International Comparison of Long-Term Care Insurance Systems

As life expectancy continues to rise and birthrates decline, nations around the world face unprecedented challenges in caring for aging populations. This book offers a comprehensive analysis of long-term care insurance systems—both public and private—and the evolving landscape of eldercare services across diverse countries.

Driven by three critical factors—the growing number of elderly individuals requiring intensive care, the need to eliminate "social hospitalization," and the escalating costs of medical care for seniors—governments have been compelled to rethink and restructure their approaches to long-term care. First, the rapid increase in average life expectancy has led to an increase in the number of bedridden elderly and those suffering from dementia, and the need for and importance of long-term care has grown. Second, it was necessary to eliminate "social hospitalization”. Social hospitalization refers to a condition in which a patient is not in need of medical care but remains hospitalized in a medical institution for compelling reasons such as family circumstances. Third, medical costs for the elderly were increasing rapidly. It was necessary to control the increase in medical costs by separating medical care from long-term care.

Through comparative research and policy analysis, this book clarifies the distinct roles of public and private insurance models and offers actionable recommendations for sustainable and equitable care in aging societies. It is an essential resource for policymakers, healthcare professionals, researchers, and anyone invested in the future of social welfare and eldercare.

Hongmu Lee is a professor of risk management and insurance at Waseda University, Tokyo, where he received his Ph.D. He is also the president of the Insurance and Risk Management Institute of Waseda University. The institute aims to carry out research internationally in cooperation with industry and the academic world on insurance and risk management. He has authored several books and articles in academic and professional journals, mainly in Korea and Japan. He also serves as the president of IAFICO (International Academy of Financial Consumers). This book was authored as an outcome of IAFICO's Book Project.

Gianni Nicolini, Ph.D. is a full professor of finance at the University of Rome ‘Tor Vergata’, Rome (Italy). His main research interests involve personal finance and consumers’ financial wellbeing, and his publications include studies on financial literacy, financial education, and the functioning of pension systems. He is Past-President of the ACCI (American Council on Consumers Interest) and Vice-Chairperson of the IAFICO (International Academy of Financial Consumers).