Ayano Minamibashicountries, poses significant challenges to the sustainability of long-term care systems. Both Japan and the United Kingdom (UK) are experiencing rapid demographic aging, however, Japan’s proportion of people aged 65 and over has reached 29.7%, significantly higher than the UK’s 19.5%. countries differ substantially in how their long-term care systems are structured. In Japan, institutional care is positioned as part of a continuum of care under the long-term care insurance system. In contrast, in the UK, The key differences between Japan and the UK lie in the degree of state intervention and the method of financing. Japan introduced its long-term care insurance system in 2000, establishing a framework in which society as a whole supports elderly care. Under this system, individuals aged 40 and over pay insurance premiums, and those aged 65 and above who are certified as requiring care can access services with partial cost coverage. Users typically pay only 10-30% of service costs, while the remainder is financed through insurance contributions and public funds. This system operates as a form of prepayment for future care needs, distinguishing it from general taxation-based welfare systems. The introduction of this system aimed to move away from a traditional family-based care model. Until the 1990s, elderly care in Japan was largely provided by family members, particularly women with limited public support. However, factors such as increased female labour force participation, the rise of nuclear families, and rapid aging made this model unsustainable, leading to the socialization of care. The emphasis on in-kind service provision, rather than cash benefits, reflects this objective of replacing family care with formal services. In contrast, the UK does not have a universal public long-term care insurance system like Japan. Instead, care services are primarily funded through taxation and individual contributions. Historically the UK developed as institutional care is often regarded as a last resort due to policies prioritizing home-based care and means-tested access. This paper compares the long-term care systems of Japan and the UK, focusing on the role of institutional care. While both countries are moving toward limiting institutionalization, this trend is driven by different historical backgrounds and underlying principles. This paper argues that such convergence reflects the constraints imposed by population aging and limited resources, which can override differences in institutional design.a welfare state where both healthcare and social care were provided by the state. However, since the 1980s, neoliberal reforms and public expenditure cuts have reduced reliance on costly institutional care. As a result, access to care services in the UK is subject to means testing, where individuals’ income, savings, and assets determine their level of financial contribution. Those with assets above a certain threshold must bear a significant portion or even the full cost of care. Additionally, the concept of “aging in place” is emphasized, promoting care within the community and supporting independent living. Thus, the UK adopts a residual welfare model in which state support is considered a last resort, after personal resources, family support, and private insurance have been exhausted. Compared to Japan’s more universal and collective approach, the UK placed greater emphasis on individual responsibility. These differences also reflect contrasting views on the role of the state and a method of financing. In Japan, the state plays a comprehensive role in ensuring access to care, while in the UK, its role is more limited and conditional. Furthermore, Japan relies on a social insurance model with nationally pooled resources, resulting in relatively smaller regional disparities. In contrast, the UK’s reliance on local government funding can lead to regional inequalities particularly in areas with high care needs but limited tax revenue. These institutional differences significantly influence the role assigned to residential care facilities. Rapid population aging, particularly in developed Despite facing similar demographic pressures, the two King's College London12 Introduction Differences in Long-Term Care SystemsA Comparative Study of Long-Term Care Systems in Japan and the UK: Institutional Principles and Sustainability Challenges
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