Abstract
Japanese older people with disabilities receive community-based and institutional care services under the public, mandatory Long-Term Care Insurance (LTCI) system that started in 2000. Levels of provision are among the highest in the world. LTCI includes home nursing, physical therapy and oversight by physicians, but most medical care is covered by health insurance. Integration is a current policy focus, as a means to reduce demand for institutional care by providing “24-hour care” in the community. Specifically, home doctor visits have been encouraged by increasing payments under health insurance, and organizational experiments are being carried out in many localities to improve communication between physicians and LTC care managers. A particular challenge, given the continuing need to control costs, is efficient management of health care and LTC for older people with the heaviest needs. The presentation will discuss integration in the context of distinctive features of Japan’s LTCI system.