A Comprehensive Analysis of Japan’s Long-Term Care Insurance (Kaigo Hoken) System

1. Introduction: The Genesis and Philosophy of Japan’s LTCI

Launched in April 2000, Japan’s Long-Term Care Insurance (介護保険制度, Kaigo Hoken Seido) system represents a fundamental pillar of the nation’s social security framework. Conceived in response to the country’s rapidly aging population, its primary objective is to provide societal support for elderly individuals requiring care and their families. The system is built upon core principles emphasizing the maintenance of dignity for the elderly, enabling them to live independently for as long as possible (jiritsu shien, 自立支援), and alleviating the burden on family caregivers. This marked a significant paradigm shift, moving away from a model where care was predominantly a private family responsibility (often falling on women) towards a system based on social solidarity and shared responsibility.The concept of “support for independence” (jiritsu shien) is central, focusing not just on assisting with daily tasks but on maximizing the elderly individual’s existing capabilities to maintain and improve their autonomy. Furthermore, the “user-centered” (riyousha hon’i, 利用者本位) principle empowers individuals to choose from a diverse range of health, medical, and welfare services offered by various providers, tailored to their specific needs and preferences. The introduction of the LTCI system was a national response to profound socio-economic shifts, aiming to establish a sustainable care infrastructure. However, it inherently involves navigating the balance between promoting independence and providing necessary support to those certified as needing care or assistance. This balance is constantly evaluated during the eligibility assessment (Chapter 4) and care planning (Chapter 5) processes.