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The government has disclosed a plan to raise the out-of-pocket share paid by elderly people considered to have high incomes for services received under the nursing care insurance system from the current 10 percent to 20 percent.

Although increases in out-of-pocket payments by wealthier people to sustain the insurance system may be inevitable, the government must ensure equitability among participants in the insurance system. It is particularly problematic that while the government can accurately figure out the income of company employees, it is having difficulties doing the same for the self-employed. If the government cannot calculate individuals’ income accurately, it will be difficult to ensure equitability.

Currently, participants in the nursing care insurance system shoulder 10 percent of the cost of services. If they reside in special nursing homes for the elderly, they have to pay heating, lighting and city water expenses plus part of the cost for food in addition to 10 percent of the overall cost for services.

In August, the social security system reform national conference under the Cabinet submitted a proposal to Prime Minister Shinzo Abe, proposing to raise the out-of-pocket share for high-income people receiving services under the insurance system.

The proposal is based on concern that if the current system is left as it is, the continuing rise in nursing care costs will lead to a financial crisis as the graying of the population progresses. It is estimated that in fiscal 2025 — when all postwar baby boomers have reached the age of 75, the total cost for nursing care services for the aged under the insurance system will hit ¥21 trillion.

The health and welfare ministry has disclosed two options for raising out-of-pocket payments for nursing care services. The first option covers the top 20 percent (in terms of income) of total participants in the nursing care insurance system; the second option covers the top 50 percent of participants in the insurance system who are paying residential taxes.

The first option applies to a single person whose annual pension is at least ¥2.8 million and a married couple whose annual pension is at least ¥3.59 million (¥2.8 million or more for the husband and ¥790,000 or more for the wife). The second option applies to a single person whose annual pension is at least ¥2.9 million and a married couple whose annual pension is at least ¥3.69 million (¥2.9 million or more for the husband and ¥790,000 or more for the wife.)

The government will need to explain details of the options. Many people will want to know the grounds for raising their out-of-pocket share from the current 10 percent to 20 percent.

It is quite possible that the health and welfare ministry’s plan may prove inequitable. In that case, thorough discussions on how to ensure fairness will be necessary.

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