(Bioethical Public Policy & 1997 Japanese Long-term Care Insurance Law)
1 The law is published in full in Kanpô [Government Gazette], gôgai [Special Issue] No. 251 (17.12.1997), pp. 8-32.
2 See Kaigo hoken-hô, Articles 121-128. The publicly funded share is split into 25% paid by the central government, and 12.5% paid each by the prefectural governments and the municipalities. According to TOCHIMOTO (1997: 126-127), this sharing system is different from the one adopted in Germany.
3 The analysis by HISAZUKA (1997) shows the basic structure of the debate on the Long-term Care Insurance Law. He argues that the step-by-step process of justification and explanation by the Ministry of Health and Welfare for the need of care insurance for the elderly would be an important object of study as it has changed in content, although some continuity remains.
4 See Rôjin fukushi-hô [Law for the Welfare of the Elderly], Chapter II (Fukushi no sochi), Article 10, Section 3 (11.07.1963). A health and welfare activist and member of the House of Representatives, Ms. ISHIGE Eiko, points out the negative notion of sochi and proposes a "Citizen Type of Welfare" as a new model to provide welfare services by conscious citizen's mutual support and participation (ISHIGE 1997: 256-278). By contrast, even though sochi has quite a negative connotation and some bureaucratic, administrative implications, AIZAWA (1996: 79) holds that there have been some cases where the contents of sochi services had been gradually forced to change due to claims made by local people.
5 There are positive elements in this shift from the state to the individual in the sense of solidarity. However, according to some critics, there is the possibility of a decrease in the quality of care for the elderly due to both a lack in human resources for care services and the difficulty of finding standard criteria for evaluating the level of care needs. The model computer evaluation system on which the primary stage standard care evaluation is based, shows a 30% misjudgment or deviation from the results obtained by human judgment. Therefore, many complaints about the evaluation results might be expected in the future. For example, SAKAI (1997), a social worker at one of the Elderly Home-Care Support Centers in Tôkyô, worries about a levelling-down of elderly care as a result of the new insurance law system.
6 See Kôseishô (1997c), no. 2, chapter 4: Kazoku kaigo ni tsuite, (2) genkin kyûfu ni shôkyokuteki-na iken [On Family Care, (2) Negative Opinions Toward Cash Payment for the Care Services]. OKIFUJI (1997: 61, 210) argues that one of the negative impacts of the delay in long-term care policy in Japan is the problem that men do not recognize care issues as men's issues. Today, in 85% of all cases "family care" is provided by women.
7 Concretely, it was decided to include the phrase "policies and other necessary measures to secure the system for providing health and medical services", relating to the responsibility of central and local governments, in Article 5.
8 This amendment has endorsed public participation in reflecting the insured's opinion when the municipalities need to establish or change its Care Insurance Service Plans. The idea of "citizen participation in the care planning process" may be considered as one of the fundamental proposals made by the KSSISI.
