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Public Policy and the Old Age Revolution in Japan
Thirty years ago, when compared to the U.S., England, France, and Sweden, Japan had the lowest life expectancy for males and females. Today, Japan has the highest life expectancy and is the world's most rapidly aging society. Public Policy and the Old Age Revolution in Japan captures the vitality of Japanese policymakers and the challenges they face in shaping a modern society responding to its changing needs. The rapid transition to an aging society poses a set of complex policy and resource dilemmas; the responses taken in Japan are of great value to policymakers, professionals, and students in the fields of gerontology, Asian and Japanese studies, sociology, public policy, administration and management, and anthropology in other industrial aging societies.
Readers of Public Policy and the Old Age Revolution in Japan will discover the array of social and economic implications that comes with an increasingly aged society. Such a change in demographics affects pension expenditures and pension contributions, capital formation and savings rates, health costs, service systems, tax bases, labor pools, career counseling, training, advertising, and marketing. This book does not stop with these topics, however. Readers also learn about:
how older Japanese workers are staying employed and employable
policies in Japan for a smooth transition from work to retirement
Japan's Silver Human Resource Centers
the new direction of health services in Japan
the Japanese financing system for elderly health care
the expansion of formalized in-home services for Japan's aged
Japanese housing policy and the concept of universal design
the Gold Plan, a comprehensive ten-year plan to promote health care and welfare for the aged
the concept of ikigai--promoting feelings of purpose and self-worth in the aged
Public Policy and the Old Age Revolution in Japan is one of only a handful of books prepared in English by American and Japanese
eBook
Caring for the Elderly in Japan and the US
In an era of changing demographics and values, this volume provides a cross-national and interdisciplinary perspective on the question of who cares for and about the elderly. The contributors reflect on research studies, experimental programmes and personal experience in Japan and the United States to explicitly compare how policies, practices and interpretations of elder care are evolving at the turn of the century.
eBook
Robots won't save Japan : an ethnography of eldercare automation
Robots Won't Save Japan addresses the Japanese government's efforts to develop care robots in response to the challenges of an aging population, rising demand for eldercare, and a critical shortage of care workers. Drawing on ethnographic research at key sites of Japanese robot development and implementation, James Wright reveals how such devices are likely to transform the practices, organization, meanings, and ethics of caregiving if implemented at scale.
This new form of techno-welfare state that Japan is prototyping involves a reconfiguration of care that deskills and devalues care work and reduces opportunities for human social interaction and relationship building. Moreover, contrary to expectations that care robots will save labor and reduce health care expenditures, robots cost more money and require additional human labor to tend to the machines. As Wright shows, robots alone will not rescue Japan from its care crisis. The attempts to implement robot care instead point to the importance of looking beyond such techno-fixes to consider how to support rather than undermine the human times, spaces, and relationships necessary for sustainably cultivating good care.
eBook
End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported
Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United states, and the canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United states to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.
Journal Article
The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection
This paper exploits a sharp reduction in patient cost sharing at age 70 in Japan, using a regression discontinuity design to examine its effect on utilization, health, and financial risk arising from out-of-pocket expenditures. Due to the national policy, cost sharing is 60-80 percent lower at age 70 than at age 69. I find that both outpatient and inpatient care are price sensitive among the elderly. While I find little impact on mortality and other health outcomes, the results show that reduced cost sharing is associated with lower out-of-pocket expenditures, especially at the right tail of the distribution.
Journal Article
Influenza vaccine effectiveness against hospitalization during the 2018/2019 season among older persons aged ≥ 75 years in Japan: The LIFE-VENUS Study
•We analyzed influenza vaccine effectiveness during the 2018/2019 season in Japan.•The population-based study cohort comprised older persons aged ≥ 75 years.•Vaccine effectiveness against hospitalization was 28.9%.•This is Japan’s largest cohort study on influenza vaccine effectiveness to date.
Older persons are recommended to receive annual influenza vaccinations due to their increased susceptibility to influenza infections and related complications. Routine assessments of influenza vaccine effectiveness (IVE) in older persons may help to improve vaccine development and vaccination strategies, but there is a lack of consistent epidemiological data from Japan. This study aimed to evaluate IVE against hospitalization during the 2018/2019 season among older persons aged ≥ 75 years in Japan.
This cohort study was conducted using insurance claims data and vaccination records provided by the Longevity Improvement & Fair Evidence - Vaccine Effectiveness, Networking, and Universal Safety (LIFE-VENUS) Study. The study cohort comprised older persons aged ≥ 75 years residing in an urban municipality in Japan. Vaccinated participants were identified through vaccination records from October 2018 to January 2019, and were matched with unvaccinated participants using a 1:1 ratio. The IVE against hospitalization was calculated as (1−hazard ratio) × 100% while adjusting for covariates such as age, sex, comorbidities, previous vaccinations, and care needs levels.
We analyzed 30,881 vaccinated participants matched with 30,881 unvaccinated participants. Among these, 587 (1.9%) vaccinated participants and 644 (2.1%) unvaccinated participants were hospitalized during the 2018/2019 season. The adjusted IVE against hospitalization was estimated to be 28.9% (16.6–39.4%).
The influenza vaccine for the 2018/2019 season showed moderate effectiveness among older persons in Japan. The LIFE-VENUS Study represents a potential platform for the continued monitoring of IVE among the older Japanese population.
Journal Article
Japanese Local Governments’ Dissemination Activities for Advance Care Planning: A Descriptive Analysis of a Nationwide Survey during the COVID-19 Pandemic
This study aims to compare the awareness-raising activities between municipalities with and without focused anti-infection measures during the 2019 coronavirus disease (COVID-19) pandemic. Descriptive analysis was conducted using a nationwide self-administered questionnaire survey on municipalities’ activities for residents and for healthcare providers and care workers (HCPs) in October 2022 in Japan. This study included 433 municipalities that had conducted awareness-raising activities before 2019 Fiscal Year. Workshops for residents were conducted in 85.2% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures than those without measures (86.8% vs. 75.4%). Additionally, 85.9% of the municipalities were impacted by the pandemic; 50.1% canceled workshops, while 26.0% switched to a web-based style. Activities for HCPs were conducted in 55.2–63.7% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures. A total of 50.6–62.1% of the municipalities changed their workshops for HCPs to a web-based style. Comparisons between areas with and without focused anti-infection measures indicated that the percentages of those impacted for all activities were not significantly different. In conclusion, awareness-raising activities in municipalities were conducted with new methods during the COVID-19 pandemic. Using information technology is essential to further promote such activities for residents.
Journal Article
Development and application of a Japanese vaccine database for comparative assessments in the post-authorization phase: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study
•This is Japan’s first database that enables comparative assessments of vaccines.•A pilot study assessed influenza vaccine safety in vaccinated and unvaccinated groups.•The VENUS Study can support a variety of vaccine studies in the post-authorization phase.
Japan currently lacks a data platform that can support quantitative assessments of the causal relationships between vaccines and adverse events. This study describes the development and application of the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) Study to facilitate such assessments.
A database was created by linking public insurance enrollees’ claims data with vaccination records acquired from participating municipalities. To provide an overview of the study data, we produced descriptive statistics of sex, age, and vaccinations. We also conducted a pilot study using the database to assess influenza vaccine safety during the 2018/2019 season among older persons (≥65 years) residing in a single municipality.
Our database was created using data from approximately 1.12 million individuals in 7 municipalities between 2013 and 2020. The data during fiscal year 2018 included 853,016 individuals (male: 363,079, female: 489,937) with a median age of 70 years (interquartile range: 52–79). We obtained information on 17 vaccine types, including the pneumococcal vaccine and influenza vaccine. In the pilot study, we analyzed 48,723 vaccinated persons matched with 48,723 unvaccinated persons. The only adverse event that occurred in both groups was Bell’s palsy, which had an adjusted incidence rate ratio of 1.21 (95 % confidence interval: 0.48–3.07).
The VENUS Study is Japan’s first healthcare data platform that enables comparative assessments of vaccinated and unvaccinated persons in large samples covering all age groups. Efforts are underway to increase the number of participating municipalities and to generate evidence on vaccine effectiveness and safety.
Journal Article
Digital-Based Policy and Health Promotion Policy in Japan, the Republic of Korea, Singapore, and Thailand: A Scoping Review of Policy Paths to Healthy Aging
People are living longer, and our life has become more digital. Hence, the benefits from digital technology, including economic growth, increasing labor productivity, and ensuring health equity in the face of an aging population emerged as a vital topic for countries around the world. Japan, the Republic of Korea (ROK), Singapore, and Thailand are in the top ten rankings in terms of information and communication technology (ICT) development within the Asia Pacific Region and all are facing challenges of population aging. Well-designed national ICT policy and health promotion policies enabled the countries to make significant progress and development in terms of digitalization and healthy aging. This paper aims to answer questions regarding digitization and health promotion: when it started, how it is going, what are the achievements, and what it holds for the future, considering healthy aging and digitalization by reviewing the national ICT policy and health promotion policies of Japan, Korea, Singapore, and Thailand. This paper is expected to help readers build a comprehensive understanding of each country’s journey towards building a healthy aging digital society. Furthermore, we hope this paper can be a source for countries to exchange experiences and learn from each other with a joint goal of building a healthy aging digital society.
Journal Article