An article on the Guardian Healthcare Network today highlights the way in which Japan deals with the issue of an ageing population, an issue that healthcare companies in the UK are desperately trying to address.
Japan runs a ‘parallel scheme’, encompassing both regular medical care and social care for the elderly. Bear in mind that, in Japan, a baby girl can be expected to live to 86, a boy, 79, yet they manage to take care of their increasingly aged population with lower healthcare expenditure than the UK and Germany. This is, partly, attributable to Japan’s handle on costs being vice-like in comparison to the UK’s “chuck money in a sieve and see what we’ve got left in 10 years” approach. But the real masterstroke here is Japan’s Long Term Care Insurance System. The LTCI effectively creates a compromise position between families and the state in looking after the elderly – from the age of 40, everyone pays a little bit into the scheme and then, come the age of 65, you suddenly have a menu of social care assistance that you can take advantage of. Both families and the health system feel a relief on the burden of social care; hospital stays are reduced, and expenditure on the parts of both the family and the hospital is mitigated. Some charges are added, such as for ‘residential’ stays, but these are means tested.
The world economic climate at the moment, naturally, pushes any kind of scheme like this into the cold light of scrutiny, but it’s hard to believe, with expenditure in Japan so much lower than here, that a social care solution could be achieved any better. Without sounding too partisan, it’s also hard to believe that Andrew Lansley will come up with anything better. The population is ageing. Fact. We don’t really have a choice here; we have to do something.
What Japan has achieved is what we really need to focus on – breaking down the distinctions between different types of care. Health problems, whether age-related, physical or mental, all need to be addressed equally and without prejudice. They also need to be met through equal discourse between the population and the government, both locally and nationally.
The elderly, benefitting from home price increases, are sitting on a great deal of potential equity, but there is no robust method by which they can access that capital – capital that could contribute greatly to a scheme such as LTCI. The increased, and ever-increasing, age of the population is something that everybody is starting to worry about, but not necessarily addressing. In Japan, the LTCI scheme begins taking payments at the age of 40; if we were to start that planning ourselves, then we can avoid seeing the problems in our old age that the current elderly population are facing now. The unavoidable truth is that social care, whether packaged on an equal footing with all other elements of care (and with a redistribution of the, currently, way unequal healthcare budget) or seen as a separate section with a separate budget, needs more money. The Dilnot Commission, whose findings were published last year, proposes a similar scheme to LTCI; means tested payments coming from those who need nursing care, but when and if this will come into effect is still very much in question.
The question of where to find the money for a fairer social care budget needs to be answered, and answered soon – just as Japan did 12 years ago.