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The outline of the opening remarks by the delegates and the presentation of views, opinions, suggestions and discussions which took place at the symposium may be summarized as follows:

Miss. Watanabe began her opening remarks by enumerating the historical perspective of how Japan's Long Term Care Service Insurance System was enacted as a law(s) in 1997 and its implementation in April, 2000. Since the law(s) enacted in 1997 required the review of the law(s) as a stipulation at the time of the enactment of the law(s), the first round of which is to be completed by the end of March, 2005.Mrs.Watanabe firstly focused on "Basic Principle of Establishment Long-term Care Insurance System by citing a number of fundamental points out of which the current system has been put it in place. She cited by listing four major basic principles which are: (1) Decentralization of power; Municipal insurers are responsible for operation and finance, (2) Selection and competition; Services selection by users. Introduction of civil vitality, (3) Promotion of in-home care, and (4) Fairness and efficiency of benefits and burden; Benefits included; Certification of long-term care needs, care management, and preventive benefits. On Burden side, it called for collection of premium from the elderly.On the process of reviewing the current system in place, the Ministry of Health, Labor and Welfare undertook the task of investigating the various factors both pros and cons of this system through the nation-wide hearing from regional and local governments as well as the providers of the care services for the elderly. It was pointed out by her that "Reconsideration of the system" planned 5 years after the implementation is a critical problem. Thus, the on-going process of reviewing of the system which is now being undertaken which is due by the end of March, 2005 is regarded as more complexes and challenge for the Ministry to cope with.

Implementation Condition of Long-term Care Insurance System (1) was another topic which she referred to. She noted that services users are rapidly increased for the last three years. According to her presentation, number of primary insured has increased from 21.65 million at the end of April, 2000 to 24.12 million at the end of August, 2003.

As far as number of people certificated in need of care has increased from 2.18 million at the end of April,2000 to 3.65 million at the end of August, 2003, which is an increase of 67%. On the change of service users, she noted that number of users for in-home services and facilities were 1.49 million at the end of April, 2000, out of which 970 thousands users were at in-home services and 520 thousands were at the various institutional facilities. Whereas, the total users at the end of June, 2003 were reported at 2.81 million and 2.09 million at in-home services and 720 thousands at facilities. It has shown the increase of 89%, 115% and 40% respectively. She commented that these statically reported figures indicate that the system has been widely integrated into the community of the elderly and their families for the benefits of this system.

Commenting on increase in people requiring care at support level or lower level, she pointed out that (1) the number of people certified in need of care increased by 1,46 million in 3 years and 4 months (67%) and (2) people certified in need of care at support level or care level 1 has been increased by 100%. Projection or trends of the number of people certified in need of care by care level is summarized as follows;

The increasing rate since the end of April, 2000 has been reported;

  • Total-----------67%
  • Level 5---------51%
  • Level 4---------32%
  • Level 3---------44%
  • Level 2---------58%
  • Level 1--------108%
  • Support level---85%


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