Abstract
Long-term care (LTC) must be carefully delineated when expenditures are compared across countries because
how LTC services are defined and delivered differ in each country. LTC’s objectives are to compensate for
functional decline and mitigate the care burden of the family. Governments have tended to focus on the poor but
Germany opted to make LTC universally available in 1995/1996. The applicant’s level of dependence is assessed
by the medical team of the social insurance plan. Japan basically followed this model but, unlike Germany where
those eligible may opt for cash benefits, they are limited to services. Benefits are set more generously in Japan
because, prior to its implementation in 2000, health insurance had covered long-stays in hospitals and there had
been major expansions of social services. These service levels had to be maintained and be made universally
available for all those meeting the eligibility criteria. As a result, efforts to contain costs after the implementation
of the LTC Insurance have had only marginal effects. This indicates it would be more efficient and equitable
to introduce public LTC Insurance at an early stage before benefits have expanded as a result of ad hoc policy
decisions.