History Of Japan's Medical Insurance Policy, Under The Pressure Of Declining Birthrate Aging

Japan has the highest degree of aging with the fastest speed. Since it entered into the aging society in 1970, the ratio of the population of senior people over 65 years old in the total population has been rising rapidly and has surpassed 20% in 2005, namely, there is one senior person in every five people, which is European Country's 100-year result. The rocketing ageing of population threw severe pressure onto all areas of society in Japan including shortcoming of labor force, rising aged-dependency ratio, the long-term and stable needs of medical and nursing care, the increasing health-care costs, the growing financial burden of social security, etc.The thesis gives a systematic introduction of Japan's responsive adjustment of health-care security policy facing these pressures and tries to find out some experiences beneficial to China. Viewing the bring-in of nursing care insurance as the turning point, Japan's medical care security policy can be divided into two stages because the introduction marks that the whole social security system involving medical care security has begun to transform form "arranging system" to "contract system". As the objects of the implementation of those policies, the aged who had had to passively accept the government's arrangement before could take the initiative to choose different services according to their needs then. The transformation makes the policy not only more humane and faire but also helps to avoid overuse and waste of medical resources. However, it still couldn't drag Japan out of the dilemma between finance and security.Using the method of comparative analysis to compare all the health-care security policies around major reforms in Japan, the thesis analyzes some related issues of aging and their influence on the reform of medical care security policy from the perspective of life course, role tension, relation between generations, change of family structure and so on.As a responsive adjustment to financial shortage, the old-old medical care policy replaced the aged preservation of health institution. The future direction of policy adjustment in Japan will still aim at decreasing the cost under the condition of remaining as much security as before. In addition, the Japanese government hopes to reduce its running cost and increase the efficiency with the hand of civil power.