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This chapter will review the evaluations of the newly developed elderly care system in Japan, Long Term Care Insurance, and its social implications with the focus on demographic change.

By reviewing literature, this chapter will examine how demographic and social change over the years has impacted the features of caregivers. Then, how this policy change has demedicalized the aging process will be described. Finally, this chapter will evaluate whether this insurance has shifted the responsibility for elderly care from the family to society as the governmental slogan advertised.

The new insurance has offered more options in different services and established a new norm of self-reliance and determination for one’s own aging however it is doubtful if this new insurance has shifted the responsibility from family to society.

Applying the implications of policy reforms for elderly care in Japan to the United States, one can assume the traditional U.S. norms and values can facilitate effective utilization of the elderly care system. However, since each nation faces different problems with its specific condition, continuous studies and observations on the relationship between elderly care, immigration issues, and demographic changes will be necessary in order to offer more specific suggestions for each aging nation.

As Japan’s new insurance scheme for the elderly has been studied by many aging nations, recommendations for more comprehensive plans are suggested including building a community-based support system into the Long Term Care Insurance scheme to prevent social isolation and respond to emergency situations for the elderly.

Reports that under a third of the increasing numbers of US citizens needing long‐term care (LTC) in a nursing home pay their own fees; and that Medicaid (health programme for the poor) meets over half of LTC costs. Describes the rules applied to qualify for Medicaid LTC payments, the growth of “Medicaid estate planning” to shield the income/assets of the middle classes so that they can qualify and the actions taken by the government to restrict misuse of Medicaid and reduce its costs. Explains methods which are still being used to protect middle class income/assets without losing Medicaid eligibility; and the alternative of private LTC insurance, including its tax implications. Discusses efforts to develop a partnership between Medicaid and the insurance companies in some states; and the pros and cons of the plans available for both individuals and the government.

This chapter reviews the existing empirical evidence on how social insurance affects health. Social insurance encompasses programs primarily designed to insure against health risks, such as health insurance, sick leave insurance, accident insurance, long-term care insurance, and disability insurance as well as other programs, such as unemployment insurance, pension insurance, and country-specific social insurance programs. These insurance systems exist in almost all developed countries around the world. This chapter discusses the state-of-the art evidence on each of these social insurance systems, briefly reviews the empirical methods for identifying causal effects, and examines possible limitations to these methods. The findings reveal robust and rich evidence on first-stage behavioral responses (“moral hazard”) to changes in insurance coverage. Surprisingly, evidence on how changes in coverage impact beneficiaries’ health is scant and inconclusive. This lack of identified causal health effects is directly related to limitations on how human health is typically measured, limitations on the empirical approaches, and a paucity of administrative panel data spanning long-time horizons. Future research must be conducted to fill these gaps. Of particular importance is evidence on how these social insurance systems interact and affect human health over the life cycle.

To describe, analyze, and compare two long-term care (LTC) systems for elders in Germany and Israel.

Secondary analyses of data on LTC beneficiaries, structure of service provision and content analyses of policy documents in a comparative perspective based on the Esping-Andersen welfare state typologies.

Descriptive background of demographic attributes in the two countries; discussion of LTC development laws which in Israel focuses on “aging in place” concept, where in-kind services are geared only to community-dwelling frail elders while in Germany it’s for community and institutionalized elders. Analyses of various service types provided their use, resources invested, and benefits incurred for frail elders and their family caregivers.

The advantages and shortcomings of the two systems were analyzed with recommendations for future developments. Such comparisons across nations can inform social policy debates in Germany and Israel as to how to prepare for population aging. The originality of such comparison can shed light on issues for LTC service development in other countries.

The purpose of this study is to develop new type of reverse mortgage contract. How to provide adequate services and housing for an increasing number of people that are dependent on the help of others is a crucial question in the European Union (EU). The housing stock in Europe is not fit to support a shift from institutional care to the home-based independent living. Some 90% of houses in the UK and 70%–80% in Germany are not adequately built, as they contain accessibility barriers for people with emerging functional impairments. The available reverse mortgage contracts do not allow for relocation to their own adapted facilities. How to finance the adaptation from housing equity is discussed.

The authors have extended the existing loan reverse mortgage model. Actuarial methods based on the equivalence of the actuarial present values and the multiple decrement approach are used to evaluate premiums for flexible longevity and lifetime long-term care (LTC) insurance for financing adequate facilities.

The adequate, age-friendly housing provision that is appropriate to support the independence and autonomy of seniors with declining functional capacities can lower the cost of health care and improve the well-being of older adults. For financing the development of this kind of facilities for seniors, the authors developed the reverse mortgage scheme with embedded longevity and LTC insurance as a possible financial instrument for better LTC services and housing with care in assisted-living facilities. This kind of facilities should be available for the rapid growth of older cohorts.

The numerical example is based on rather crude numbers, because of lack of data, as the developed reverse mortgage product with LTC insurance is a novelty. Intensity of care and probabilities of care in certain category of care will change after the introduction of this product.

The model results indicate that it is possible to successfully tie an insurance product to the insured and not to the object.

The introduction of this insurance option will allow many older adult with low pension benefits and a substantial home equity to safely opt for a reverse mortgage and benefit from better social care.

While currently available reverse mortgage contracts lapse when the homeowner moves to assisted-living facilities in any EU Member State, in the paper a new method is developed where multiple adjustments of housing to the functional capacities with relocation is possible, under the same insurance and reverse mortgage contract. The case of Slovenia is presented as a numerical example. These insurance products, as a novelty, are portable, so the homeowner can move in own specialised housing unit in assisted-living facilities and keep the existing reverse mortgage contract with no additional costs, which is not possible in the current insurance products. With some small modifications, the method is useful for any EU Member State.

Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated.

This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization.

Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of “health.” Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations.

This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable counterpart, are prime challenges in any health care reform initiative, especially as it adapts to the changing demographic and socio-economic characteristics of the insured population and regulatory landscape of health insurance in the USA.

Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.

Design/methodology/approach: Care managers (CMs)/social workers (SWs) (N = 124) participated in a comparative vignette study including Japan, South Korea, and Sweden. Systems theory was used.

Findings: Japanese CMs/SWs clearly describe their efforts to create networks in a relational way between formal and informal actors in the community. South Korean CMs/SWs balance between suggesting interventions to support daily life at home or a move to a nursing home, often acknowledging the family as the main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting the older adult and the interventions offered, and families primarily give social support. Regarding self-determination, the Japanese priority is for CMs/SWs to harmonize within the family and the community. South Korean CMs/SWs express ambivalent attitudes to older adults’ capability for self-determination in the intersection between formal and family care. Swedish CMs/SWs adhere to the older adult’s self-determination, while acknowledging the role of the family in persuading the older adult to accept interventions. The results suggest emerging defamilialization in South Korea, while tendencies to refamilialization are noticed in Japan and Sweden, albeit in different ways.

Research limitations/implications: In translation, nuances may be lost. A focus on changing families shows that country-specific details in care services have been reduced. For future research, perspectives of “care” need to be studied on different levels.

Originality/value: Using one vignette in three countries with different welfare regimes, discussing changing views on families’, communities’ and societal caregiving is unique. This captures changes in policy, influencing re- and defamilialization.

This article proposes principles for reforming English adult social care by drawing on the experiences of other countries. These illustrate how the funding, organisation and delivery of services could be reformed, and shed light on the potential political and social factors affecting implementation of reforms.Reforms in other countries are commonly driven by the desire to develop and/or maintain universal access to social care. Formerly fragmented, un‐co‐ordinated and locally variable arrangements are being replaced with universal schemes, with national eligibility arrangements applicable to everyone regardless of age or ability to pay. Cash payments (personal budgets etc) instead of services in kind are widely used. However, such options can have different aims, including supporting family carers and stimulating local provider markets, as well as offering ‘consumer’ choice. Policies for family carers are usually integral to overall long‐term care arrangements. Finally, even in federal systems like Germany, Austria, Spain and Australia, central governments play a crucial role in ensuring universal, equitable and sustainable social care. Central government leadership: maximises risk pooling; enhances budgetary control mechanisms; safeguards equity and quality control; and provides political legitimacy.

The paper compares the introduction of universal long‐term care schemes and the regulations of migrant care work within the framework of multi‐level governance in Austria and Germany. The aim of the paper is twofold. First, it reveals the characteristics of country‐specific universal policy schemes and second, it explains their designs – the new type of universalism and its completion by regulations of migrant care work within the family framework – by the policy‐making process.

Conceptually, the paper combines approaches within long‐term care research to define dimensions of universalism, as well as on multi‐level governance and new‐institutionalism to examine the policy‐making process. Empirically, Austria and Germany are selected as two cases.

The findings reveal the significant dimensions of the new type of universalist policy design and of policies towards migrant care work. The country differences are explained by the policy‐making process within countries and with cross‐border effects. In particular, the impact of the disability movement in Austria and the coalition between the political parties in Germany resulted in a country‐specific definition of universalism. The integrated approach towards migrant care work in Austria is contrasted with the fragmented approach in Germany. In both countries, the regulations of migrant care work question the idea of universalism.

The impact of societal actors and their ideas on the creation of a new type of universalism and the interrelated regulation of migrant care work has only rarely been examined. The analysis contributes to an understanding of the policy‐making process and its interrelationship with selected policy designs.

This paper aims to provide an overview of the inequalities between three countries – England, The Netherlands and Taiwan – in relation to the welfare and long‐term care of older people. It compares the positive and negative distinctions between the respective countries and their systems.

This paper discusses and analyses data from public sources and literature and measures the similarities and differences between demographic and social issues, the cultural and political differences shaping policy objectives, economic constraints and long‐term care services.

All three countries face similar pressure in long‐term care provision of ageing populations, funding limitations and shrinking numbers of carers. None of the countries studied completely conforms to Esping‐Andersen's ideal types; instead they seem to constitute hybrids. The care system in the Dutch social democratic‐conservative welfare regime seems to provide wider support for older people who need care, the English liberal‐social democratic welfare regime comes second and Taiwanese conservative‐liberal welfare regime comes third. Overall, some converse trends of the long‐term care systems indicate a narrowing of the gap in responsibility between state, family and individuals in the East and the West.

The paper contributes suggestions to further research in the area of elements and structures of care systems support and the failure to provide ongoing quality of long‐term care and reflects on the implications for the global market of care‐workers and the extensive use of migrant workers in the field.

The paper provides a detailed consideration of the wide‐ranging issues that impact on older people's care provision in England, The Netherlands and Taiwan.