This report aims to inform an approved Technical Product on Long-term care financing: lessons for low- and middle-income countries, which aims to share experiences globally to inform programs and policies in low- and middle-income countries. The report also aims to fulfil WKC’s objective for local engagement, by engaging researchers in the Kansai region to learn from and inform a global technical product. The report aims to describe the current system of financing long-term care (LTC) for older people focusing on long-term care insurance (LTCI) at the national and local levels. The report describes how a financially stable system is achieved and reviews the historical policy changes and evolution of the related data collection systems in the pursuit of LTC.

This brief is part of a series about financing health and social long-term care: lessons for low- and middle-income countries (LMICs). Countries take a universal or selective approach, or some mix of the two, in identifying the population that will be covered under LTC programmes. Decisions are based on the economic and social contexts, and LTC is designed with consideration of the existing infrastructure for delivering health and social care. Universal approaches are grounded in the principle of ensuring equal access to health and social care. Selective approaches focus on those in greatest need, primarily those who are low-income. While selective approaches are perceived to cost less, the total costs may be offset by the high cost of implementing means-testing to identify beneficiaries. The selective approach may also result in high levels of unmet needs among people who do not meet the low-income thresholds. Mixed universal and selective approaches enable universal coverage for some services or populations and means-tested eligibility for others; thus, older people may face high payments for some needed services. Many LMICs have initiated mixed approaches to LTC, using public and private resources while building the policies, systems and infrastructure for universal coverage of LTC.

Ageing population poses a set of complex policy and dilemmas for social security systems, intensifying the concerns about rising expenditures in health care and long-term care for elderly. In this context, ageing societies has many valuable lessons to learn by studying Japan's experience dealing with its hyper-aged society and particularly from its strategies to ensure the financial sustainability of the Long-Term Care Insurance (LTCI) system. Based on an exhaustive literature review, and the results from six original researches on long-term care expenditures in Japan (LTCE) conducted during a doctoral program, the book provides a comprehensive view in analyzing trends and factors associated with increasing expenditures in the Long-Term Care Insurance system in Japan. The book address relevant topics such as; the main socio-demographic changes experienced by the Japanese society during the last three decades, predictors of the LTCE, measuring efficiency in nursing homes, the impact of the LTCI 2005-reform to contain expenditures, cost-effectiveness of the in-home and community based services and institutional LTCE in the last year of life. The book end with a discussion on futures challenges and strategies oriented to contribute with the sustainability of LTCI system in Japan.

Aging is a process that encompasses virtually all aspects of life. Because the speed of population aging is accelerating, and because the data needed to study the aging process are complex and expensive to obtain, it is imperative that countries coordinate their research efforts to reap the most benefits from this important information. Preparing for an Aging World looks at the behavioral and socioeconomic aspects of aging, and focuses on work, retirement, and pensions; wealth and savings behavior; health and disability; intergenerational transfers; and concepts of well-being. It makes recommendations for a collection of new, cross-national data on aging populationsâ€"data that will allow nations to develop policies and programs for addressing the major shifts in population age structure now occurring. These efforts, if made internationally, would advance our understanding of the aging process around the world.

'While there already exists a crowded body of publications addressing the effect of an aging population on the economy, this monograph is most outstanding in presenting a global, in-depth analysis of the implications thereby generated for 23 developed and developing countries. . . Scholars, researchers, and practitioners everywhere will benefit immensely from this comprehensive work.' – H.I. Liebling, Choice 'Ron Lee and Andrew Mason's Population Aging and the Generational Economy is a demographic and economic tour-de-force. Their collaborative, intercontinental. . . study of aging, consumption, labor supply, saving, and private and public transfers is the place to go to understand global aging and its myriad and significant economic challenges and opportunities.' – Laurence Kotlikoff, Boston University, US 'The culmination of. . . work by Lee, Mason, and their collaborators from around the world to extend Samuelson's framework to accommodate realistic demography, empirical measurement of age-specific earnings, consumption, tax payments, and benefit receipts, the studies. . . demonstrate the power of this integrated economic-demographic framework to advance our understanding of critical public policy challenges faced by countries at different stages of demographic transition and population aging.' – Robert Willis, University of Michigan, US 'Lee and Mason have done scholars and practitioners a magnificent service by undertaking this comprehensive, compelling, and supremely innovative examination of the economic consequences of changes in population age structure. The book is a bona fide crystal ball. It will be a MUST READ for the next decade!' – David Bloom, Harvard School of Public Health, US 'Population Aging and the Generational Economy provides an encompassing account of what we know about population aging and the impact that this process will have on our economies. It does not confine itself to the advanced industrial countries, where aging has already been largely studied, but adopts a truly global perspective. I am sure it will become a key reference for researchers, students and those involved in policy-making in areas that are affected by population aging.' – Giuliano Bonoli, Swiss Graduate School of Public Administration (IDHEAP), Switzerland Over coming decades, changes in population age structure will have profound implications for the macroeconomy, influencing economic growth, generational equity, human capital, saving and investment, and the sustainability of public and private transfer systems. How the future unfolds will depend on key actors in the generational economy: governments, families, financial institutions, and others. This path-breaking book provides a comprehensive analysis of the macroeconomic effects of changes in population age structure across the globe. The result of a substantial seven-year research project involving over 50 economists and demographers from Africa, Asia, Europe, Latin America, and the United States, the book draws on a new and comprehensive conceptual framework – National Transfer Accounts – to quantify the economic lifecycle and economic flows across generations. It presents comprehensive estimates of both public and private economic flows between generations, and emphasizes the global nature of changes in population age structure that are affecting rich and poor countries alike. This unique and informative book will prove an invaluable reference tool for a wide-ranging audience encompassing students, researchers, and academics in fields such as demography, aging, public finance, economic development, macroeconomics, gerontology, and national income accounting; for policy-makers and advisers focusing on areas of the public sector such as education, health, pensions, other social security programs, tax policy, and public debt; and for policy analysts at international agencies such as the World Bank, the IMF, and the UN.