Ow to finance and deliver care for a population that is ageing fast is

JAPAN’S SUPER-AGED SOCIETY
Japan’s demographics are changing rapidly, creating a top-heavy 
pyramid with more older people than younger people. 
Population (millions of people)
Male Female
Ag
e
100+
90–94
80–84
70–74
60–64
50–54
40–44
30–34
20–24
10–14
0–4
6
6
4
4
2
2
0
*projected data
1960
2015
2045
*
ST
A
TIS
TICS D
A
SHBO
ARD
, GO
VERNME
NT OF J
AP
A
N
Nature | Vol 601 | 20 January 2022 | S13
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A l l
r i g h t s
r e s e r v e d .
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S p r i n g e r
N a t u r e
L i m i t e d .
A l l
r i g h t s
r e s e r v e d .

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to increase. But the high level of enthusiasm 
for the LTCI didn’t come easily, says Curry. 
It required a major change in public opinion 
because there was a feeling of shame in not 
looking after older relatives. “They designed 
the system to be quite generous, so the bene-
fits were obvious,” she adds. “I think this made 
people realize that old people weren’t being 
given a substandard system.” 
The government also ensures that individu-
als are not given cash but are instead allotted a 
budget that goes directly to the professional 
care establishment of their choice. This stops 
people taking their allowance but remaining 
in the sole care of their family. 
“I admire how well designed it is,” says Curry. 
“When you’re assigned your care level, you get 
a care manager who helps you decide where to 
spend your allowance, and this helps people to 
navigate what could otherwise feel like quite 
a complicated system.” 
Is it a success? Many of the problems that 
Japan sought to offset with the LTCI are still 
there, but they have abated since the system 
was introduced. Japan’s working-age popu-
lation shrank by more than 11 million people 
between 2000 and 2018, but the workforce 
increased by 600,000. This rise is attributed 
to increased numbers of women in the work-
place — possibly because the LTCI reduced 
their family care concerns and so levelled the 
playing field, says Curry. “With the shrinking 
working population, the government became 
aware it had a lot of women tied up in informal 
care,” she says. “One objective of the LTCI was 
to shift this burden of care.”
The demographics of an ageing population 
remain, however, so Japan’s labour-market woes
are not over. Despite the gains made in employ-
ing more women, the country’s Health, Labour 
and Welfare Ministry predicts a national 
workforce of just 53 million by 2040 — a 20% 
decrease from 2017 figures. Meanwhile, the 
number of older people eligible for LTCI sup-
port is expected to grow in line with the nation’s 
ageing population, raising the question of how 
to fund the scheme in future decades.