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ABSTRACT
Developed countries have
thought and planned for population aging, but
if the developing countries do not think about
programming for health services of aged people,
in the near future they will encounter socioeconomic
and health crises. A better understanding of aging
society which covers different dimensions of economic,
welfare, health and treatment helps to identify
the challenges facing aging. What distinguishes
the aging of Japanese society from that of other
industrialized societies is its rapid pace. In
1995, elderly persons made up only 14.6% of the
population. Current projections are that this
proportion will nearly double to 27.4% in the
year 2025. The proportion of working age people
to Japan's entire population is also sharply declining.
By 2050 it is expected that one in every three
persons will be 65 years old or over. This will
be not so much due to an increase in the average
lifespan as to the decreasing birthrate; that
is, the Japanese will have fewer children.
Until now, the elderly in Japan have lived relatively
comfortable lives partly because of the financial
stability made possible by pensions and partly
because of the availability of low-cost medical
care under the universal insurance system. Below
the surface, however, lie some concerns, such
as long-term care, medical insurance finance and
pension finance. The Gold Plan and the long-term
care insurance bill are intended to address long-term
care issues, and the Angel Plan is designed to
improve the low birthrate issue. In addition,
as the proportion of the elderly grows, old-age
pension payments will decrease and the Laws designed
to protect their human rights and human dignity,
including adult guardian law, should be passed.
Another knotty problem is how the values of the
older generations can be transmitted to the young.
This is a particularly crucial issue in Japan
where there is almost no continuity of values
between the old and the young.
This study provides a
comprehensive description of the older population
in Japan to foster a better understanding of their
experiences and challenges. The information we
are interested in includes population dynamics
in Japan, its contributing factors, its social
implications, current conditions of the Japanese
elderly, and social policies that are related
to the elderly.
Key words:
Aging in Japan; Japan, health, economic; sanity;
insurance; retirement; population aging.
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INTRODUCTION
Aging, of course, is a phenomena
not isolated to any one nation, language, or culture.
Nations around the globe are attempting to cope with
unprecedented numbers of persons who will live longer
than ever before in human history. In response to this
pervasive trend, the generation of new knowledge in
environment and aging is occurring around the globe.
In many countries around the
world, including Japan, decreasing birth rates and higher
life expectancy are resulting in a demographic shift
known as population aging-a shift to a higher share
of older people in the population. Japan's high percentage
of the population age 60 or older is expected to rise
further, from 27 percent in 2006 to an estimated 42
percent by 2050 (WHO Kobe Centre, 2001, 2002).
For Japan, the central
cause of the rapid rate of aging is not only the higher
life expectancy among the elderly and the resultant
increase in their number, but also the steady decline
in numbers among the younger generations. When Japanese
people talk about "the elderly," they usually
mean "people aged 65 and over." In the meantime,
a number of corporations set a mandatory retirement
for their employees at age 60, and those retirees are
often considered "the elderly" (AARP 2006).
As of October 1, 2005,
the total Japanese population was approximately 127.76
million, of which 26.82 million or 21.0% were aged 65
and over. In other words, Japan is the most aged society
in the world. While Japanese population has been declining
since 2005, the population aging will continue. The
proportion of the elderly is expected to become 35 %
and by 2040.
DATA
GATHERING METHODS
From the reliable documents
and author experiences and observations during 10 years
stay in Japan and some interviews with experts in the
field of aging, the information was collected and presented
in this study.
Features
of Japan's Aging Society
Japan as predicted as one of
most aged countries is about to face a population decline
as of 2005 (Takagi, F., 2006). In Figure 1 the trend
of population growth for males and females from 1950
to 2050 is illustrated. It is very clear that population
decline started from 2005.
Figure
1 Japanese population transition: 1950-2050
According to US Census Bureau, the population
of Japan in 2007 was 127.34 million from which 62.25
million were male and 65.18 million were female (Figure.
2).
Figure 2 Japanese population pyramid:
2007
Declining
Birth Rate and Aging Population
From
the eighteenth century through the first half of the
nineteenth century, Japan's population remained steady,
at 30 million-plus citizens. However, following the
Meiji Restoration in 1868, it began expanding in tandem
with the drive to build a modern nation-state. In 1926,
it reached 60 million, and in 1967, it surpassed the
100 million mark.
However,
Japan's population growth has slowed in more recent
years, with the annual pace of population growth averaging
about one percent from the 1960s through to the 1970s.
Since the 1980s, it has declined sharply. The population
figure of 127.76 million released in the 2005 Population
Census was below the 2004 population estimate (127.78
million). This marked the first time since World War
II that the population has fallen compared to the previous
year, and the beginning of a population decline in Japan.
Comparing
the age structure of Japan's population, the population
pyramid of 1950 shows that Japan had a standard-shaped
pyramid with a broad base. However, the shape of the
pyramid has changed dramatically as the birth rate and
death rate have declined. In 2005, the population of
elderly citizens (65 years and over) was 26.82 million,
constituting 21.0 percent of the total population and
marking record highs in both number and percentage terms.
The speed of aging of Japan's population is much faster
than in advanced Western European countries or the U.S.A.
Although the population of the elderly in Japan accounted
for only 7.1 percent of the total population in 1970,
24 years later in 1994, it had almost doubled in scale,
to 14.1 percent. In other countries with an aged population,
it took 61 years in Italy, 85 years in Sweden, and 115
years in France for the percentage of the elderly to
increase from 7 percent to 14 percent of the population.
These comparisons clearly highlight the rapid progress
of demographic aging in Japan (Campbell JC, Ikegami
N., 2000, 2007).
Population
of elderly citizens in Japan
In 2005, the population of elderly
citizens (65 years and over) was 26.82 million, constituting
21.0 percent of the total population and marking record
highs in both number and percentage terms. The speed
of aging of Japan's population is much faster than in
advanced Western European countries or the U.S.A. Although
the population of the elderly in Japan accounted for
only 7.1 percent of the total population in 1970, 24
years later in 1994, it had almost doubled in scale,
to 14.1 percent. In other countries with an aged population,
it took 61 years in Italy, 85 years in Sweden, and 115
years in France for the percentage of the elderly to
increase from 7 percent to 14 percent of the population)
Takagi, F., 2006). These comparisons clearly highlight
the rapid progress of demographic aging in Japan. The
proportion of the elderly is expected to become 35 %
by 2040.
Life
expectancy at birth, healthy life expectancy
Japanese life expectancy at
birth has grown constantly, from 50 years for males
and 54 years for females in 1947 to 78.5 years for males
and 85.5 years for females in 2005 and is expected to
be 79.8 for males and 87.6 for females between 2020
and 2025. According to WHO, Japan also has the highest
health expectancy. As of 2002, it was 72.3 years for
males and 77.7 years for females (Japan Aging Research
Center, 2007).
Currently, the life expectancy
at age 65 is 18.1 years for males and 23.2 years for
females. Hence, those who are currently 65-year-old
are expected to live for 83.1 years if they are males
and 88.2 years if they are females. These numbers are
higher than the life expectancy at birth.
Health
care system and insurance
The introduction of Japan's
long-term care insurance system in April 2000 has made
long-term care an explicit and universal entitlement
for every Japanese person aged 65 and older based strictly
on physical and mental status. At the start of the program,
more than two million seniors were expected to apply
for services to approximately 3,000 municipal governments,
which are the system insurers. The Japanese healthcare
system provides a high degree of equity of access by
geographical areas despite the apparent unevenness in
the distribution of medical personnel and facilities
across regions. If the crude mortality rate of each
prefecture is taken as a proxy for the need for healthcare,
there are good correlations between the need and access
rates variously measured, i.e. doctors and beds per
capita, consultations and admissions per capita and
health expenditure per capita. Thus, the uneven geographical
distribution of resources and treatments largely reflects
different needs in different prefectures. This is a
result mainly of universal health insurance but has
been reinforced by the regional medical plans drawn
up by prefecture governors to rectify geographical imbalances.
It is not possible to carry out a similar analysis of
equity of access across income groups in the absence
of relevant mortality and morbidity information (Ministry
of Health, Labour and Welfare, 1999).
In the Japanese system neither
the consumer's choice of health insurers nor the insurer's
choice of service providers is possible. People are
assigned an insurer according to their employment situation
or residence. Service providers are now designated by
the central government as eligible for treating patients
under the social health insurance.12 Competitive forces
operate only in the market for services, with no guarantee
that this results in efficient resource allocation,
in the absence of basic attributes of a well functioning
market. For example, high demand for the outpatient
services in large hospitals is largely due to the fee
structure and the absence of objective information concerning
the quality of service providers. Hospitals find the
outpatient service an attractive revenue source not
only because of the relatively generous payments by
insurers but also because it represents an important
source of admission to beds. About 60 per cent of admissions
resulted from consultation in the outpatient department
of hospitals (Sasaki, Yamaguchi, 2006).
Long-term
Care
The Japanese government drew
up the Ten-Year Strategy to Promote Health Care and
Welfare for the Elderly (Gold Plan) in 1989. In December
1994, five years into the plan, the New Gold Plan was
formulated to incorporate revisions to the first plan
and increase its effectiveness. Goals for establishing
urgently needed infrastructure for care services for
the elderly were identified and basic frameworks for
additional policies, which must be pursued in the near
future, were presented. Moreover, a long-term care insurance
bill was submitted to the National Diet with the aim
of providing more efficient long-term care services
starting with the year 2025 (Borowski A, Schmid H.;
2000).
Working Status and pension of seniors
in Japan
A mandatory retirement was normally
set at age 55 in Japan between 1920s and 1980s. The
life after a mandatory retirement was considered as
being "the elderly." A mandatory retirement
age started rising in the 1980s. As of the beginning
of the 21st century, employment rates for those aged
55 to 59 are about 94% for males and about 59% for females.
Rates for those aged 60 to 64 are about 72% and 39.5%
for males and females, respectively. For people aged
65 and over, employment rates are about 33% for males
and about 14% for females. While the working-age (15-64)
population has been declining in Japan, the number of
the elderly (both aged 60+ and 65+) is increasing rapidly.
Baby-boomers will be in their 60s by 2010, and our society
needs preparations for the population aging including
those baby-boomers (Ikegami, 2007).
In Japan, the pension system
covers nearly the entire population of the country,
just like medical insurance. However, the system itself
is very complex. It is divided into five schemes depending
on whom you work for, and contains gaps in benefit amounts
among the different schemes. Thus, the integration of
the system remains a significant challenge for the future.
In addition, pension benefits rose markedly after the
pension system was reformed in 1973, and since then
several additional revisions have been made. Now, however,
a reduction in current pension benefits is being debated
due to a serious concern over future financing of the
pension system.
CONCLUSION
Although many are anxious about
their future, the majority of older citizens at least
today enjoy very favorable conditions. The main reason
is the expansion/improvement of the medical care system
and the financial stability primarily provided by the
pension program.
By 1995, the average life expectancy
at birth for men had risen to 76.38 years while that
for woman had reached 82.85 years, and life expectancy
in Japan has been the highest in the world since the
middle of the 1990s.
As of 2005, the total Japanese
population was approximately 127.76 million, of which
26.82 million or 21.0% were aged 65 and over. In other
words, Japan is the most aged society in the world.
According to the experiences
of Japanese aging strategy the following key points
should be focused on:
1. Dignity
Like people of other generations,
the elderly should be given respect for their dignity
as individuals.
2. Social Participation
In order to create a society in which all generations
can live in security, it is necessary that older persons
lead active lives. To this end, society at large should
develop businesses and occupations which utilize the
skills of older persons and expand opportunities for
those who are eager to actively participate in the society.
3. Social Contribution
In order to create the society for all generations to
live in peace, older persons shall interact with younger
generations and participate in activities which contribute
to the society, in such fields as social welfare, environmental
maintenance, community development, dissemination of
traditional culture and international exchange.
4. Health Promotion
Older persons shall maintain their own physical functions
so that they can lead fulfilling lives in the society.
To this end, support systems such as municipal health
centers and health promotion networks should be fully
developed.
5. Community Development
In order to create a safe living environment for people
regardless of physical abilities and living skills,
development of housing and communities without barriers
should be a central theme in public works. At the same
time, people should all try to remove their own psychological
barriers and help each other in the society.
6. Social Security Systems
Pensions, health insurance, long-term care insurance
and other social security systems need to be fully established
to meet people's needs throughout their life courses,
and society should enable all generations to enjoy security
through these systems. Based on the spirit of mutual
support, the systems should be run efficiently with
fair financial responsibilities, and the systems should
be constructed comprehensively so as to ensure the vitality
of society as a whole. People receiving services through
these systems must bear part of the cost so far as it
is possible and appropriate, and their autonomy must
be respected as much as possible.
7. Lifelong Learning
In order to support diverse lifestyles of older persons,
means should be provided for lifelong learning. In addition,
systems should be developed so that the experience and
knowledge of older persons can be utilized in education
of children and young people.
Men and women of all generations, including the elderly,
shall work together to accomplish these goals.
REFERENCES
AARP (2006). Multinational survey
of opinion leaders. AARP global aging program. www.AARP.org/global
aging.
Arai Y, Zarit SH, Kumamoto K et al (2003).
Are there inequities in the assessment of dementia under
Japan's LTC insurance system? Int J Geriatr Psychiatr;
18:346-352.
Borowski A, Schmid H. (2000) Israel's long-term
care insurance law after a decade of implementation.
J Aging Soc Policy; 12: 49-71.
Campbell JC, Ikegami N. (2000) Long-term
care insurance comes to Japan. Health Aff; 19: 26-39.
Campbell JC, Ikegami N. (2007) Japan's
radical reform long-term care. Soc Policy Adm; 37: 21-34.
Ikegami N, Campbell JC. (2007) Medical
care in Japan. N Engl J Med; 333: 1295-1299.
Japan Aging research center (2007). Aging
in Asia and oceania: Japan country report. http://www.jarc.net.
Ministry of Health, Labour and Welfare
(1999), Survey on Patients Behaviour and Satisfaction
(Juryo Kodo Chosa) 1999, Tokyo (in Japanese).
Seki Y, Tsutsui T, Miyano T. Yokaigo (2003).
Nintei Ichiji-Hantei Logic-no Kiso-to Natta Tokei Model
no Dato-sei. Nihon Ouyou Toukei Gakkaishi; 29: 101-110
SasakiM, Yamaguchi J. (2006). Experience
of Long-term Care Insurance Law for one year. Nippon
Ronen Igakkai Zasshi (Jap J Geriatr); 37: 18-19.
Takagi, F. (2006) Japanese population projection.
Japan Aging Research Center, Tokyo.
WHO Kobe Centre, (2001). A framework for
understanding community health care in ageing societies,
Ageing and Health Technical Report Series 2, Kobe, Japan,
WHO Kobe Centre, 2002. Global health expectancy
research among older people. Ageing and Health Technical
Report Series 1, Kobe, Japan 10.
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