I-7 Is there collaboration with other agencies of the United Nations System or other partners?
No
II-1 Justification of the initiative
Japan introduced Long-Term Care Insurance (Kaigo Hoken) in 2000 to address the growing need for eldercare due to rapid population aging, shrinking family support systems, and rising healthcare costs. As of July 2025, over 7 million people 65 years and older, namely around 1 in 5 older persons, were certified as needing long-term care or support. In 2022, around 6.3 million persons aged 15 and over provided care and support to an older person in Japan, of whom over 3.6 million were employed. Women accounted for about 65 per cent of these unpaid family carers, underscoring the disproportionate share of care responsibilities they continue to shoulder.
II-10 Focus on other branches of economic activity
No sectoral focus
II-11 Focus on certain categories of enterprises or economic units according to their size
Not applicable
II-12 Focus on specific status in employment
Workers not classifiable by status
II-13 Focus on other specific categories of workers and employers, not captured elsewhere
Long-term care / geriatric care workers
II-13 Focus on other specific categories of workers and employers, not captured elsewhere
Workers in the informal economy
II-14 Focus on specific groups of population / persons prioritized in the initiative
Persons with other care responsibilities
II-14 Focus on specific groups of population / persons prioritized in the initiative
Migrants or forcibly displaced persons
II-14 Focus on specific groups of population / persons prioritized in the initiative
Older persons
II-15 Has the initiative been developed through effective social dialogue processes and inter-institutional coordination mechanisms?
Yes, through social dialogue
II-2 Objectives and description of the initiative
Kaigo Hoken, or Japan's Long-Term Care Insurance, is a mandatory public system for residents aged 40 and over, designed to provide affordable care services for seniors and individuals with disabilities due to aging. The main objective of the insurance is to ensure universal access to affordable, quality long-term care for the elderly. Funded by a mix of contributions, taxes, and co-payments, the system provides a variety of long-term care services such as home-based and residential care, easing the burden on families and health services.Those aged 65+ are eligible for care for any reason, while those aged 40-64 can receive care for specific aging-related conditions. To access services, an individual must apply for and receive certification of their need for long-term care from their municipal government.
II-3 Type of initiative
National/local law
II-4 Which of the Rs in the 5R Framework for Decent Care Work guides this initiative?
Recognition, reduction and redistribution of unpaid care
II-4 Which of the Rs in the 5R Framework for Decent Care Work guides this initiative?
Reward care workers
II-4 Which of the Rs in the 5R Framework for Decent Care Work guides this initiative?
Representation of care workers
II-5 Which is the main policy area of the 5R Framework for Decent Care Work does the practice focus on?
Social Protection policies
II-6 Which other policy areas of the 5R Framework for Decent Care Work does the practice focus on?
Care policies
II-6 Which other policy areas of the 5R Framework for Decent Care Work does the practice focus on?
Skills policies
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Design and implement integrated and coherent care policies and systems for decent work and gender equality
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Promote employment and macroeconomic policies that create decent jobs in the care economy
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Universal social protection systems that provide adequate protection to care workers and recognize unpaid care work
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Invest in and make available high-quality, affordable, adequate and accessible care services, including childcare, health care and long-term care
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Enhancing the availability of assistance and support services for persons with disabilities to promote individual autonomy and independence
II-8 Which beneficiaries in the care economy does the practice focus on?
Unpaid carers (workers or persons with care responsibilities, parents, other family members, etc.)
II-8 Which beneficiaries in the care economy does the practice focus on?
Paid care workers (nurses, domestic workers, teachers, childcare workers, personal assistants, etc.)
II-8 Which beneficiaries in the care economy does the practice focus on?
Care recipients (children, older persons, persons with disabilities, etc.)
II-9 Geographical scope
Urban and rural
III-1 In a short paragraph, summarize the main results and impacts obtained
The long-term care system expanded access to care, reduced family caregiving pressures, created new employment in the care sector, and improved quality of life for older adults. In 2024, the LTC insurance system covered 35.9 million people (insured) aged 65+, with 7.1 million (19.4%) certified as needing care and an average of 6.1 million monthly users. In 2023, Japan was investing around 1.8 per cent of GDP in the long-term care benefits (net of co-payments), supporting a rapidly growing care sector that employed 2.1 million workers in 2023, with demand projected to rise.
III-2 Explanation of the innovative element of the initiative for advancing decent work in the care economy
By professionalizing eldercare, Kaigo Hoken created stable jobs with training standards, raising recognition of care work as essential to the economy and its social protection system.
IV-1 What were the main challenges or difficulties during the design and implementation? How were they faced/ addressed?
Initial challenges included financing strain and workforce shortages. Japan responded through system revisions (e.g., adjusting copayment levels), expanding training for care workers, and welcoming migrant workers. From the outset, Japan’s Long-Term Care Insurance (LTCI) faced serious financing pressures due to rapid population ageing, rising demand for services, and escalating costs. By the late 2000s, expenditures were outpacing revenue, threatening sustainability. In response, the government introduced system revisions: raising copayment levels for higher-income beneficiaries (from 10% to 20% in 2015 and to 30% in 2018), periodically increasing insurance premiums, and tightening eligibility for “support-level” users to prioritize those with higher care needs.At the same time, workforce shortages quickly emerged as a critical bottleneck. Although the care sector created over 2 million jobs, retention was difficult due to low pay, long hours, and limited career progression. Japan sought to address this by expanding training and certification programs, improving wage subsidies, and setting national standards for care managers. To supplement the domestic workforce, the government also opened channels for migrant care workers through Technical Intern Training Program (TITP and Specified Skilled Worker (SSW)).
IV-2 Lessons learned and good practices, including room and opportunities for improvement
Japan’s Long-term care insurance (LTCI) was the first universal long-term care social insurance system in Asia. Its universal coverage and needs-based eligibility can be considered as good practices. The iterative reforms, such as the revision of co-payment levels, are an important lesson to ensure adaptability of such a large scale programme.Other Asian countries can draw on this scheme, for example as South Korea did when developing their own long-term care system.
IV-3 Key conditions for success
Key conditions for the success of this Long-term care insurance (LTCI) model are: Universality of the coverage and the design of the insurance, being funded both by taxes and contributions.A distinct insurance scheme, separate from health care insurance.Iterative, adaptive process with revisions that adjusted the financing mechanism, eligibility and benefit design, allowing policy-makers to respond to demographic changes and fiscal constraints.
IV-4 Key conditions for sustainability
The conditions for sustainability of the Kaigo Hoken Long-term care insurance (LTCI) model are: Its diversified financing model (taxes and contributions). Care workforce supply and retention: sustainability requires improving pay, career progression, and working conditions for care workers.Integration of community-based care, reducing hospitalization and institutionalization, making long-term care services better aligned with beneficiaries’ preferences.
IV-5 Potential for transferability, expansion and replicability in other countries and contexts
The core design features of Japan’s Long-term care insurance (LTCI) model —universal mandatory coverage, needs-based eligibility, clear separation from health insurance, and public financing mix—are broadly transferable to other ageing societies.Some conditions for replication would include: Strong administrative capacity.Sufficient fiscal space (large tax base), and political consensus to fund the system.Care workforce availability and adequate working conditions.
V-2 Contact information of ILO focal point
Yuta Momose, Technical Officer, Social Protection ([email protected])