One of the most recent cost containment measures introduced was a substantial increase in copayments. Effective in September 1997, all insured persons are required to make copayments amounting to 20-30 percent of their medical care costs. Prior to this change, the amount of copayments ranged from 10 to 30 percent of the total medical costs.
Because there has been a severe shortage of long-term care facilities for the elderly, the overwhelming majority of elderly inpatients receive medical care at general hospitals, thus substantially increasing the average duration of hospitalization; data gathered in 1996 show that the average length of hospitalization for those aged 65 and over is 66 days, as opposed to 11 days for those at ages 0-14 (Health and Welfare Statistics Association, 1997). Institutions for long-term care for the elderly are a relatively recent development; the establishment of such institutions were officially approved by the government in 1983.
Because institution-building is a slow process, and Japan's population aging is expected to accelerate in the next few decades, it is highly probable that the long period of hospitalization will continue to be the main source of the growth of public medical expenditure in the years to come. In order to avoid this future development, the government emphasized in its 1987 White Paper on Health and Welfare that the responsibility for looking after elderly patients should be shifted from hospitals to family caregivers, who are usually middle-aged women. To facilitate this transfer process, the government started in 1990 to increase substantially, through its 10-year project called "the Golden Plan," its budgetary allocation for the social service programs for elderly patients (Ogawa and Retherford, 1997).
Along the same line of policy objectives, the government has recently introduced a mandatory insurance system to provide nursing care for the elderly. This system is expected to be established in the year 2000 to help elderly persons in need of nursing care and to alleviate the burden of their family caregivers. Services will include dispatching workers to provide care at home and help with household chores, dispatching nurses, and providing daytime and short-term stays at care facilities and long-term stays at nursing homes.
To sustain the long-term care insurance, everyone 40 and over will be required to contribute to the scheme. The Ministry of Health and Welfare has estimated that the monthly payment per policyholder in the year 2000 will be approximately 2,500 yen. However, a raise in monthly payments is likely to be gradually implemented as the process of population aging advances.
