The Development of Social Policy for the Elderly in Japan

Social Service Review

Volumn 71, Issue 3, 1997, Pages 360-381

  Usui, Chikako ^a   Palley, Howard A ^b  

^a UNIVERSITY OF MISSOURI ST LOUIS   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0038251651     PISSN: 00377961     EISSN: None     Source Type: Journal    
DOI: 10.1086/604262     Document Type: Article

References (78)

1. Asahi Shinbunsha, Japan Almanac (Tokyo: Asahi Shinbunsha, 1995), pp. 53 and 217; Prime Minister's Office, Kokumin Seikatsu Hakusho, white paper on conditions of citizen's lives (Tokyo: Government Printing Office, 1993), p. 5.
2. Asahi Shinbunsha, Japan Almanac (Tokyo: Asahi Shinbunsha, 1995), pp. 53 and 217; Prime Minister's Office, Kokumin Seikatsu Hakusho, white paper on conditions of citizen's lives (Tokyo: Government Printing Office, 1993), p. 5.
3. Yasuhito Kinoshita and Christie W. Kiefer, Refuge of the Honored (Berkeley and Los Angeles: University of California Press, 1992), p. 42.
4. Tadashi Fukutake and Kazuo Aoi, The Structure of Aging Society and Its Challenge (Tokyo: Nihon Seimei Zaidan, 1983), p. 156; Kinoshita and Kiefer (n. 2 above), p. 53.
5. Prime Minister's Office (n. 1 above), p. 20.
6. Kazunori Yamanoi, "Gray Out," Japan Update 36 (September 8-9, 1994): 8. Also see "Koreika Shakai e Taio Dekiruka," Asahi Shinbun (December 13, 1996): 7, and "Bold Initiatives for an Aging Society in Japan," Look Japan (December 1996): 4-8.
7. Kazunori Yamanoi, "Gray Out," Japan Update 36 (September 8-9, 1994): 8. Also see "Koreika Shakai e Taio Dekiruka," Asahi Shinbun (December 13, 1996): 7, and "Bold Initiatives for an Aging Society in Japan," Look Japan (December 1996): 4-8.
8. Kazunori Yamanoi, "Gray Out," Japan Update 36 (September 8-9, 1994): 8. Also see "Koreika Shakai e Taio Dekiruka," Asahi Shinbun (December 13, 1996): 7, and "Bold Initiatives for an Aging Society in Japan," Look Japan (December 1996): 4-8.
9. Ministry of Health and Welfare (Japan), Health and Welfare for the Elderly (Tokyo: Foundation for Social Development for Senior Citizens, 1992); Kinoshita and Kiefer (n. 2 above); Yamanoi (n. 5 above).
10. Chalmers Johnson, Japan: Who Governs? (New York: Norton, 1995), p. 165.
11. W. G. Beasley, The Rise of Modern Japan (New York: St. Martin's, 1990), p. 232.
12. Arduth W. Burks, Japan: A Post Industrial Power (Boulder, Colo.: Westview, 1991), p. 115.
13. Ibid.
14. Nobuo Tomita, Akira Nakamura, and Ronald J. Hrebenar, "The Liberal Democratic Party: The Ruling Power of Japan," in The Japanese Party System, ed. Ronald J. Hrebenar (Boulder, Colo.: Westview, 1992), pp. 273-74.
15. Harold R. Kerbo and John A. McKinstry, Who Rules Japan? The Inner Circles of Economic and Political Power (New York: Praeger, 1995), p. 121.
16. Beasley (n. 8 above), p. 232; Kerbo and McKinstry (n. 12 above).
17. Burks (n. 9 above), p. 115.
18. Chalmers Johnson, MITI and the Japanese Miracle (Stanford, Calif.: Stanford University Press, 1982); Kerbo and McKinstry (n. 12 above).
19. Thomas M. Huber, Strategic Economy in Japan (Boulder, Colo.: Westview, 1994); Johnson, Japan: Who Governs? (n. 7 above); Kerbo and McKinstry (n. 12 above).
20. Thomas M. Huber, Strategic Economy in Japan (Boulder, Colo.: Westview, 1994); Johnson, Japan: Who Governs? (n. 7 above); Kerbo and McKinstry (n. 12 above).
21. Johnson, MITI and the Japanese Miracle (n. 15 above).
22. Tomita, Nakamura, and Hrebenar (n. 11 above), p. 273.
23. Haruhiro Fukui, Party in Power: The Japanese Liberal-Democrats and Policy-Making (Berkeley: University of California Press, 1970), p. 146. Also see Tomita, Nakamura, and Hrebenar (n. 11 above), p. 271.
24. Erdman B. Palmore and Daisuku Maeda, The Honorable Elders Revisited: A Revised Cross-Cultural Analysis of Aging in Japan (Durham, N.C.: Duke University Press, 1985), pp. 87-88.
25. John C. Campbell, How Policies Change: The Japanese Government and the Aging Society (Princeton, N.J.: Princeton University Press, 1992), p. 52.
26. As in many countries, Japan's pension programs developed in a fragmented manner. The oldest pension program was introduced for the military in 1876. In 1885, it added public employees. These two pensions were consolidated in 1923. A separate public pension for railroad workers was created in 1928, and five other separate pensions were established to cover workers in printing, forestry, and communications. In 1944, the new employee pension act mandated the coverage of workers for enterprises with five or more people. However, owing to reconstruction of the economy after World War II, the legislation was subsequently revised in 1954. In 1959, pensions for self-employed and family workers were added to cover those working in extremely small businesses. See Kiyoshi Murakami, Nenkin no Chishiki (Tokyo: Nippon Keizai Shinbunsha, 1990).
27. Campbell (n. 21 above), p. 59.
28. Ibid., p. 61.
29. Ibid., p. 59-60.
30. Murakami (n. 22 above), pp. 11 and 35; Martha Ozawa, "Soaal Security Reform in Japan," Social Service Review 46, no. 3 (September 1985): 476-95.
31. Campbell (n. 21 above).
32. David E. Woodsworth, Social Security and National Policy (Montreal: McGill-Queen's University Press, 1977), pp. 115-17.
33. Stephen J. Anderson, Welfare Policy and Politics in Japan (New York: Paragon House, 1993), p. 125.
34. Howard M. Leichter, A Comparative Approach to Policy Analysis: Health Care Policies in Four Nations (New York: Cambridge University Press, 1979), p. 243.
35. Anderson (n. 29 above), pp. 121-23.
36. Ibid., p. 123.
37. Ibid The conservative parties were also concerned about political competition, but the merger of the Liberal Party and the Democratic Party marked the beginning of a period of LDP dominance. See Mikisio Han, Modern Japan (Boulder, Colo.: Westview 1986), pp. 353-59.
38. The elderly population increased from 5 percent in 1950 to 7 percent in 1970.
39. Campbell (n. 21 above), p. 145.
40. Anderson (n. 29 above), p. 149.
41. Ibid.
42. Campbell (n. 21 above), p. 145.
43. Murakami (n. 22 above), pp. 29 and 38; In 1960, Prime Minister Hayato Ikeda announced an "income doubling within a decade" plan and raised minimum full pension benefits under the National Pension System from ¥10,000 in 1960 to ¥20,000 in 1969 (ibid., p. 38).
44. Alex Inkeles and Chikako Usui, "The Retirement Decision in Cross-National Perspective," in Contemporary Retirement, ed. Rita Ricardo-Campbell and Edward P. Lazear (Stanford, Calif.: Stanford University, Hoover Institution Press 1988), p. 284. Also see Tomiko Shimada, Nenkin Nyumon (Tokyo: Iwanami Shoten, 1992), p. 10.
45. Alex Inkeles and Chikako Usui, "The Retirement Decision in Cross-National Perspective," in Contemporary Retirement, ed. Rita Ricardo-Campbell and Edward P. Lazear (Stanford, Calif.: Stanford University, Hoover Institution Press 1988), p. 284. Also see Tomiko Shimada, Nenkin Nyumon (Tokyo: Iwanami Shoten, 1992), p. 10.
46. Campbell (n. 21 above), p. 167.
47. Rodney Clark, The Japanese Company (New Haven, Conn.: Yale University Press, 1979), p. 229.
48. Anderson (n. 29 above), p. 129; Campbell (n. 21 above), pp. 158 and 179.
49. Ministry of Health and Welfare (Japan), Health and Welfare for the Elderly (Tokyo: Foundation for Social Development for Senior Citizens, 1993).
50. Ibid.
51. Anderson (n. 29 above), p. 133.
52. Campbell (n. 21 above), p. 289.
53. Anderson (n. 29 above), pp. 133-38.
54. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1993 (n. 44 above), p. 50; Keizai Koho Center, Japan 1993: An International Comparison (Tokyo: Keizai Koho Center, 1993). The calculation is based on ¥250 = $1 for 1982 and ¥111 = $1 for 1993. See Keizai Koho Center, Japan 1994: An International Comparison (Tokyo: Keizai Koho Center, 1994).
55. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1993 (n. 44 above), p. 50; Keizai Koho Center, Japan 1993: An International Comparison (Tokyo: Keizai Koho Center, 1993). The calculation is based on ¥250 = $1 for 1982 and ¥111 = $1 for 1993. See Keizai Koho Center, Japan 1994: An International Comparison (Tokyo: Keizai Koho Center, 1994).
56. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1993 (n. 44 above), p. 50; Keizai Koho Center, Japan 1993: An International Comparison (Tokyo: Keizai Koho Center, 1993). The calculation is based on ¥250 = $1 for 1982 and ¥111 = $1 for 1993. See Keizai Koho Center, Japan 1994: An International Comparison (Tokyo: Keizai Koho Center, 1994).
57. Kinoshita and Kiefer (n. 3 above), p. 69.
58. Ozawa (n. 26 above).
59. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1992 (n. 6 above), p. 42; The Gold Plan adopted in 1989 is the culmination of two earlier initiatives of previous governments. In 1986, the cabinet developed the General Policies of Measures for an Old-Age Society, outlining a detailed set of policies for the aged. In 1988, the Ministry of Health and Welfare and the Ministry of Labor presented the Welfare Vision (On the Principles and Goals of Measures to Realize an Old-Age Society) to the national Diet. The Gold Plan is a revised and expanded version of the Welfare Vision. It strengthened concrete measures to achieve the stated goals.
60. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1992 (n. 6 above), p. 96.
61. Ibid., p. 39.
62. Ibid., p. 105.
63. Ministry of Health and Welfare (Japan), White Paper (Tokyo: Government Printing Office, 1995).
64. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1992 (n. 6 above), p. 112.
65. Ministry of Health and Welfare, White Paper (n. 56 above).
66. Ministry of Health and Welfare, Health and Welfare for the Elderly, 1992 (n. 6 above), p. 61.
67. Ibid., p. 62.
68. Ibid., p. 62.
69. Ministry of Health and Welfare (Japan), The New Gold Plan (Tokyo: Government Printing Office, 1995).
70. Ibid. The initial budget for the Gold Plan was ¥6 trillion (about $60 billion).
71. In addition to financing the growing cost of social welfare including services for the elderly, the Japanese government is involved in a number of new policy initiatives with respect to the elderly. In order to finance such initiatives, the consumption tax has been raised from 3 percent to 5 percent (effective April 1, 1997). Equally significant is the preparation of a new proposed law, Kaigo Hoken Ho (Elderly Care Insurance). If instituted, this law will provide benefits and services to older persons in need of the institutional, intermediate, and home care described in app. table A1, plus other services such as equipment rental (e.g., wheelchairs). In order to qualify, one must be 65 years of age or older, but special provisions are also made for those age 40 and over who have disabilities. If enacted, the Elderly Care Insurance will begin in the year 2000 and will be financed by a payroll contribution for those ages 40-64. A monthly contribution is set at ¥2,500 (divided equally between employee and employer), and this will increase to ¥3,500 in 2010. For those self-employed or not working, the national government will cover 50 percent of the contribution. The Ministry of Health and Welfare estimates that 13 percent of persons ages 65 and older would use these services. See Asahi Shinbun (n. 5 above); and Look Japan (n. 5 above). Other reforms that have been introduced since 1996 affect national health care. At present, older persons pay a flat monthly rate of ¥1,020 (about $10) for a doctor visit. This will be changed to a ¥500 ($5) copayment per visit. If an elderly person sees a doctor more than four times in the same month, no copayment will be assessed for the fifth visit. In addition, a ¥15 (15¢) prescription charge will be imposed per medication per day. According to one estimate, these charges will triple the elderly's out-of-pocket expenses per month. The hospitalization fee will also increase from the current rate of ¥710 ($7)/day to ¥1,000 ($10)/day. See Asahi Shinbun (n. 5 above). These reform measures, in addition to Elderly Care Insurance, were presented to a regular session of the Diet in February 1997. These reforms are still being deliberated at the time of this writing.
72. In addition to financing the growing cost of social welfare including services for the elderly, the Japanese government is involved in a number of new policy initiatives with respect to the elderly. In order to finance such initiatives, the consumption tax has been raised from 3 percent to 5 percent (effective April 1, 1997). Equally significant is the preparation of a new proposed law, Kaigo Hoken Ho (Elderly Care Insurance). If instituted, this law will provide benefits and services to older persons in need of the institutional, intermediate, and home care described in app. table A1, plus other services such as equipment rental (e.g., wheelchairs). In order to qualify, one must be 65 years of age or older, but special provisions are also made for those age 40 and over who have disabilities. If enacted, the Elderly Care Insurance will begin in the year 2000 and will be financed by a payroll contribution for those ages 40-64. A monthly contribution is set at ¥2,500 (divided equally between employee and employer), and this will increase to ¥3,500 in 2010. For those self-employed or not working, the national government will cover 50 percent of the contribution. The Ministry of Health and Welfare estimates that 13 percent of persons ages 65 and older would use these services. See Asahi Shinbun (n. 5 above); and Look Japan (n. 5 above). Other reforms that have been introduced since 1996 affect national health care. At present, older persons pay a flat monthly rate of ¥1,020 (about $10) for a doctor visit. This will be changed to a ¥500 ($5) copayment per visit. If an elderly person sees a doctor more than four times in the same month, no copayment will be assessed for the fifth visit. In addition, a ¥15 (15¢) prescription charge will be imposed per medication per day. According to one estimate, these charges will triple the elderly's out-of-pocket expenses per month. The hospitalization fee will also increase from the current rate of ¥710 ($7)/day to ¥1,000 ($10)/day. See Asahi Shinbun (n. 5 above). These reform measures, in addition to Elderly Care Insurance, were presented to a regular session of the Diet in February 1997. These reforms are still being deliberated at the time of this writing.
73. In addition to financing the growing cost of social welfare including services for the elderly, the Japanese government is involved in a number of new policy initiatives with respect to the elderly. In order to finance such initiatives, the consumption tax has been raised from 3 percent to 5 percent (effective April 1, 1997). Equally significant is the preparation of a new proposed law, Kaigo Hoken Ho (Elderly Care Insurance). If instituted, this law will provide benefits and services to older persons in need of the institutional, intermediate, and home care described in app. table A1, plus other services such as equipment rental (e.g., wheelchairs). In order to qualify, one must be 65 years of age or older, but special provisions are also made for those age 40 and over who have disabilities. If enacted, the Elderly Care Insurance will begin in the year 2000 and will be financed by a payroll contribution for those ages 40-64. A monthly contribution is set at ¥2,500 (divided equally between employee and employer), and this will increase to ¥3,500 in 2010. For those self-employed or not working, the national government will cover 50 percent of the contribution. The Ministry of Health and Welfare estimates that 13 percent of persons ages 65 and older would use these services. See Asahi Shinbun (n. 5 above); and Look Japan (n. 5 above). Other reforms that have been introduced since 1996 affect national health care. At present, older persons pay a flat monthly rate of ¥1,020 (about $10) for a doctor visit. This will be changed to a ¥500 ($5) copayment per visit. If an elderly person sees a doctor more than four times in the same month, no copayment will be assessed for the fifth visit. In addition, a ¥15 (15¢) prescription charge will be imposed per medication per day. According to one estimate, these charges will triple the elderly's out-of-pocket expenses per month. The hospitalization fee will also increase from the current rate of ¥710 ($7)/day to ¥1,000 ($10)/day. See Asahi Shinbun (n. 5 above). These reform measures, in addition to Elderly Care Insurance, were presented to a regular session of the Diet in February 1997. These reforms are still being deliberated at the time of this writing.
74. Critiques of democratic societies, characterized by intense interest-group competition and pluralism, suggest that such societies (e.g., the United States, the United Kingdom) fail to integrate social and economic planning. See Theodore J. Lowi, The End of Liberalism, 2d ed. (New York: Norton, 1979); Ramesh Mishra, The Welfare State and Capitalist Society (Toronto and Buffalo, N.Y.: University of Toronto Press, 1990); Harold L. Wilensky, ¢Political Legitimacy and Consensus: Missing Variables in the Assessment of Social Policy,¢ in Evaluating the Welfare State: Social and Political Perspectives, ed. Shimon E. Spiro and Ephraim Yuchtman-Haar (New York: Academic Press, 1983), pp. 51-74. Such critiques maintain that integrated social and economic policies are most evident in corporatist democracies where bargaining processes develop that allow for the interplay of powerful, frequently centralized, economic blocs. These bodies are often employer, labor, and professional associations that negotiate with a centralized government. This bargaining occurs with respect to the broad national context rather than solely on labor market issues (Wilensky, p. 71). Such corporatism results in social policy and economic policy decisions being jointly addressed, as is characterized by policies in Austria, Norway, and Sweden. Japan and France can be classified as variants of corporatism; they do not integrate organized labor.
75. Critiques of democratic societies, characterized by intense interest-group competition and pluralism, suggest that such societies (e.g., the United States, the United Kingdom) fail to integrate social and economic planning. See Theodore J. Lowi, The End of Liberalism, 2d ed. (New York: Norton, 1979); Ramesh Mishra, The Welfare State and Capitalist Society (Toronto and Buffalo, N.Y.: University of Toronto Press, 1990); Harold L. Wilensky, ¢Political Legitimacy and Consensus: Missing Variables in the Assessment of Social Policy,¢ in Evaluating the Welfare State: Social and Political Perspectives, ed. Shimon E. Spiro and Ephraim Yuchtman-Haar (New York: Academic Press, 1983), pp. 51-74. Such critiques maintain that integrated social and economic policies are most evident in corporatist democracies where bargaining processes develop that allow for the interplay of powerful, frequently centralized, economic blocs. These bodies are often employer, labor, and professional associations that negotiate with a centralized government. This bargaining occurs with respect to the broad national context rather than solely on labor market issues (Wilensky, p. 71). Such corporatism results in social policy and economic policy decisions being jointly addressed, as is characterized by policies in Austria, Norway, and Sweden. Japan and France can be classified as variants of corporatism; they do not integrate organized labor.
76. Critiques of democratic societies, characterized by intense interest-group competition and pluralism, suggest that such societies (e.g., the United States, the United Kingdom) fail to integrate social and economic planning. See Theodore J. Lowi, The End of Liberalism, 2d ed. (New York: Norton, 1979); Ramesh Mishra, The Welfare State and Capitalist Society (Toronto and Buffalo, N.Y.: University of Toronto Press, 1990); Harold L. Wilensky, ¢Political Legitimacy and Consensus: Missing Variables in the Assessment of Social Policy,¢ in Evaluating the Welfare State: Social and Political Perspectives, ed. Shimon E. Spiro and Ephraim Yuchtman-Haar (New York: Academic Press, 1983), pp. 51-74. Such critiques maintain that integrated social and economic policies are most evident in corporatist democracies where bargaining processes develop that allow for the interplay of powerful, frequently centralized, economic blocs. These bodies are often employer, labor, and professional associations that negotiate with a centralized government. This bargaining occurs with respect to the broad national context rather than solely on labor market issues (Wilensky, p. 71). Such corporatism results in social policy and economic policy decisions being jointly addressed, as is characterized by policies in Austria, Norway, and Sweden. Japan and France can be classified as variants of corporatism; they do not integrate organized labor.
77. Tomita, Nakamura, and Hrebenar (n. 11 above), pp. 274-75. Also see Akira Nakamura, "Different Faces with a Familiar Style: From Bureaucratic Dominance to Conservative Party Dominance in Japanese Policymaking," Journal of Management Science and Policy Analysis 7, no. 3 (Spring 1990): 191-210.
78. This concern with fiscal constraint is reflected in the fact that the proportion of national income that was devoted to social welfare including services for the elderly, for 1996 was 37.2 percent. This compares with 36.3 percent in the United States, 53.4 percent in Germany, 62.6 percent in France, and 69.8 percent in Sweden. See "Bold Initiatives" (n. 5 above), p. 5.