ABSTRACT
This chapter uses a revised version of multiple-streams framework to examine long-term care insurance (LTCI) reform in Japan. Policy entrepreneurs, after learning from the experience of Germany, proposed funding long-term care by social insurance. However, the process of passing the LTCI bill was not smooth due to the inability of the Ministry of Health and Welfare (MHW) to reconcile conflicting and competing interests among multiple stakeholders. In order to pass the LTCI bill, the MHW and the ruling party had to incorporate the principle proposed by the opposition party into the LTCI bill and make compromises that weakened the effectiveness of the LTCI system in solving the problem of ‘medicalization of elderly care’. After the passing of the LTCI bill, the ruling party, out of electoral concerns, revised the LTCI system, which resulted in obstructing accomplishment of the objective of socializing care for the elderly. At present, Japan is a super-aged society. The government needs to make continued and unremitting efforts to ensure fiscal sustainability of the LTCI system, secure adequate professional care workers for the elderly, and provide necessary support for family caregivers.
