The fact that the premiums would be clearly earmarked for long-term care made it more attractive to the public, especially in the light of a general consensus that Japan must meet the challenges of an ageing society. With the implementation of public long-term care insurance (LTCI) in Japan on April 1, 2000, long-term care became an entitlement available to all older people, 65 and over, irrespective of income or amount of family support. The number one social policy concern in Japan has been the ageing of society. The first issue immediately faced by the Ministry of Health and Welfare was the opposition from the social welfare establishment on the grounds that those with low income would be disadvantaged by LTCI. The fact that LTCI is expanding more or less as planned, and expenditures are close to what was budgeted, is a remarkable achievement, given the difficulty of predicting the outcome of large social programmes.