Home > Statistics > Handbook > Chapter 15 Social Security, Health Care, and Public Hygiene
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Saying good-bye at day's end with a visiting nurse. Currently, Japanese society is increasingly aging with fewer children. A long-term care insurance system began in April 2000 so that society as a whole can support people needing assistance and nursing care, who are expected to increase in number due to the further progression of aging and the trend toward having nuclear families.
In Japan, where the fertility rate is staying substantially lower than the population replacement level, society is aging at an unprecedented pace at the same time. Meanwhile, its social security system is required to address various changes in the socioeconomic environment, including the expanding deficit.
In April 2000, a long-term care insurance system was launched. This is owed to the fact that the issue of elderly care, including the excessive burden of care resting on family members alone, had loomed as a social problem as the aging of society progressed. At the onset of the system (in 2000), the number of care service users was approximately 1.5 million. It subsequently jumped, coinciding with rapid rises in the aggregate long-term care insurance cost (long-term care insurance finances). Therefore, an all-round revision was made to the system in 2005, including putting greater emphasis on disease prevention. As of July 2008, the number of long-term care service users amounted to approximately 3.78 million.
Total expenditure on social security benefits is increasing annually, thus making a review of benefits and burdens an urgent issue in order to ensure that the social security system is sustainable over the long term. In fiscal 2006, social security benefit expenditures totaled 89.1 trillion yen (up 1.5 percent from the previous fiscal year), a figure which amounted to 697,400 yen per person. The proportion of Japan's social security expenditure to national income registered 23.9 percent. Benefits for the aged accounted for approximately 70 percent of total social security benefit expenditures.
Trends in social security benefit expenditures by sector showed that the proportion of pension to the total social security benefit expenditures has recently risen. In fiscal 2006, pensions accounted for more than half (53.1 percent) of total social security benefit expenditures, while medical care accounted for 31.5 percent, and social welfare and others for 15.4 percent. Social security benefit expenditures are forecasted to continue growing, and are projected to reach 141 trillion yen in fiscal 2025.
In accordance with the rise in social security benefit expenditures, the amount of funds necessary to cover these expenditures has also increased, reaching 104.4 trillion yen in fiscal 2006. This was financed by 56.2 trillion yen from social insurance contributions, 31.1 trillion yen from taxes and 17.1 trillion yen from other sources.
The national contribution ratio (the combined ratios of taxes and social security costs to national income) was 40.0 percent in fiscal 2007 (taxation burden: 24.8 percent; social security premiums: 15.2 percent), up 0.9 percentage points from 39.1 percent in fiscal 2006. The national contribution ratio in 2006 was 34.7 percent in the U.S.A., 49.2 percent in the U.K., and 66.2 percent in Sweden. While the ratio in Japan was higher than that of the U.S.A., it was lower than European countries.
The social welfare institutions shown below provide users with various services either for free or partially free.
Japan has a national health insurance system to ensure that anyone can receive necessary medical treatment. Under this system, every citizen belongs to a public medical insurance system, such as employees' health insurance or national health insurance.
This medical care system is highly regarded internationally because, along with improvements in the living environment and better nutrition, it has contributed to Japan's achieving the highest life expectancy and healthy life expectancy in the world, as well as a high standard of healthcare. Currently, reform of the whole system is being undertaken in order to sustain this medical insurance system in the future.
Life expectancy at birth was 86.05 years for women and 79.29 years for men in 2008. Japan's life expectancy remains the highest in the world. Japan's infant mortality rate fell to as little as 2.6 per 1,000 births in 2008.
The death rate was 907.1 per 100,000 population in 2008. The leading cause of death was malignant neoplasms (277.2 per 100,000 population). Other major causes were lifestyle diseases such as heart diseases (144.4; excluding hypertensive diseases) and cerebrovascular diseases (100.8), in which people's daily diet and behavior are significant factors therefor. Together, these causes accounted for approximately 60 percent of all deaths. Malignant neoplasms became the leading cause of death in 1981. The death rate by malignant neoplasms has continued to increase since, reaching 30.0 percent of all deaths in 2008.
Due to the increasingly complex social environment created by a highly-technological, competition-oriented society, the stress levels felt by all age groups are rising. The number of suicides in Japan surpassed the 30,000 mark for the first time in 1998 and has since remained in the range of 30,000 per year, registering at 30,197 in 2008. The number of suicides was particularly high for men in their 20s, 30s and 40s.
Due to the increased international movement of people and goods, and to the impact on the environment caused by land development, emerging infectious diseases and re-emerging infectious diseases, including AIDS, Influenza A (H1N1) and tuberculosis, pose a serious threat to the health of the Japanese people.
In terms of healthcare provision, Japan had 275,127 physicians engaged in medical care, or 215.3 physicians per 100,000 population, in 2006. While the number of physicians providing healthcare is increasing nationwide, their uneven distribution has become a problem due to the lack of physicians specializing in certain areas of medicine and the lack of physicians operating in regional parts of the country.
The number of hospital beds in Japan (excluding those in general clinics and dental clinics) totaled 1,268.0 per 100,000 population in 2007.
National medical care expenditures have been increasing gradually. In fiscal 2006, the expenditures totaled 33.1 trillion yen or 8.88 percent of Japan's national income. The cost of medical care per person averaged 259,300 yen in fiscal 2006.
Medical costs for treating the elderly in fiscal 2006 were 11.3 trillion yen, or about one-third of national medical care expenditure, and accounted for 3.02 percent of the national income. The per-capita cost of medical care for the elderly averaged 832,373 yen for the year. Rising medical costs for the elderly, resulting from the rapidly aging population, etc., is one of the major contributors to the overall uptrend in national medical care expenditures.
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