applicant about the decision. Applicants who are not certified as requiring preventive or care services
covered by the long-term care insurance can be eligible to receive long-term care prevention services under
the community-support project conducted by the municipality.
5.2.7 Care Management
Once the care (support) level is decided, a personal Care Plan is created, which combines packages of
care and support within the limit of services for each category. The creator of the Care Plan varies
depending on the category. The Care Plans for those eligible to receive care services and requiring care
level 1 to 5 are created by Long-Term Care Support Specialists (Care Managers) at in-home long-term care
support businesses or care facilities. The Care Plans for those eligible to receive preventive services and
requiring support level 1 to 2 are created at Integrated Community Care Support Centers (地域包括支援セ
ンター).
The Integrated Community Care Support is a scheme created in line with the emphasis on the
preventive services when the law was revised in 2005. It serves as the center for elderly care, and is
responsible for care management to prevent long-term care, creating Care Plans for preventive long-term
care services, providing consultations to the elderly and their family, protecting elderly rights and early
detection of abuse.
5.2.8 Remuneration for services
When long-term care providers deliver preventive or long-term care services for recipients, they
receive remuneration for services based on the official price list of the Long-Term Care Benefit Expense,
which is decided by the Minister of Health, Labour and Welfare according to a recommendation of Social
Security Council. The price list consists of in-home long-term care/preventive services and facility services,
and is revised every three years. 90% of a price is paid to a provider through a prefectural health insurance
organization, and 10% by recipients as the co-payment.
5.3 Current Issues in the Long-Term Care Insurance
5.3.1 Financial Strain and the Reform of FY 2011
Soon after its enactment, it has become evident that the initial financial arrangement was not enough
to meet the cost of the long-term care. As shown in Figure 5.2, the number of persons certified for the
long-term care increased by more than 140% from 2000 (2.18 million) to 2013 (5.64 million). The number
of care recipients also grew from 1.49 million (0.52 in facilities and 0.97 in-home care) in September 2000
to 4.80 million (0.88 in facilities, 3.56 in-home care and 0.35 in community-based services) in September
2013. The financial outlay grew steadily from ¥3.6 trillion (2000) to ¥8.2 trillion (2011).