marked age compositional shift of the Japanese population will generate a substantial
effect on the pattern and level of demand for medical care services, as will be discussed
in the next section.
Fourthly, it should be noted that the total dependency ratio is relatively low until
the turn of the century. In 1991-1992 the index of total dependency is 43.3, which is the
lowest in postwar Japan. Moreover, it is also one of the lowest levels in the contemporary
developed world (United Nations, 1994). In the next century, however, the index is
expected to increase continuously, thus reaching its peak value of 66.9 in 2025, which
will be the highest among all the industrialized nations at that time. In view of these
projected results, appropriate policies should be formulated before the end of this
century to cope with the negative effects of the anticipated acceleration in population
aging.
It is interesting to note that the peak of total dependency over the projected period
is comparable to Japan's highest level (71.6) recorded in 1920. It has been observed in a
few existing studies (Wander, 1978) that the average per capita total expenditure
(')rivate and public) is roughly equal between young and old dependents. If this
observation holds for Japan,one may say that because Japan had already experienced greater
total dependency in the prewar period, the rising total dependency burden to be placed
upon the productive population in 21st-century Japan will be within a manageable range. It
should be stressed, however, that over the next three decades, Japan's tempo of the
increase in total dependency is the fastest among all the industrialized nations, thus
suggesting that Japan, compared with other developed nations, is likely to face more
formidable adjustment
Table 3. International comparison of the speed of population aging
