Enhancing the quality of nursing care services so that elderly people can live without worries, while at the same time keeping the cost of services under control, is a difficult problem that is unavoidable for the system to be kept in place in this super-aging society.

A bill to reinforce regionwide comprehensive care systems aimed at reforming the nursing care insurance system has passed into law with a majority vote, with support from the Liberal Democratic Party, its coalition partner Komeito, opposition party Nippon Ishin no Kai and others.

One of the major pillars of the new system is to have people shoulder a financial burden that corresponds to their financial strength.

For elderly people with high incomes who earn as much as those still in working generations, their out-of-pocket payments will be raised to 30 percent from the current 20 percent. About 120,000 people, or 3 percent of current service users, are expected to be classified at the higher rate. The increase will be implemented in August 2018.

Up until 2025, when the nation’s postwar baby boomers will be at least 75 years old, nursing care expenses will swell. It is inevitable to ask elderly people in high-income groups to shoulder heavier financial burdens. What is important is to observe the course of events so people are not restrained in their use of necessary care services.

The insurance premium for those ages 40 to 64 will also become more in line with their financial strength. While raising the financial burden to be assumed by corporate health insurance unions with subscribers who enjoy relatively high levels of income, the new care system will reduce the burden on unions with insured subscribers who have lower levels of income. A total of 13 million people, mainly working at large companies, will see their financial burdens increase. Meanwhile, the financial burden will be lessened for 17 million people working at small and midsize companies and others.

As the financial burden to be covered by corporate health insurance unions will be decided according to the number of subscribers under the present system, the burdens on other unions, whose subscribers have lower income levels, are relatively heavy. Changing the system into one with financial burdens set in accordance with the income levels of subscribers seems to be necessary to ensure fairness.

Yet another pillar of the new system is to promote care supporting independent living and prevent people’s conditions from worsening. The legislation makes it mandatory for local municipalities to write down — in their nursing care insurance plans — their measures to maintain and improve care levels needed by elderly people in their communities, and set specific targets. Local municipalities that achieve tangible results will be given financial support from the state.

The course of action to keep expenses in check by raising the degree of self-support is reasonable.

In Wako, Saitama prefecture, the municipality extends support in line with the individual conditions and living environment of each elderly person, in cooperation with people working in diverse types of professions related to nursing care, such as those specializing in rehabilitation. By enhancing the degree of self-support, the municipality has reduced the ratio of elderly people classified as recipients of nursing care services.

The city has also expanded services like exercise classes — even though they are not covered by nursing care insurance — and social exchange meetings for local people.

Among those in need of serious nursing care and others, there are cases in which there is hardly any hope for improvement. Yet paying attention only to changes in the ratio of elderly people classified as recipients of nursing care services may allow some municipalities to attempt to improve the appearance of the ratio by applying a tougher criteria when judging the levels of care needed.