Changes to the nursing care insurance system, adopted in a law enacted in the last Diet session, end some services provided to people with less severe medical conditions as municipalities take over the responsibilities. Meanwhile, the out-of-pocket share that some care recipients in the insurance system pay for services is going up.

The measures are intended to sustain the public insurance for nursing care amid tightening finances for the nation’s social security programs. But the government needs to make sure that these steps do not result in a decline in the overall quality of services for people in need of nursing care.

The number of people aged 75 or older is expected to exceed 20 million — nearly one-fifth of Japan’s population — in 2025, when the postwar baby boomer generation reaches that age bracket. Demand for nursing care services will no doubt spike. However, it will be difficult to increase the services under the public insurance system in accordance with the surge in the elderly population.

Of the services now provided under the nursing care insurance program, home visits by attendants for people with relatively less severe conditions and services for such outpatients at day care centers will be gradually transferred to local municipalities beginning next spring. After that, the menu of services provided and their fees will be set by each municipality.

The government says the municipalities will be better able to offer services that cater to the diverse needs of local residents, rather than the uniform menu of services under the care insurance system. But opposition lawmakers pointed out during the Diet debate that the move could result in disparities in the quality of services between different municipalities and regions because some are financially stronger than others. Concerns remain that municipal governments with tight fiscal conditions may not be able to provide sufficient services for elderly residents in need of nursing care. Lack of appropriate services for people with less severe conditions may result in their conditions worsening, which would then increase the total cost. The government should present minimum and necessary rules or guidelines that municipalities must follow at any cost to avoid confusion among the municipalities and the users of the services.

In addition to professional caregivers, the changes also enable nonprofit organizations and volunteer staff to provide services. But people involved in nursing care for the elderly point out that volunteers without professional knowledge in such matters as senile dementia may miss signs of deterioration in the mental condition of those under their care.

For the first time since the nursing care insurance system was introduced in 2004, the out-of-pocket share that some participants in the system pay for the services will be raised from 10 percent to 20 percent.

The increase, beginning in August 2015, will be limited to people with incomes above a certain level — although the exact threshold will be decided in government ordinances to be adopted later. The Health, Labor and Welfare Ministry assumes that people with annual pension income of ¥2.8 million or more will be subject to the hike, but critics argue that this income threshold is too low and would increase the financial burden for a large number of elderly people.

The government should come up with a fair and reasonable criteria that will include other factors in addition to pension income such as the value of the recipients’ savings and investments.

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