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CHAPTER 23 SOCIAL SECURITY

This chapter presents social security, social insurance, and social welfare.

Social security presents statistics on social security benefits and finances. The primary source of data is "Financial Statistics of Social Security " compiled by the National Institute of Population and Social Security Research.

Social insurance presents statistics on medical care insurance, pension insurance, employment insurance, workmen's accident compensation insurance, nursing-care insurance for the elderly, pensions, and aid to wounded and sick-retired soldiers. The sources of data are "Annual Statistical Report on Social Security" compiled by the National Institute of Population and Social Security Research and "Annual Operational Report" of each social insurance.

Social welfare presents statistics on social welfare administration services, old age health and medical welfare, general welfare services, livelihood aid and social welfare institutions. The sources of data are "Report on Social Welfare Administration and Services", "Survey of Social Welfare Institutions", "Comprehensive Survey of Living Conditions ", "Survey of Insutitutions and Establishments for Long-term Care" by the Ministry of Health, Labour and Welfare, and "Annual Statistical Report on Social Security" mentioned above.

For public health and medical care, see "24 Health and Sanitation", and for industrial injuries, "29 Disasters and Accidents".

Social security benefits

The social security benefits are estimated by the National Institute of Population and Social Security Research, in conformity to the ILO (International Labour Organisation) standards, on the basis of benefits given in the annual account settlements of all social security systems. According to the ILO standards, the social security systems include social insurances (including employment insurance and industrial accident insurance), family allowances, special systems for public employees, public health (hygiene) services, public aid allowances, social welfare systems, benefits for war victims, etc.

ILO defines the social security system as a system that meet following three conditions:

<1>The system is to provide benefits against the following risks and / or needs:
(1) old age, (2) bereaved family, (3) disabled, (4) industrial accident, (5) hygiene and medical care, (6) family, (7) unemployment, (8) residence, (9) livelihood protection, etc.
<2> The system must be established by a law to provide specific benefits, and require public, semi-public or independent organisations to assume responsibility for it.
<3> It must be managed by a public, semi-public or an independent organ established by a law. Otherwise, it must be private organs entrusted by a law to execute their duties.

Social insurance

Social insurance is a system granting benefits in such cases as diseases, old-age, disability, death, unemployment, etc., in order to secure the livelihood of the insured persons and their survivors. It comprises medical care insurance which provides necessary medical treatments in case of diseases, injuries, deliveries, etc. and grants benefits for incidental economic losses; pension insurance against the loss or decrease in the ability of work due to old-age, disability, death, etc.; employment insurance against unemployment of persons who are competent for work but have no opportunity to work; workmen's accident compensation insurance which compensates for losses due to accidents on duty or while commuting; and the nursing-care insurance which publicly support the nursing care for the elderly persons. In addition, there are medical insurance and pension insurance under the social insurance system as explained below.

Medical insurance

The medical insurance has the following kinds depending on work, area and age.

Health insurance for ordinary employees (there are two systems, namely, the society-managed, employment-based health insurance managed by the associations for employees of large scale establishments where health insurance associations are set up according to the Health Insurance Act, and the public-corporation-run health insurance (up to September 2008, government-managed health insurance) for employees of medium and small establishments where health insurance associations are not set up).
The public-corporation-run health insurance for day workers (up to September 1984, the government-managed health insurance for day workers, and from October 1984 to September 2008, the government-managed health insurance).
Seamen's insurance (sickness section) and various mutual aid associations for the national and local government employees as well as the private school personnel (The mutual aid associations for the employees of public corporations such as Japan Railways, Japan Tobacco Industry, and Japan Telegraph and Telephone were integrated to the mutual aid associations of Government employees in April 1984 and recognised as the applicable legal associations. However, after April 1997, the health insurance associations were set up in the medical and health areas which became the applicable legal associations).
National health insurance for general residents other than the above (There are the national health insurance for specific occupations such as construction industries, medical doctors, etc. and the national health insurance for the ordinary persons other than the above).
Further, those persons aged 75 and over are covered by the long life medical care system (medical care system for elderly in the latter stage of life).

Pension insurance

The pension insurance was reformed in April 1986 in which the basic pension (or the national pension) system to cover all the Japanese was introduced, and the pensions for the employed was added on top of it. The pensions for the employed has the employees' pension insurance to cover general employees and the mutual aid associations to cover the central and local government workers as well as private school employees (The mutual aid associations for the former public corporations and the aid association for agriculture, forestry and fishery workers were integrated with the employees' pension insurance in April 1997 and in April 2002 respectively). In addition, there are the employees' pension fund, which is established by large establishments with more employees than a fixed number in order to carry out a part of the old age pension and to pay additional pension on the basis of provisions of the Employees' Pension Insurance Act, and the national pension fund to pay additional pension to the self employed persons as well as others who are not covered by the pensions for the employed. There also is the farmers pension (which was changed to a reserve system after January 2002) to pay additional pension to the said workers who are in the first category of the national pension and have satisfied certain specific conditions. Recipients here refer to the full-amount recipients and the recipients of partial amount or partially-suspended amount for reasons such as younger age or high income; and pensioners include the recipients, as well as those whose pension is completely suspended due to young age or re-employment.

Nursing-care insurance for the elderly

The Nursing-Care Insurance System for the Elderly started in April 2000 as a new system to support the nursing-care for the elderly by all the people of country by consolidating the old nursing-care systems, which had been separated into medical care and welfare care.

The insurer is the municipalities (shi, machi, and mura, including the special wards of Tokyo), and the insured persons consist of the first category who are 65 years old and over, and the second category who are the participants of the medical insurance and in the age bracket of 40 or more but less than 65 years of age.

Persons who need nursing-care: Persons of 65 years or older who are in need of nursing care, and persons of 40 years or older but below 65 who are in need of nursing care due to physical or mental disability caused by aging-related diseases specified by the Cabinet Order.
Persons who need support: Persons of 65 years or older who are in need of support, and persons of 40 years or older but below 65 who are in need of support due to physical or mental disability caused by the specified diseases.

Onkyu pension

Onkyu pension refer to those granted by the national government or local public bodies to their personnel or their survivors in order to secure their livelihood in the event that the government employees retired or died after a prescribed term of office, or retired or died of injuries or diseases incurred in line of duty. Onkyu pension are classified either as onkyu pension for military personnel for ex-soldiers or onkyu pension for public servants for civil service employees. It is noted that, since 1963, the system of onkyu pension, which had been absorbed completely into the mutual aid system, is applied at present only to the personnel or their survivors who retired or died in and before December 1962.

Estimates of National Medical Care Expenditure

National medical care expenditure is estimated every year by the Ministry of Health, Labour and Welfare to cover all expenditure associated with disease and wound treatments in the medical institutions during the said fiscal year. The amount includes expenditure for medical examinations and treatments, dispensing, inpatient meal service, inpatient living support, home-visit nursing care, etc.

Report on Social Welfare Administration and Services

The Report on Social Welfare Administration and Services is conducted to clarify the actual administrative performances based on the social welfare laws and regulations in the prefectures, designated cities and core cities, and to obtain basic data for the implementation of national social welfare policy. This survey used to be conducted as the Case Reports of Ministry of Health and Welfare since the establishment of the Ministry of Health and Welfare (currently Ministry of Health, Labour and Welfare) in 1938. It was renamed as "Report on Social Welfare Administration and Services" corresponding to the partial change of the Local Autonomy Act in fiscal 2000. The contents of the reports have been partially revised every fiscal year, due to the enactment or revision of laws and regulations or to administrative needs.

The reports are compiled every year, based on the monthly and annual reports from organs related to social welfare administration as well as social welfare institutions and facilities, which are transmitted through prefectures, cities designated by Cabinet Order and core cities. From fiscal 2012, the topics related to livelihood protection are integrated into the Survey on Public Assistance Recipients.

Administrative Organs Related to Social Welfare

They include the welfare offices established to provide assistance, nurturing or rehabilitation services based on the Social Welfare Act, as well as the child guidance clinics based on the Child Welfare Act, the assistance and rehabilitation clinics for the physically disabled persons based on the Welfare Act for Physically Disabled Persons, the rehabilitation clinics for intellectually disabled persons based on the Welfare Act for Intellectually Disabled Persons, and women's clinics based on the Prevention of Prostitution.

Survey on Public Assistance Recipients

This survey is conducted by the Ministry of Health, Labour and Welfare with the aim of clarifying conditions of receiving public assistance for household which are receiving or have received public assistance under Livelihood Protection Act and obtaining basic data needed for planning and management of the livelihood protection system and administration on health, labour and welfare. In fiscal 2012, the topics related to livelihood protection included in the Report on Social Welfare Administration and Services and those of the national survey on public assistance recipients were consolidated, and a new name, Survey on Public Assistance Recipients, was given. This survey is conducted based on reports on specified items from prefectures, designated cities by cabinet order and core cities.

Survey of Social Welfare Institutions

The actual conditions of social welfare institutions were originally reported in the administrative statistics based on the Statistical Reports on Health and Welfare Government Services, but since 1956 when the Survey of Social Welfare Institutions was initiated as an independent survey of the Ministry of Health and Welfare (currently Ministry of Health, Labour and Welfare), a detailed survey has been conducted every three years since 1985, and a simplified survey in those years between the two detailed surveys, they have been investigated every year by this survey. The survey investigates functions of the nationwide social welfare institutions as of 1 October (31 December through 1971 and before). The conduct of the survey is entrusted by the Ministry of Health, Labour and Welfare to a private corporation, and the questionnaires are sent out by mail and entered by the representatives of social welfare institutions.

Social Welfare Facilities

They are facilities established to manage social welfare activities based on the Social Welfare Act. They include the protection facilities based on Livelihood Protection Act, the elderly welfare facilities based on Elderly Welfare Act, the support facilities for persons with disabilities based on Services and Supports for Persons with Disabilities Act, the institutions for supporting social activities of the physically disabled based on Act on Welfare of Physically Disabled Persons, the women's protection facilities based on the Act of Prevention of Prostitution, the child welfare facilities based on Child Welfare Act, the mother-and-child welfare facilities base on Welfare Act for Mother-and-child and Widowed Women, and other social welfare facilities.

Survey of Insutitutions and Establishments for Long-term Care

The Survey of Insutitutions and Establishments for Long-term Care is conducted by the Ministry of Health, Labour and Welfare since 2000 in conjunction with the start of the Nursing-Care Insurance System in April 2000, with a purpose to obtain the basic information needed for the base development for the nursing-care service supply.

The Survey covers nursing-care facilities, in-house service establishments and in-house care support establishments, and managers of all the facilities and establishments currently active are requested to fill in the questionnaire.

Welfare Nursing-Care Facilities for the Elderly

They are the Special Nursing Homes for the Elderly defined in the Elderly Welfare Act (with the capacity of 30 or more persons, since April 2008 due to the revision of the nursing-care insurance system), and also designated by the prefecture governors as such in accordance to the Long-Term Care Insurance Act. They are intended to provide, according to the institutional service plans, dairy life care services such as bathing, excreting, eating and support for other daily activities, as well as functional training, health care and recuperation support.

Medical Nursing-Care Facilities for the Elderly

They are the facilities established with a permission from the prefecture governors to provide, according to the institutional service plans, such services as nursing-care under the supervision of medical and nurse personnel, functional training, other medical treatment and support of daily activities to those persons who need nursing-care inside the facilities.

Medical Facilities for Recuperation and Nursing-Care for the Elderly

They are the medical facilities defined by the Medical Act and also received prefecture governor's permission under the Long-Term Care Insurance Act. They are intended to provide, based on the institutional service plans, medical and nursing care, nursing care under medical supervisions, functional training and other necessary medical treatments to those who need nursing-care inside the institutions.

Child Allowance

The Child Allowance under the Child Allowance Act (in fiscal 2010 and 2011, the allowance under the name of "Kodomo teate" based on two acts legislated for this allowance) has been in effect since 1972 with the purpose of achieving stability of living for families etc. and helping them bring up healthy children who will be leading the next generation.

Comprehensive Survey of Living Conditions (Fundamental Statistical Survey)

This survey is conducted by the Ministry of Health, Labour and Welfare with the aim to provide basic data for planning and implementation of health, labour and welfare policy. It was initiated in 1986 by consolidating "Basic Survey for Welfare Policy", "National Health Survey" and "Basic Survey for Health and Hygiene". Full scale surveys are conducted every three years and simplified surveys are conducted in other years.

The survey is a sampling survey covering all the households and their members within the sample districts chosen by a stratified random sampling method from the enumeration districts of the 2010 Population Census. The household questionnaires are distributed and collected by the enumerators through the channels of prefectures, cities having health centres and special wards, and health centres. The 2013 survey, was conducted as of 6 June covering about 300,000 households and about 740,000 household members in 5,530 districts.

Household of the aged

Referring to household consisting of male and / or female of 65 years old and over only, or with the addition of unmarried child(ren) under 18 years old.

Mother and child (ren) household

Referring to household consisting of female under 65 years old without spouse and her child(ren) under 20 years old only.

Father and child (ren) household

Referring to household consisting of male under 65 years old without spouse and his child(ren) under 20 years old only.

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