Shuffling the books on nursing care

The health and welfare ministry is considering cutting nursing care insurance costs by shifting elderly people who do not need intensive nursing care from care services provided under the insurance system to care services provided by municipalities.

Because local governments’ financial conditions vary from municipality to municipality, such a change could introduce inequality into the level of services offered to elderly people.

To receive services under the nursing care insurance system, people must take tests to receive certification that they need care. Those who are approved are classified into one of seven categories in ascending order from the least to the greatest need of care.

Each category has a limit on available services calculated in terms of cost. Within the limit, insured people have to shoulder 10 percent of the cost. Beyond that limit, they must pay all costs.

Under the ministry’s new plan, services from the insurance system would be ended for people classified in the lowest two categories. Instead, municipalities would provide services to them.

As of December 2012, some 1.5 million people fell into those categories, accounting for more than a quarter of all elderly people recognized as having need of care. Helpers mainly assist with housekeeping, shopping and cooking. The costs of these services amount to about 5 percent of the total costs of the services provided under the nursing care insurance system. Total costs have been on the increase from the initial ¥3.6 trillion in fiscal 2000 to ¥7.8 trillion in fiscal 2010 and to ¥8.9 trillion in fiscal 2012. They will likely reach ¥21 trillion in fiscal 2025 when most postwar baby boomers are at least 75 years old.

Unless premiums for the insurance system are raised, more tax money will need to be injected into the system. The average monthly premium paid by people aged 65 and up was about ¥2,900 in fiscal 2000. In fiscal 2013, it was about ¥5,000. The ministry says that if nothing is done, the average monthly premium will go up to about ¥8,200 in fiscal 2025.

The ministry insists that if municipalities use volunteers and nonprofit organizations, they will be able to provide services to elderly people requiring a lower level of care at a lower cost than under the nursing care insurance system. But many municipalities are suffering from shortages of funds and human resources, and there is the danger that the quality of the services will worsen.

First and foremost, excluding some people from the nursing care insurance system runs counter to its spirit. The ministry’s proposal also will lead to a deterioration of measures designed to maintain the physical and mental health of elderly people whose care needs are presently small. As a result, the number of elderly people whose conditions are severe will increase, thus pushing up the total costs of the insurance system.

The ministry should realize that its proposal will not lead to lower costs unless the quality of care is reduced as well. It should instead try to rein in costs by coming up with economical and effective ways to keep elderly people as healthy as possible. As the saying goes, an ounce of prevention is worth a pound of cure.