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That surging economy allowed the Liberal Democratic Party to expand the country's health care system as Japan aged, but by the s, the enormous price tag raised the spectre of tax hikes. Shoppers browse at a store in the Sugamo district of Tokyo. Japan chose to supplement its national pension plan with long-term-care insurance LTCI , which was implemented in Professor Nanako Tamiya, a Japanese health care expert writing in The Lancet, called LTCI "one of the most generous long-term-care systems in the world in terms of coverage and benefits.

It is incredibly comprehensive, and removes the anxiety and unpredictable nature of elderly care elsewhere.

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People pay into the system starting in their 40s and are eligible to receive benefits starting at 65, or earlier in the case of illness. When they apply, applicants are interviewed by a municipal employee who feeds the resulting information into an algorithm that assigns the person a care level. That, in turn, is analyzed by an expert committee of welfare workers.

A care plan is then drawn up, allowing the patient to choose between competing institutions and service providers offering everything from home visits, bathing and help getting groceries to paying for short stays in hospitals or long-term residence in nursing homes and specialized group homes for dementia patients. LTCI co-payments are capped or waived for low-income individuals, and the system saves money by providing options other than full-on institutionalization. Around six million people are enrolled in LTCI. But the government already introduced significant reforms in that attempted to better integrate health care, prevention and long-term care.


Over the years, Japan — which controls health care policy through the central government, unlike Canada — has demonstrated to other governments around the world that it pays to adjust programs before problems become systemic. Hajime Ikushima, who worked as a carpenter in greater Tokyo, is an example of the many self-employed Japanese who didn't pay an adequate amount into their pensions throughout Japan's strong period of economic growth. Ikushima, who has moved back in with his son as he sells used shoes, watches and jewellery at a small neighbourhood market in Saitama city.

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Over the years, many poor Japanese — particularly elderly people who have no family caregivers — have become poorer as Abenomics and aggressive monetary easing devalued the Japanese yen, boosting profits for exporters but making the price of daily goods more expensive. Ken Kato, an assistant professor at Nagoya's Fujita Health University, says Japan's policies have helped shift people from staying in institutions.

Before LTCI, there were no co-payments required from patients, and staying in institutions became something of a social activity for elderly Japanese people. That has changed, Dr. Kato says, but there are still too many regional variations in the way patients are graded, the facilities that are available and the level of care. Kato says. The LTCI system was originally designed to alleviate the strain on family caregivers, but that hasn't entirely happened. Research shows that LTCI, in terms of freeing up family carers to work and have more free time for themselves, has only marginally benefited caregivers, and only then from wealthier families.

Hanae Nozawa, a year-old housewife, did what has been traditionally expected of Japanese daughters-in-law: She took care of her elderly mother-in-law, who has since died. She also took care of her father-in-law, who had dementia. Now that both of her in-laws have passed, she's looking after her year-old father. Hanae Nozawa and her father. But even for caregivers like Ms.

Nozawa, Japan is innovating. Japan is facing a shortage of physicians as well, particularly in outlying areas, and many can be pressed for time.

Hori says. Leaders at the hospital in rural Asuke took other initiatives, as well. They surveyed the community to figure out their problems with the existing system, organized a private transit network of subsidized taxis and buses that bring elderly patients for appointments, and implemented electronic health records long before other jurisdictions in the West. The hospital even issued digital ID cards tagged with the person's medical history, allergies and illnesses to hundreds of elderly people in the district, which can be quickly scanned by emergency personnel or doctors.

Takanori Shibata and his Paro robotic seal. Japan is also leading in other areas, such as robotics. Long used in industrial settings, Japanese researchers are now looking at whether robots can help as the country ages, from robot suits that help rehabilitation to fully functional humanoid robots. One of the best examples is a robotic seal called Paro, invented by Takanori Shibata, the chief senior research scientist at Tsukuba's National Institute of Advanced Industrial Science and Technology.

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The fuzzy seal has been proven in various settings to reduce anxiety, stress, depression and even patients' perception of pain during chemotherapy treatments. Distributors in various countries have sold about 3, seals in 30 countries and they are deployed by 80 per cent of Denmark's local governments in state-run nursing homes. Shibata says the seal is especially useful for calming dementia patients and stops them from wandering around. It has often replaced heavy doses of psychotropic drugs.

Shibata explains a philosophical divide that has helped Japan develop these types of robots: In the West, robots are generally viewed with fear and are given tasks humans don't want to do, while artificial intelligence is viewed with deep suspicions; in hyper-modern Japan, however, most people are fine living alongside and being helped by robots and advanced technology. Shibata says. But they didn't work out too well. Also, perhaps understandably, he adds: "Dog lovers didn't like the cat robot. And cat lovers didn't like the dog robot.

Robotics is important enough that several experimental programs are now bankrolled by Japan's powerful Ministry of Economy, Trade and Industry. Some robotic arms allow elderly farmers to continue picking fruit in old age. There are also non-robotic, mechanical aids that can ease the strain on nurses and caregivers: The hospital in Asuke, for example, has a mechanical swing-lift that can help move patients from their bed or onto the toilet.

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Real robots are much costlier. Professor Shigeki Sugano of Tokyo's Waseda University invented the humanoid Twendy-One robot, which can help seniors out of bed, grab condiments from the fridge and deliver trays of food to elderly people. Sugano says. But that doesn't stop others, such as Dr. Shibata, from envisioning a future where robots like Paro are used to help maintain Japan's legendary quality of life, as so many people age that it strains government finances.

Ueda Kaichi, a year-old who founded a non-profit that helps disabled people find jobs, thinks like many young people in Japan, who are increasingly skipping pension payments. He worries that the current system operates solely for the boomers retiring now, and will change for the worse as more Japanese partake of the country's level of social services.

Tax Policy for Aging Societies

He doubts Japan's system will be as generous or as affordable when he retires, but he is optimistic about what his country can teach the world. It's necessary to also know the positive parts of Japanese society and what [they] can contribute. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe. If you would like to write a letter to the editor, please forward it to letters globeandmail. Readers can also interact with The Globe on Facebook and Twitter.

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