This chapter first describes the key elements of “comprehensive long-term care (LTC) policy” and makes the case that it is a reasonable policy target for advanced industrial nations. Second, it discusses the two “ideal models” for comprehensive LTC: direct public services and social insurance. Third, it analyzes the policy process. It examines how Japan first opted for direct services and then switched to an approach similar to Germany. Fourth, it turns to comparative analysis to try to explain how and why the Japanese program differs from that in Germany.

The U. S. Congress is considering the Community Living Assistance Services and Supports (CLASS) Act, a voluntary insurance program that would help pay for long-term services and supports to disabled Americans. In Germany and Japan, social insurance programs are universal, support family caregivers, and allow individuals considerable flexibility in securing the services they require. We explored differences between Germany and Japan in program goals, eligibility process, scope, size, and sustainability for possible applications in the United States. Moreover, when we compared public spending on long-term care, we found that spending in the United States is actually higher than in Germany even now, prior to enactment of the CLASS Act, and is only slightly lower than in Japan.

Japan's population is ageing rapidly because of long life expectancy and a low birth rate, while traditional supports for elderly people are eroding. In response, the Japanese Government initiated mandatory public long-term care insurance (LTCI) in 2000, to help older people to lead more independent lives and to relieve the burdens of family carers. LTCI operates on social insurance principles, with benefits provided irrespective of income or family situation; it is unusually generous in terms of both coverage and benefits. Only services are provided, not cash allowances, and recipients can choose their services and providers. Analysis of national survey data before and after the programme started shows increased use of formal care at lower cost to households, with mixed results for the wellbeing of carers. Challenges to the success of the system include dissatisfaction with home-based care, provision of necessary support for family carers, and fiscal sustainability. Japan's strategy for long-term care could offer lessons for other nations.

RésuméDe nombreux pays développés ont récemment décidé d'adopter des systèmes complets de soins de santé de longue durée (SSLT). Outre les explications conventionnelles de ces changements de politique, qui sont basées sur des facteurs nationaux, il conviendrait d'étudier les enseignements que l'on peut tirer de ce qui se passe à l'étranger. Nous nous concentrerons sur le modèle d'assurance sociale des SSLT, et en particulier sur la façon dont le Japon a tiré des leçons de ce qu'avait fait l'Allemagne, et comme la République de Corée a profité de l'expérience du Japon. Nous suggérerons un certain nombre d'approches quant à la façon de considérer les enseignements politiques généraux tirés de l'expérience d'autrui et des échanges internationaux spécialisés.

AuszugIn neuerer Zeit haben viele Industrieländer umfassende Systeme der Langzeitpflege (LP) eingeführt. Neben den herkömmlichen, auf inländischen Faktoren basierenden Begründungen für diese politischen Neuerungen gilt es auch, Lernerfahrungen aus dem Ausland zu berücksichtigen. Wir konzentrieren uns dabei auf das Sozialversicherungsmodell in der Langzeitpflege (LP) und insbesondere darauf, wie Japan von Deutschland und die Republik Korea von Japan lernten. Wir schlagen dabei Ansätze vor, wie politisches Lernen allgemein und über Landesgrenzen hinweg in die Wege geleitet werden kann.

ResumenEn los últimos tiempos, muchos países desarrollados han empezado a establecer amplios sistemas de cuidados de larga duración (LTC, por sus siglas en inglés). Además de las explicaciones convencionales de estos cambios de política basados en factores internos, debería considerarse el aprendizaje de las experiencias de otros países. Este artículo se centra en el modelo de seguro social de LTC, en particular, en cómo el Japón ha aprendido de Alemania, y la República de Corea del Japón. Se proponen algunos enfoques para reflexionar sobre el aprendizaje de políticas en general y sobre el aprendizaje transfronterizo.

Recently, many developed countries have moved toward comprehensive Long-Term Care (LTC) systems. Along with the conventional explanations of these policy changes based on domestic factors, learning from abroad should be considered. We focus on the social insurance model of LTC, particularly how Japan learned from Germany and the Republic of Korea learned fromJapan. Some approaches for how to think about policy learning in general as well as cross-border learning are suggested.