b) Renovation of the Public Pension System
In 1985, our public pension system was completely renovated. The main purpose of this renovation was to restructure our public pension programs so that they can function well even at the peak of the aging of our society, which will come around the year 2020. For this purpose, among others, the level of the retirement benefits was considerably lowered, though serious consideration was given to the interests of those who were already receiving retirement benefits. In light of the much longer average life span of women, necessary revisions were implemented.
c) National Subsidy Program for the Establishment of Health Care Facilities
In 1988, the National Government started a National Subsidy Program for the establishment of Health Care Facilities for the Elderly (Rojin Hoken Shisetsu). The purpose of such institutions is to provide long-term institutional care for the elderly who are suffering from chronic diseases and need intensive care, but do not need hospitalization. Until then, because of the lack of public home-care services and because of lenient public sickness insurance regulations regarding long-term hospitalization, many of them had been hospitalized for long periods. Needless to say, this represented nothing but a waste of society's financial and manpower resources. Another purpose of these institutions is to improve the services to such patients by caring for them in places that are more adequate than nursing homes. In Japan, the nursing home is not a health care institution. Therefore, the health and medical care provided in Japanese nursing homes is limited. The new Health Care Facility for the Elderly is to fill the gap between hospitals and nursing homes. Actually, however, the most important aim of this program is to accelerate the development of long-term care institutions by utilizing the public sickness insurance fund. Previously, nursing homes were established and run with money from general revenues. As it is almost always difficult to expand general revenues, the development of nursing home service in Japan has not kept pace with the rapidly expanding needs for long-term institutional care of the elderly. Many social gerontologists specializing in long-term care of the elderly suggest that, in industrialized societies, the number of beds for long-term institutional care should be at least 4 percent of the population aged 65 and over, even when home care and domiciliary services are well developed. This means that at the peak of population aging, i.e., around the year 2020, Japan will have to have approximately 1,200,000 such beds It seems to me that without the establishment of this new type of long-term care institutions utilizing the money of the public sickness insurance programs, a realization of this goal will be almost impossible.
