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Abstract Background Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤). Methods Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members’ age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age. Results Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need. Conclusions Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.

Abstract As longevity occurs, people encounter various risks associated with ageing, including economic uncertainty and health issues. Therefore, in addition to extending healthy life expectancy, it is crucial to create an environment where older people can live better even when their intrinsic capacity declines. Additionally, integrated and comprehensive care for older adults is needed to maintain their functional ability and well-being at higher levels. This review provides an overview of the systems and initiatives in Japan, a forerunner of population ageing that supports the quality of life of older people and summarises their remaining challenges. In Japan, with support for access to necessary care available from social welfare councils and community comprehensive support centres, various health and welfare services are provided to respond to the needs of people with different levels of intrinsic capacity, including medical care, preventive care, long-term care, adult guardianship systems, pensions, and social assistance. Nevertheless, there are challenges for the systems, including the gap between life and healthy life expectancy, moderate accumulation and decumulation of retirement assets, lack of human and financial resources for care, and user-unfriendliness and non-covered needs of the current system. Therefore, integrated and comprehensive care beyond health and long-term care is needed to maintain the well-being of older adults, even with their intrinsic capacity declining.

Abstract This study aims to estimate the potential economic benefits of healthy ageing by obtaining estimates of the economic losses generated by functional limitations among middle-aged and older people. Utilising two data sources retrieved from nationally representative samples of the Japanese people, we analysed the association between functional limitation and economic indicators, including labour market outcomes, savings, investment, consumption, and unpaid activities among individuals aged ≥ 60. Using the estimated parameters from our micro-econometric analyses and the official statistics by the Japanese government and a previous study, we calculated the financial costs that can be averted if healthy ageing is achieved as foregone wages and formal medical/long-term care costs incurred by functional limitations. Our micro-econometric analyses found that functional limitation was associated with a 3% point increase in retirement probability, with a stronger association among those aged 60–69. Moreover, functional limitation was linked with higher total health spending and less active involvement in domestic work. Foregone wages generated by functional limitation were estimated to be approximately USD 266.4 million, driven mainly by individuals in their 60s. Long-term care costs, rather than medical care costs, for older people aged ≥ 85 accounted for most of the additional costs, indicating that the estimated medical and long-term costs generated by functional limitations were approximately USD 72.7 billion. Health interventions can yield economic benefits by preventing exits from the labour market due to health issues and reducing medical and long-term care costs.

Abstract The two important elements of universal health coverage—(1) enabling everyone to access the necessary health services and (2) providing financial protection from catastrophic health spending—are vital for not only healthcare but also long-term care in the context of population ageing. In this review, we provide an overview of the public long-term care system in Japan to help other countries that are experiencing (or are expected to experience) problems associated with population ageing. Japan’s approach to long-term care may not be universally generalisable, given the differences in population/geographical sizes, socioeconomic development, population ageing, and cultures across countries. However, the challenges faced by older people may be common. Japan’s long-term care system has several challenges, including financing, labour force shortages, support for people with dementia, an integrated continuum of healthcare and long-term care, and utilising services outside the purview of insurance coverage. We have provided the government’s actions and potential directions to address these challenges.

Abstract Physical inactivity is a pandemic that requires intensive, usually costly efforts for risk reduction of related chronic diseases. Nevertheless, it is challenging to determine the effectiveness of physical activity in healthcare cost reduction based on existing literature. Therefore, this study aimed to investigate the impact of physical activity (daily steps) on healthcare costs utilising the data retrieved from a health promotion project (the e-wellness Project, held in three municipalities in Japan). Evaluating the effects of daily steps, measured by pedometers, on healthcare costs by a quasi-experimental approach among participants aged 40–75 years (about 4000 person-years of observation, between 2009 and 2013), we found that a one-step-increase in the annual average daily step reduced outpatient healthcare costs by 16.26 JPY (≒ 0.11 GBD) in the short run. Based on the assumption of a dynamic relationship between the health statuses in multiple years, the long-run effects of daily steps on healthcare costs were estimated at 28.24 JPY (≒ 0.20 GBD). We determined the health benefits of walking in a sample of middle-aged and older Japanese adults by our findings that an increase in step counts reduced healthcare costs.

Objectives While the development of vaccines against the Novel Coronavirus (COVID-19) brought hope of establishing herd immunity and ending the global pandemic, vaccine hesitancy can hinder the progress towards herd immunity. In this study, by analysing the data collected when citizens undergo public health restrictions due to the pandemic, we assess the determinants of vaccine hesitancy, reasons for hesitation and potential effectiveness of vaccine passports used to relax public health restrictions on mitigating vaccine hesitancy.Design Cross-sectional study, longitudinal study and conjoint experimental design.Setting An online survey conducted in Japan in July 2021.Participants A demographically representative sample of 5000 Japanese adults aged 20–74.Primary outcome measures COVID-19 vaccination intentionResults We found that about 30% of respondents did not intend to get vaccinated or had not yet decided, with major reasons for vaccine hesitancy relating to concerns about the safety and side effects of the vaccine. In line with previous findings, younger age, lower socioeconomic status, and psychological and behavioural factors such as weaker COVID-19 fear were associated with vaccine hesitancy. Easing of public health restrictions such as travel, wearing face masks and dining out at night was associated with an increase in vaccine acceptance by 4%–10%. Moreover, we found that more than 90% of respondents who intended to get vaccinated actually received it while smaller proportions among those undecided and unwilling to get vaccinated did so.Conclusion With a major concern about vaccine safety and side effects, interventions to mitigate against these may help to reduce vaccine hesitancy. Moreover, when citizens are imposed with restrictions, vaccine passports that increase their freedom may be helpful to increase vaccination rates.

Japan, the world's most rapidly aging society, faces increasing financial strains related to personalized dementia care. The government has shifted its focus from prevention to coexistence with dementia, as outlined in the 2023 Basic Act on Dementia. Emphasis on financial inclusion aligns with the G20's 2019 "Fukuoka Policy Priorities on Aging and Financial Inclusion", which addresses financial exclusion due to cognitive decline and poor financial literacy. While economic activity among older adults is already hampered by legal challenges and risks associated with dementia, outcomes are expected to worsen as the assets of older adults with dementia are projected to reach 215 trillion JPY ($1.4 trillion USD) by 2030. Government measures and research in financial gerontology advocate for protecting older adults and promoting flexible financial practices. Enhanced efforts and shared research outcomes are crucial for Japan to be a leader as an advanced aging society. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of this study is to investigate the association between financial literacy and age as well as gender differences in financial literacy.MethodsWe analyse a sample of 25,000 individuals from 'The Financial Literacy Survey 2016' conducted by the Central Council for Financial Services Information (Bank of Japan). The analysis focuses on the relationship of age and financial literacy as well as that of age and self-rated financial knowledge. To consider factors accounting for gender differences in financial literacy, we use the Blinder-Oaxaca decomposition method. To further our understanding of financial literacy, we conduct additional analyses on financial behaviour and attitude.ResultsAlthough age is associated with increased financial literacy (Men, β: 0.249, standard error [SE]: 0.030; Women, 0.354, SE: 0.026), the growth rate decreases among the older respondents (Men, β: -0.002, SE: 0.000; Women, -0.003, SE: 0.000). However, the association between age and self-rated financial knowledge among men moves in the opposite direction (Age, β: -0.021, SE: 0.009, Age2, β: 0.000, SE: 0.000). Furthermore, female respondents are likely to be less financially literate than their male counterparts (β: -0.586, SE: 0.095) due to gender differences in the distribution of the factors that affect financial literacy (specifically education), their responses to financial literacy, and the interactions of these effects. In contrast to knowledge-based financial literacy, financial behaviour and attitudes among women are more preferable to those among men, namely, more premeditated.ConclusionFinancial literacy increases until about one's early 60s, after which it declines, while confidence in financial literacy reflects the inverse trend, especially among men. Additionally, men are more financially literate than women; however, these differences could be mitigated through education. Meanwhile, financial behaviour and attitudes among men are less premeditated. Thus, policies are needed that can help older adults with their financial decision-making, enhance women's financial literacy, and improve men's financial behaviours and attitudes.

Objective To estimate the average treatment effect of working past the current retirement age on the health of Japanese men. Methods We used publicly available data from the National Survey of Japanese Elderly, extracting a sample of 1288 men who were 60 years or older. Survey respondents were followed-up for at most 15 years for the onset of four health outcomes: death, cognitive decline, stroke and diabetes. By using the propensity score method, we adjusted for the healthy worker effect by incorporating economic, sociodemographic and health data in the form of independent variables. By calculating the differences in times to a health outcome between those in employment and those not employed, we estimated the average treatment effects on health of being in paid work past retirement age. Findings Compared with those not employed, those in employment lived 1.91 years longer (95% confidence interval, CI: 0.70 to 3.11), had an additional 2.22 years (95% CI: 0.27 to 4.17) before experiencing cognitive decline, and had a longer period before the onset of diabetes and stroke of 6.05 years (95% CI: 4.44 to 7.65) and 3.35 years (95% CI: 1.42 to 5.28), respectively. We also observed differences between employees and the self-employed: the self-employed had longer life expectancies than employees. In terms of years to onset of diabetes or stroke, however, we only observed significant benefits to health of being an employee but not self-employed. Conclusion Our study found that being in employment past the current age of retirement had a positive impact on health. [ABSTRACT FROM AUTHOR]