PhD defended at:
The vast and rapid demographic change in Japan, rendering over 25 per cent of the population older than the retirement age, poses a challenge not only to social security systems, but also the social integration of the elderly. The immense ageing process and the introduction of long-term care insurance in 2000 sparked the debate concerning social inequality and discussions, whether recent developments in Japanese social policy rather provide an egalitarian approach, such as long-term care insurance, or whether the country’s familialistic orientation towards the male breadwinner in family life is a disadvantage in social policy. The socialisation of care through the introduction of long-term care insurance not only changed the welfare mix between the institutions of the market, the state, the family and the community, but it also illustrated that social organisation, access to livelihood security systems and community engagement
play a vital role.
This dissertation, therefore, aims to fathom why and how long-term care insurance as an element of social security in Japan contributed to addressing the social risks of ageing and what effects its introduction has had on the welfare mix. For this purpose, a mixed methods approach was utilised in order to provide a coherent and thorough presentation of the subject matter. Apart from the analysis of social policies and aggregate data, qualitative data from participant observation and interviews was collected during ten months of fieldwork in Japan.
The results indicate that long-term care insurance in Japan has not only partially relieved individuals and their kin from care burdens and that care facilities likely contribute to the social inclusion of the elderly, but also that the given institutional framework of long-term care insurance has had positive effects on the market and communities in welfare creations. Furthermore, the results point to significant gender differences in the perception and usage of long-term care services. Additionally, regional disparities come into effect and require local strategies of problem-solving. In particular, here it proves that local communities in rural regions provide a considerable contribution to welfare creation—which is planned to be enhanced by future reforms of the long-term care insurance policy.