September 23, 2007


Land of the rising geriatrics: In any other country, 100th birthdays are a cause for celebration. Not so in Japan, where extraordinary life expectancy is creating a timebomb for the nation's health and social security systems. (Jeremy Laurance, 24 September 2007, Independent)

Japan is facing an ageing crisis as its elderly population grows. It is the fastest ageing society in the world and one in five Japanese people is over 65. By 2015, that proportion will have grown to a quarter – 33.8 million people – and it is projected to rise to 40 per cent by 2055. At the same time, the birth rate is falling because of the same social pressures facing western nations – later marriages, more women going to work and the trend for having smaller families. In 1949, Japanese women had an average of 4.32 children in their lifetime but this had halved by 1971. The birth rate has plunged further to 1.26 today, well below the replacement rate. As a result, Japan's population is projected to fall from its current 127 million to 90 million by 2055.

No country in the world has faced a challenge on this scale. As its elderly population grows, medical and pensions costs are surging but the number in the labour force who pay taxes to support the country's welfare system is falling. Thanks to Japan's long economic recession, which began with a stock market crash in 1989, the government debt is already the highest among developed nations. Today, there are three people of working age to support each person 65 but that number will have fallen to 1.2 by 2055.

Ed Wright, the First Secretary for Science and Health at the British Embassy in Tokyo, said: "It's a tough time to be 50 in Japan. People sold themselves to their companies in the 1970s in anticipation of a comfortable retirement. Now they have fears about job security, house prices which are worth a quarter of what they were. The stock market, which peaked at 40,000 points in 1989, now stands at 16,000, having been down to 7,000. They also worry about health insurance."

The ageing juggernaut about to hit Japan is heading down the tracks in all developed countries, and threatens social and economic meltdown on a global scale. That is why the world is watching closely to see how the Japanese cope. The government has responded on three fronts – with a new insurance scheme for the elderly, a strategy to stem the rise of obesity and other lifestyle diseases, and the introduction of hefty patient contributions to curb demand for healthcare. Will it be enough? [...]

The government is struggling to tackle a triple threat from the growing number of elderly, the incursion of western lifestyles and the increasing demands on the health system – with mixed results. In 2000, a long-term care insurance scheme was launched to which everyone over 40 is required to contribute an average of £20 a month. The fund is used to pay for care for the elderly, whose needs are ranked on a scale, either in their own homes or in care homes such as the one occupied by Mrs Matsumara. But the scheme has already run into difficulty as demand has vastly exceeded supply. Hence, the premium has been raised 40 per cent in five years and elderly applicants have been re-classified to a lower dependency level in order to reduce their benefits. The changes have raised doubts about the viability of the scheme and heightened the sense of insecurity about the future.

Dr Testuro Ichida, the head physician at his privately-run Ichida Hospital, said: "Many of us in the field feel the long-term care system is collapsing. There is not enough to pay decent wages to care assistants. We already have four patients over 100 in our hospital, and there will be many more."

In a further effort to restrain costs, the government has announced that, from next year, health insurers will be required to offer medical checks to anyone over 40. The aim is to reduce the burden of chronic diseases such as diabetes, which affects almost 20 million Japanese. A target to reduce diabetes by 25 per cent by 2015 has been set. In Britain, such a scheme would be unlikely to change people's behaviour on the scale required but in the more conformist society of Japan, it is already paying dividends. Staff health checks introduced by the car-maker Mitsubishi are claimed to have reduced risk factors by 30 per cent after lifestyle problems were identified.

On a third front, the government has massively increased the level of patient contributions – called "co-payments" – to the costs of healthcare. is that the growing majority of consumers won't dun themselves ever more for the services when they can just tax the providers more heavily.

Posted by Orrin Judd at September 23, 2007 8:27 PM

I believe that is why Aristotle thought that democracies couldn't last.

Posted by: Brandon at September 24, 2007 10:45 AM

Maybe they should institute a compulsory National Service draft of everyone who reaches an age ending in zero to have to serve a year in exchange for the next decade's "benefits".

Posted by: Raoul Ortega at September 24, 2007 11:03 AM

Surely robots can save the day!

Posted by: Randall Voth at September 25, 2007 1:54 AM

Productivity vs. human nature will define the 21st century. If we can get everything as cheap as dirt, in economic terms, then people can go about their merry way getting fat, dumb, and old.

Kill productivity (with say too much liberalism for instance), and its back to wars, famine, dictatorships, being skinny...and other fun 20th century activities.

Posted by: Perry at September 25, 2007 9:44 AM