senile dementia LTC strength building Hospital HP1.1 HC1.1 Institute for Health Economics and Policy, Tokyo, Japan

Benefits　of LTCI Persons requiring long term care or support will receive benefits in the following services. - In-home services - Facility services Institute for Health Economics and Policy, Tokyo, Japan

In-home services Home-visit/ commuting care service Home-visit care (Home help service) HC 3.3 ? HP 3.6? Home-visit bathing services Home-visit nursing HC 3.3 Home-visit rehabilitation Commuting for care (Day services, at day care centres) HC 3.2 Commuting rehabilitation (Day care) Welfare equipment rental service X Short-term stay service Short-term stay at a care facility HC 3.2? Medical care service through a short-term stay Others Daily life care in communal living for the elderly with dimentia Daily life care for residents in a special facility Management guidance for in-home care Allowance for purchasing welfare equipment Allowance for modifying house Institute for Health Economics and Policy, Tokyo, Japan

Degree of Need of LTC Needing Assistance Condition Yen /Month Needing Assistance Not deemed LTC but needing assistance in everyday life 61,500 Needing LTC 1 Needing some LTC 165,800 Needing LTC 2 Needing small degree of LTC 194,800 Needing LTC 3 Needing medium degree of LTC 267,500 Needing LTC 4 Needing large degree of LTC 306,000 Needing LTC 5 Needing highest degree of LTC 358,000 Institute for Health Economics and Policy, Tokyo, Japan

SHA application of LTC LTCM TBD LTCH LTCW Home care Need 5 Need 4 Assi. Increase of medical provision → Intensity of medical need → = Include in HHA Institute for Health Economics and Policy, Tokyo, Japan

Conclusion Pilot Study to estimate LTC will start beginning of 2003, when all relevant data will be published. Institute for Health Economics and Policy, Tokyo, Japan

Japan SHA Team Koki HAYAMIZU Tastuo IHARA Yoshiyuki OZAWA Hiroyuki　SAKAMAKI Manabu　YAMAZAKI Institute for Health Economics and Policy, Tokyo, Japan