National Instituteof Population andSocial SecurityResearch

The greatest policy issue facing Japan at the present time is responding to our country’s low fertility rates and aging population. Having undergone a period of high economic growth following World War II, the average life span of the Japanese grew and our lives became affluent. On the other hand however, as the number of elderly people increased, expenditures for social security programs, such as pensions, medical and nursing care, increased markedly. Meanwhile, the youth population, who must shoulder new production, is continuing to decline. The issue of how Japan will sustain the high quality society which had been built up so far has now become a major challenge.

The super-aged society that Japan is now facing is the first experienced in human history. However, this is not an occurrence unique to Japan, as numbers of Asian countries, and possibly the majority of countries worldwide, will encounter the same phenomenon in the near future. It is for this reason that many countries are now watching to see how Japan will tackle this problem.

While the low fertility and aging population tend to be perceived pessimistically, one also often hears the optimistic argument that our country still has much potential vitality – and if it is skillfully applied, we will easily be able to overcome our problems. However, it is perilous to create policy based on optimistic expectations. What is necessary is not to ignore the problems confronting us, or to become despondent, but to face the problems squarely, pursue possibilities based on evidences, and formulate achievable and effective policies. In order to accomplish this, it is necessary to collect accurate and detailed data concerning existing conditions and to perform highly accurate estimations based on scientific analyses.

The National Institute of Population and Social Security Research, attached to the Ministry of Health, Labour and Welfare, was created in 1996 through the integration of the Institute of Population Problems, attached to the Ministry of Health and Welfare, and the Social Development Research Institute. Along with investigating population and household trends, the Institute carries out research concerning social security policies and systems in Japan and abroad.

The population data we compile and publish is the basic material for determining our country’s essential policies, including pensions and other social security measures. Therefore, it is our mission to respond to the high expectations held by various government actors, as well as many other parties concerned.

The policy challenges that our country is facing now are complex and difficult. The situation of low fertility and population aging is different by municipality, and also by time period. In addition, people’s life-styles and ways of thinking are diverse. The issues arising from such a society do have diversity and include not only the level of low fertility and population aging, but also poverty, employment, gender inequality and care for the disabled.

In order to respond attentively to the diversity of these problems and create a sustainable society which enables healthy and culturally rich lives for all people, it is essential to formulate policies based on detailed and accurate evidence.

We commit to providing the basic information which contributes to policy formation, and will carry out advanced research regarding how social security should be in the future and convey such information to the public. The importance of these activities needs no reiteration, but it is a matter of course that such research is not something that can be achieved through our efforts alone. It can be met with the interest and support of many government agencies, as well as society at large.

All our staff members are mindful of this mission and responsibility, and will work even harder than we have until now. Therefore, we sincerely ask for your understanding and warm support for our Institute’s activities.

April 2017

Prof. Hisao EndoDirector-General

National Institute of Population andSocial Security Research

Message from the Director-General

Table of ContentsMessage from the Director-General .................................................................................................... 1

Table of Contents .................................................................................................................................2

History .................................................................................................................................................3

Population Projection ......................................................................................................................... 4

The Financial Statistics of Social Security in JapanProviding data for relevant government ministries and international organizations ....................... 6

Annual Population and Social Security Surveys .................................................................................7The National Fertility SurveyThe National Survey on Migration ..................................................................................................... 8The National Survey on Social Security and People’s LifeThe National Survey on Family .......................................................................................................... 9The National Survey on Household Changes

Research Projects ..............................................................................................................................101. Aiming to construct a healthcare and nursing care delivery system for 2025 and beyond

Study on sustainable evaluation and reflection in planning for the effective use of funds to ensure comprehensive healthcare and nursing care (2015-2016) [Project by MHLW Grant]

2. Investigating ways of rehabilitation that improve activity and participation levels .................... 11Comprehensive study on effective rehabilitation and rehabilitation management that contributes to life enhancements of elderly requiring long-term care (2015-2017) [Project by MHLW Grant]

3. Exploring the next generation projection system and its policy applications based onanalysis of advanced population and household trends ............................................................... 12Comprehensive study on population and household dynamics and population projections in an era of declining population (2014-2016) [Project by MHLW Grant]

4. Comprehensive study of aging populations and migration in East Asian/ASEAN countries ..... 13(2015-2017) [Project by MHLW Grant]

Other Research Projects

International Cooperation .................................................................................................................14

Seminars ............................................................................................................................................. 15

Publication, Database ......................................................................................................................... 16Library

Organization ...................................................................................................................................... 17

Advice and Evaluation by External Experts .....................................................................................18

3

Institute of Population Problems established

Publication of the Journal of Population Problems started

The first estimation of future population

Integrated with Research Institute of the Ministry of Health and Welfare to become Department of Population of the Ministry’ s Research Institute

Attained independence once again to become the Institute of Population Problems

Merged The Quarterly of Social Security Research and The Review of Comparative Social Security Research, and began publication of the Journal of Social Security Research

Social Development Research Institute established

Publication of the Quarterly of Social Security Research started

Publication of the Overseas Social Security News started

50th Anniversary of Social Development Research Institute

20th Anniversary of Institute of Population and Social Security Research

Institute of Population Problems

Social Development Research Institute

National Institute of Population and Social Security Research

1939.8

1940.4

1940.5

1942.11

1946.5

1962.8

1965.1

1965.1

1968.1

1984.8

1996.12

2014.8

2015.1

2016.6

2016.12

Integration of Institute of Population Problems and Social Development Research Institute

75th Anniversary of Institute of Population Problems

Recommendation of the establishment of a research institute by the Advisory

Council on Social Security System

Started collecting statistics on social security benefits (collected as social

security financial statistics from 2012)

Before World War II, the concern for overpopulation grew due to the food shortage and unemployment, and population problems drew wide public attention in view of securing human resources. Consequently, in August 1939, the Institute of Population Problems was established. It was the fi rst national research institute in the world that focused on population issues. After World War II, a decline in fertility rates and the aging of the population became evident as the economy developed, and the importance of systems and policies to cope with these issues became apparent.

Social security in Japan progressed steadily and the universal coverage of public pension and health insurance was achieved by the mid-1960s. However, basic as well as comprehensive research systems to study social security had yet to be organized. In January 1965, the Social Development Research Institute was established under the recommendation of Advisory Council on Social Security System.

Continuous trends of low fertility, aging, and slowdown in economic growth have brought the relationship between population and social security closer. As such, there arose a growing need to understand the interaction between the two fi elds. On the other hand, during this period, the reorganization of research institutions under the Ministry of Health and Welfare was requested in the context of government reform to better cope with the evolving situation of Japanese society. In December 1996, the Institute of Population and Social Security Research was created by integrating two institutes – the Institute of Population Problems and the Social Development Research Institute.

August 2014 marked the 75th anniversary of the Institute of Population Problems, January 2015 marked the 50th anniversary of the Social Development Research Institute, and December 2016 marked the 20th anniversary of the Institute of Population and Social Security Research.

History

4

26.6%

60.8%

12.5%

38.4%

51.4%

10.2%

6.3%

68.1%

25.6%

1880 1900 1920 1940 1960 1980Year

2000 2020 2040 2060 2080 2100

(Million)140

120

100

80

60

40

20

0

26.6%

60.8%

12.5%

38.4%

51.4%

10.2%

6.3%

68.1%

25.6%

36.65 million(1880) 43.85 million

(1900)

127.09 million(2015)

98.27 million(1965)

88.08 million(2065)

50.56 million(2115)

Total Population

Child Population

Productive-Aged Population

Aged Population

1965 120

100

90

80

70

60

50

40

30

20

10

0120120 100 80 60 40 20 0 100806040200

Population (10,000)

Male Female

2015 120

100

90

80

70

60

50

40

30

20

10

0120120 100 80 60 40 20 0 100806040200

Population (10,000)

Male Female

2065

120

100

90

80

70

60

50

40

30

20

10

0120120 100 80 60 40 20 0 100806040200

Population (10,000)

Male Female

Fertility – low variant

Fertility – medium variant

Fertility – high variant

Population Projection for Japan

In order to provide basic information for planning mid- to long-term national social security system and for other related policies, the National Institute of Population and Social Security Research releases various projections regarding population and social security. They include “Population Projections for Japan,” “Population Projections by Prefecture,” “Population Projections by Municipality,” Household Projections for Japan,” and “Household Projections by Prefecture.”

“Population Projection for Japan” is a projection of the overall size and the age-sex breakdown of the future population in Japan, used widely as an important reference by the national and local governments and in other various fi elds. This projection is based on information from the Census, vital statistics, as well as research developed from various national representative surveys on population and social security problems conducted as the Institute.

Population Projection

●Population Trends in Japan

●Changes in Population Structure

Sources: Population Estimates by the former Statistics Bureau, “Population Census of Japan”, “Population Estimates”, by Statistics Bureau, Population Projections for Japan: 2017-2065 (Medium Variant)

Sources: 1965, 2015: “Population Census of Japan”, 2065: “Population Projections for Japan: 2017-2065 (Medium Variant)

5

Regional Population ProjectionsDue to declining fertility rates and the ageing of the population, demand for regional population projections (by prefecture and by municipality) as the basis of various economic, social and welfare programs have been signifi cantly increasing. According to our regional population projections, the pressure of population decline will grow constantly in all regions, although there are considerable regional variations.

●Regional Population Projection:Population increase of residents 65 years and older by prefecture from 2010 to 2040

2010

2040

0 100 200 300 400 500(10,000)

Percentage of individuals 65 years and older by municipality in 2010, 2025 and 2040 (%)

(%)

2010

2025

2040

Sources: Census (October, 2010), Regional Population Projections (March, 2013)

25.0

30.0

35.0

40.0

45.0

50.0

TokyoKanagawa Prefecture

Osaka PrefectureAichi Prefecture

Saitama PrefectureChiba Prefecture

HokkaidoHyogo Prefecture

Fukuoka PrefectureShizuoka Prefecture

Ibaraki PrefectureHiroshima Prefecture

Kyoto PrefectureMiyagi PrefectureNiigata Prefecture

Nagano PrefectureGifu Prefecture

Tochigi PrefectureGunma Prefecture

Fukushima PrefectureOkayama Prefecture

Mie PrefectureKumamoto PrefectureKagoshima Prefecture

Shiga PrefectureNara Prefecture

Ehime PrefectureOkinawa Prefecture

Nagasaki PrefectureYamaguchi Prefecture

Aomori PrefectureIwate Prefecture

Ishikawa PrefectureOita Prefecture

Miyazaki PrefectureYamagata Prefecture

Toyama PrefectureAkita Prefecture

Kagawa PrefectureWakayama PrefectureYamanashi Prefecture

Saga PrefectureFukui Prefecture

Tokushima PrefectureKochi Prefecture

Shimane PrefectureTottori Prefecture

Only includes total results for Fukushima Prefecture

6

1970

(Trillion Yen) 55

50

45

40

35

30

25

20

15

10

5

01975 1980 1985 1990 1995 2000 2005 2010 2014

(Fiscal Year)

Pensions54.4 trillion yen

(48.5%)Medical care

36.4 trillion yen(32.4%)

Welfare & others21.5 trillion yen

(19.1%)

USAJapanJapan (FY2014) UK Germany Sweden France

(%) 35

30

25

20

15

10

5

0

Other social policy areas

Housing

Unemployment

Active labor market programmes

Family

Health

Incapacity-related benefits

Survivors

Old age

●Social benefi t by category

● International Comparison of Social Expenditure relative to GDP in FY2013

The Financial Statistics of Social Security in JapanProviding data for relevant government ministries and international organizationsEvery year, the National Institute of Population and Social Security Research releases “The Financial Statistics of Social Security in Japan.” The statistics estimate both total and categorical amounts of annual receipt and expenditure on social security schemes in Japan on the basis of two international standards; the ILO (International Labour Organization) standards and the OECD (Organization for Economic Co-operation and Development) standards. In 2012, “The Financial Statistics of Social Security in Japan” was designated as under the scope of Fundamental Statistics by the Statistical Act.

According to the time-series trend of social benefi t by three categories, the benefi ts for pensions and medical care have been increasing year by year as a result of the ongoing phenomenon of population aging and the advancement of medical technology.

The international comparison shows that most social expenditure goes to the elderly in Japan. According to the comparative social expenditure per GDP by nine policy areas, social expenditure on the elderly – such as pension or long-term care benefi ts – is the second highest, while social expenditure on family – such as family benefi ts – is the second lowest among the six developed countries compared.

Statistics have been broadly used as fundamental sources to monitor social security policies and their fi nancing, and also as a signifi cant index to conduct international comparisons of social security expenditures.

Sources:Social Expenditure: OECD Social Expenditure DatabaseGDP: Japan is from the Cabinet Offi ce, Goverment of Japan, “Annual Report on National Accounts 2016.” Other nations are from OECD National Accounts 2015.* Made by National Institute of Population and Social Security Research based on the materials above

2010

2040

0 100 200 300 400 500(10,000)

Percentage of individuals 65 years and older by municipality in 2010, 2025 and 2040 (%)

(%)

2010

2025

2040

Sources: Census (October, 2010), Regional Population Projections (March, 2013)

25.0

30.0

35.0

40.0

45.0

50.0

TokyoKanagawa Prefecture

Osaka PrefectureAichi Prefecture

Saitama PrefectureChiba Prefecture

HokkaidoHyogo Prefecture

Fukuoka PrefectureShizuoka Prefecture

Ibaraki PrefectureHiroshima Prefecture

Kyoto PrefectureMiyagi PrefectureNiigata Prefecture

Nagano PrefectureGifu Prefecture

Tochigi PrefectureGunma Prefecture

Fukushima PrefectureOkayama Prefecture

Mie PrefectureKumamoto PrefectureKagoshima Prefecture

Shiga PrefectureNara Prefecture

Ehime PrefectureOkinawa Prefecture

Nagasaki PrefectureYamaguchi Prefecture

Aomori PrefectureIwate Prefecture

Ishikawa PrefectureOita Prefecture

Miyazaki PrefectureYamagata Prefecture

Toyama PrefectureAkita Prefecture

Kagawa PrefectureWakayama PrefectureYamanashi Prefecture

Saga PrefectureFukui Prefecture

Tokushima PrefectureKochi Prefecture

Shimane PrefectureTottori Prefecture

Only includes total results for Fukushima Prefecture

7

1985-1989

37.3%

3.1%

35.5%

18.4%

5.7%

37.7%

3.4%

34.6%

16.3%

8.1%

39.3%

3.8%

32.8%

13.0%

11.2%

40.3%

3.8%

28.4%

12.2%

15.3%

42.9%

4.1%

24.0%

9.7%

19.4%

33.9%

4.2%

23.6%

10.0%

28.3%

1990-1994

1995-1999

2000-2004

2010-2014

2005-2009

Composition (%)100

80

60

40

20

0

Not statedNot employed before pregnancyResignation upon pregnancyContinuous employment (no parental leave)Continuous employment (parental leave)

Year of birth of first child

A: Continuous employment 38.3%B: Resignation upon pregnancy 46.9%C: Continuous employment 53.1%

A C

B

Employedbefore

giving birth

8th(1982)

9th(1987)

10th(1992)

11th(1997)

12th(2002)

13th(2005)

14th(2010)

15th(2015)

2.622.67 2.64

2.53 2.56

2.482.42

2.20 2.232.18

2.16 2.13 2.11

2.07

2.342.30

2.23

2.15

2.05 2.07 2.04

2.29

2.232.17

2.13

2.03

2.10

2.12

2.32

2.01

1.91

2.02

2.8

2.6

2.4

2.2

2.0

1.8

0.0

Ideal number of children (married couple)Intended number of children (married couple)Desired number of children (unmarried women)Desired number of children (unmarried men)

Annual Population and Social Security Surveys

平成 27年度出生動向基本調査 平成 23 年度

人口移動調査

平成 24 年度生活と支え合いに関する調査

平成 26 年度世帯動態調査

平成 25 年度全国家庭動向調査

1940 年に第1回調査が行われ、ほぼ 5年周期で実施しています。

National Surveyon Migration

in 2016

National Surveyon Social Security

and People’sLife in 2017

National Surveyon Family in 2013

National Surveyon Household

Changesin 2014

National FertilitySurvey in 2015

平成 23 年度人口移動調査

平成 24 年度生活と支え合いに関する調査

平成 25 年度全国家庭動向調査

平成 26 年度世帯動態調査

平成 27年度出生動向基本調査

1940 年に第1回調査が行われ、ほぼ 5年周期で実施しています。

The National Fertility SurveySince 1940, the National Fertility Survey has been conducted every 5 years to investigate the situation and issues of marriage, childbirth and child-rearing in Japan. The survey is carried out separately for both married couples and unmarried individuals, exploring policy-related issues from the perspective of social science. Japan continues to experience declining fertility rates, which leads to population decline and population aging as well as other changes in people’s lives. In the coming years, these changes will have a major infl uence on Japanese society. One of the important themes of the survey is to understand the mechanisms of fertility change and its underlying causes.

The results of the survey are used in various academic research initiatives and policy planning, such as setting fertility assumptions for Population Projections for Japan, evaluating the policy targets of the Basic Plan for Gender Equality (e.g. the proportion of continuous employment after the 1st birth, 55%, 2010), and for many other offi cial reports (e.g. Annual Health, Labour and Welfare Report, White Paper on Gender Equality, Declining Birthrate White Paper), in addition to governmental policy committee documents.

The fi gure below-left shows the employment status of wives before and after giving birth to their fi rst child. Between 2010 and 2014, the percentage of women employed both before and after birth was 38.3%, a large increase compared to previous years. Of note is the signifi cant growth in the percentage of wives who used parental leave after their fi rst child. Of wives who worked before giving birth, 53.1% continued their employment. The fi gure below-right shows the ideal, intended and desired number of children of both unmarried people and married couples. Overall, average numbers for both the ideal number and intended number of children for married couples, and the desired number of children for unmarried people has been declining since the 1980s.

●Changes in the average ideal, intended and desired number of children, by survey

●Changes in employment status of wives before and after giving birth, by year of birth of fi rst child

Notes: Married couples are those where the wife’s age is under 50 years old, and unmarried people are between 18 to 34 years old.

8

Ratio

resp

ondi

ng “

hars

h” o

r “ve

ry h

arsh

”

20-29 30-39 40-49 50-59 60-69 70-79

80

70

60

50

40

30

20

10

0

Age

Men (working)

Women (working)

Men (not working)

Women (not working)

Perc

enta

ge o

f ind

ivid

uals

Every day Once every2-3 days

Once every4-7 days

Less than oncein 2 weeks

100

90

80

70

60

50

40

30

20

10

0

Men (single-person hh)

Men (couple-only hh)

Women (single-person hh)

Women (couple-only hh)

The National Survey on Social Security and People’s LifeJapanese society is undergoing population ageing and changes in household structures at an unprecedented speed. In order to maintain the long-term sustainability of our social security system, it is necessary to implement a series of reforms while also keeping in mind a delicate balance of self-help, mutual-help (by family members) and public help. The National Survey on Social Security and People’s Life is conducted to understand the challenges people face regarding their living conditions, and how they cope with them by supporting each other – through family members and within communities.

●Frequency of Conversation: by Household (hh) type(Persons aged 65 and above)

●Ratio (%) who responded that their living standard is“Harsh” or “Very Harsh,” by sex, age and work status

Especially among men in their 30’s to 60’s who are not working, the ratio responding “Harsh” or “Very Harsh” is very high.

Among elderly persons aged 65 and above, most have conversations with someone at least every day. However, among elderly men who live in single-person households, 16.7% have conversation less than once in two weeks.

The National Survey on MigrationThe National Survey on Migration is conducted to observe trends in the lifetime geographic mobility of the people living in Japan, as well as prospects of future migration patterns. Started in 1976, the quinquennial survey provides detailed data on individual migration experience that cannot be obtained from other governmental statistics. The 8th National Survey on Migration, conducted in July 2016, reveals the lifetime mobility of people residing in Japan, including foreigners, and resulted indicators are shown by each prefecture. Due to the population ageing, both past mobility and future prospect of migration are diminishing slowly. The most frequent reasons for migration are housing related reasons, work-related reasons and change in marital status. 68.6% of people are living in the prefecture which they were born and 20.4% of people are return migrant. 17.3% of people considered that they might move within five years. The results of the survey are used in formulating relevant policies and regional population projections in Japan. 0 250 km500125

29.3

28.8 15.2

19.8

18.3

19.2

17.6

15.4

17.419.2

18.4

16.5

17.1

16.6

19.7

20.6

20.720.0

21.5

21.4

21.1

21.9

20.2

21.7

21.7

22.6

23.8

22.6

22.8

22.8

23.4

22.9

23.8

22.1

23.8

23.5

24.0

25.9

25.925.8

25.1

25.9

25.2

30.0

27.5

28.8

28.5〜20（％）20 〜2222 〜2424 〜2626 〜No survey

● Proportion of return migrant by prefecture of birth

9

Redu

ced

wor

king

hou

rs

Car

e le

ave

syst

em

Cha

nge

of w

ork

dutie

s

Und

erst

andi

ng o

f cow

orke

rs

Elde

rly n

ursi

ng h

ome

Day

ser

vice

or d

ay c

are

Shor

t sta

ys

Hom

e vi

sit c

are

(hom

e he

lper

)

Dom

estic

cho

res

serv

ice

for m

eals

, cle

anin

g, e

tc.

Und

erst

andi

ng o

fpa

rent

s an

d re

lativ

es

Und

erst

andi

ng o

f hus

band

Loca

l vol

unte

ers

Redu

ce b

urde

n on

use

of f

acili

ties

Econ

omic

sup

port

for i

n-ho

me

care

Long

-ter

m c

are

insu

ranc

e sy

stem

Oth

er

Non

e

5.6

1.70.6

8.3

1.3

15.8

6.4

4.5

1.3

5.1

13.9

0.20.9

0.0

5.6

2.4

5.8

（%）20.0

15.0

10.0

5.0

0.0

The National Survey on Family

The National Survey on Household Changes

Accompanied by low fertility rates and population aging, the functions of Japanese families have undergone significant transformation, in addition to such changes as the increase in dual income households and single-person households. The National Survey on Family attempts to capture the changes in family functions, such as the bearing and rearing of children, supporting and nursing elderly parents, and so on. The survey results are used as valuable materials for various political and administrative uses.

Households in Japan are undergoing significant changes. These changes not only include the expected decline in the number of total households, but also the increase in one-person households, couple-only households, and single parent households. The National Survey on Household Changes attempts to capture the detailed process of formation, expansion, compression and dissolution of households.

Such data on household dynamics are difficult to find in other surveys, and the results are used not only in policy purposes but also in household projections.

*The number of replies for the first and second reasons are split between the total number of people who continue working while providing care. Source: The 5th National Survey on Family in Japan, 2013

While various schemes regarding long-term care insurance assist in continuing employment, the understanding and cooperation of husbands is also necessary.

Single-person and couple-only households are increasing. The distribution in convergence suggests that single-person households will continue to increase to nearly 40% when the transition probabilities are fixed over time.

●Reason for continuing to work while providing nursing care*

●Distribution by family type and transition probability (%)

Present

5 Years Ago

No. of households (5 years ago)

Single-person

Household

Couple-only

Household

Household comprised of parent and child

Other private

households

onvergence in

distribution(Actual) (%)

Single-person Household 1,933 ( 23.2) 86.1 6.2 5.9 1.9 38.6

Couple-only Household 1,958 ( 23.5) 11.1 76.1 11.2 1.5 25.2

Household comprised of parent

and child3,511 ( 42.1) 7.2 10.6 79.8 2.4 29.7

Other private households 933 ( 11.2) 6.5 8.0 14.1 71.3 6.4

Total 8,335 (100.0) 26.4 24.7 39.2 9.8 100.0

10

Source: Created by research team with references to OECD (2015)* *Health at a Glance 2015: OECD Indicators, OECD Publishing, Paris.Source: Ishikawa Report

Research Projects1. Aiming to construct a healthcare and nursing care delivery system for 2025 and

beyondStudy on sustainable evaluation and reflection in planning for the effective use of funds to ensure comprehensive healthcare and nursing care (2015-2016) [Project by MHLW Grant]

Japan is faced with a super-aged society as the entire baby-boom generation will be over the age of 75 in 2025. It is important to maintain an environment for each citizen where they can continue to live their final years with peace of mind in a familiar setting as much as possible even when healthcare and nursing care are required. In these circumstances, it is necessary to establish a system that provides seamless healthcare and nursing care from the user's perspective, and realize sustained care that supports the independence and dignity of each citizen into the future.

To contribute to the above-mentioned measures of the Ministry of Health, Labor and Welfare from a research perspective, this project researched 1) establishing a sustainable evaluation method necessary for the effective and efficient use of funds and the construction of indicators for evaluation, 2) clarifying the influencing factors of selection of fund projects by prefectures, and 3) clarifying the actual implementation cycle in prefectures, with respect to the funds (Regional funds for promoting healthcare and long-term care) based on Article 6 of the Act on Promotion of Comprehensive Securing of Medical Care and Nursing Care in Areas.

●Figure 1. Evaluation framework for comprehensive healthcare and nursing care (outline)

●Table 1. Sample evaluation indicators of configured fund projects (project classification 1)

Individual service outcome indicator

Individual service output indicator

Type of project Description and example

Sample indicator

Output indicator Outcome indicator

1

Bed function differentiation and project cooperation

Preparation of recovery phase rehabilitation and community integrated care wards

・ The number of subject medical institutions, wards or beds

・ Number of beds lacking for each bed function (high acute phase, acute phase, recovery phase, chronic phase) prepared with the fund based on the regional healthcare concept [Regional healthcare concept, Hospital function report]

・ Number of beds for each bed function (high acute phase, acute phase, recovery phase, chronic phase) [Bed function report]

△ Notified number of beds of recovery phase rehabilitation ward hospitalization fee (1 to 3) [Regional Bureau of Health and Welfare]

・ Notified number of beds of integrated community care ward hospitalization fee (1 to 2) or integrated community care inpatient healthcare management fee (1 to 2) [Regional Bureau of Health and Welfare]

・ Number of calculations of recovery phase rehabilitation ward hospitalization fee (1-3) [NDB open data] ・ Number of calculations of integrated community care ward hospitalization fee (1-2) or inpatient

healthcare management fee (1 to 2) [NDB open data]

2

Preparation of a regional healthcare network foundation using information and communication technology (ICT)

Construction of a healthcare information network between medical institutions and nursing care facilities using ICT

・ The number of medical institutions and nursing care facilities participating in the network

△ Number of prepared zones in regional healthcare cooperation network△ Number of participating hospitals in regional medical cooperation network (number of hospitals that

disclose information)△ Number of participating medical clinics in regional medical cooperation network (number of clinics

that disclose information) ・ Number of registered patients in regional medical cooperation network△ Number of municipalities that are building collaboration between healthcare treatment and long-term

care insurance information using ICT ・ Number of times test/image information provision calculations are calculated [NDB] ・ Number of calculations of electronic diagnosis information evaluation fee [NDB]

V: Health status, level of independence, continuity of living at home= Overall outcome indicator

IV-a: Combination of appropriate care and service IV-b: Determining factors of health other than medical factors

III: Performance of care and service

a: Quality b: Access c: Healthcare/nursing care and financial resources

E.g.) Improvement of care for dementia E.g.) Improvement of nursing care service, improvement of in-home medical care and home nursing care

E.g.) Efficiency of nursing care service

II: Resources and activities for care and service

a: Healthcare insurance labor b: Healthcare insurance activities

E.g.) Hiring and training specialists E.g.) Preventive nursing care, creating health

I: Demographic and economic background, healthcare costs and financial resources

Healthcare/nursing care cooperation

11

Acute phase/recovery phaserehabilitation

Living phase rehabilitation

Living function

Part icipat ion

Training to learn how to sit, stand, walk, etc.Function recovery trainingBody functions

Activity

Encourage and coordinate environment for eating, excretion, changing clothes, bathing, etc.

Encourage and coordinate environment for cleaning, laundry, cooking, going out, etc.

Work to improve IADL

Activity Work to improve ADL

Support a place of belonging and create opportunities with a purpose in life and a role in the communitySupport the building of a role within the family

Create a role and participate in society

Deterioration rate (%)0 105 15 25 3520 30 40 45

Maintaining asitting position

Walking

Eating

Excretion

13.613.625.225.2

9.79.723.523.5

10.710.727.827.8

6.16.118.718.7

9.09.040.040.0

11.011.034.834.8

11.411.425.725.7

8.18.112.612.6

4.24.210.410.4

Home (n=2,422)Non-home (n=230)

Standing onboth feet

Shopping

Simple cooking

Removal ofa coat

Management ofmoney

0 10 20 30 40 50 60 70 80

Joint movementrange training

Muscular strengthimprovement training

Walking/movementtraining

Course ofbathing exercises

Course ofexcretion exercises

Course ofeating exercises

Course ofcooking exercises

Course oflaundry exercises

Shopping exercises

58.958.950.950.9

67.2 67.2 71.971.9

68.268.271.371.3

3.42.7

5.12.5

0.90.92.0

1.01.00.7

2.40.6

Home visit rehabilitation (n=3,989)Facility visit rehabilitation (n=1,983)

Implementation rate (%)

2. Investigating ways of rehabilitation that improve activity and participation levelsComprehensive study on effective rehabilitation and rehabilitation management that contributes to life enhancements of elderly requiring long-term care (2015-2017) [Project by MHLW Grant]

An integrated community care system, providing healthcare, long-term care, preventive long-term care, housing, and livelihood support in an integrated manner, is being built for 2025, so that the baby-boom generation that will be over 75 years old will able to continue living in familiar settings with ease even after they come to require advanced-level care

While it is important to balance each element of “body functions,” “activities,” and “participation” for elderly with deteriorated livelihood functions to continue living in familiar settings, much of the currently provided rehabilitation leans toward the recovery of “body functions.”

This research aims to identify rehabilitation methods that contribute to the improvement of activity and participation levels of the elderly, and to develop ways of management for these methods to work effectively.

●Figure 1. Image of rehabilitation for the elderly

●Figure 2. Change in the condition of users of rehabilitation

●Figure 3. Implementation of rehabilitation

The International Classification of Functioning, Disability and Health (ICF) adopted by the World Health Organization (WHO) General Assembly in May 2001, writes that three “life function” elements are needed for a person to live, which are 1) the "body functions" that are the movements of the body and mental state, 2) activities of daily living (ADL), such as eating, and general daily activities such as housework, vocational skills, and waking outdoors, and 3) participation in home and society as part of fulfilling a role.Source: MHLW Annual Health, Labour and Welfare Report 2016

Among the elderly who use rehabilitation, of the group that continued living at home one year later (home group) and those living in a facility (non-home group), in comparing the change in condition over a year, the non-home group not only saw deterioration in body functions and structures compared to the home group, but also had a greater proportion of declining ADL/IADL functions.

In examining the content of the rehabilitation performed, while a high percentage is aimed at restoring body functions such as walking and mobility training, the improvement of ADL (eating, excretion, bathing, etc.) and IADL (cooking, laundry, shopping, etc.), accounts for a low percentage of rehabilitation.

12

Projected migrations

Total migrations (=total in-migrations)

Pool

Population

Number ofmigrations

Number ofin-migrations

P1

P1×e1 P2×e2

Pn×en

P2

Pn

Projected in-migration

Pool×d1

Pool×dn

Pool×d2

0

10

20

30

40

50

60

70(%)

2009 Basic A B1 B2

62.3

25.6

36.6

50.1

23.4

26.8

53.9

24.5

29.4

57.2

23.8

33.4

57.7

24.3

33.4

50.2

23.6

26.6

51.7

23.8

27.9

ProportionBase

A' B'

Incorporation prevents a drastic drop in the basic pension level of the public pension

●Future projection method of population transition with the pool model (outline)

●Effect of incorporation of foreigners on income substitution rate of the public pension (pattern 1)

3. Exploring the next generation projection system and its policy applications based on analysis of advanced population and household trends

Comprehensive study on population and household dynamics and population projections in an era of declining population (2014-2016) [Project by MHLW Grant]

Research was conducted with the aim of projecting the future demographics of Japan as its population enters a period of decline. Projections of the future population and households is used in the formulation of various policies, but as Japan’s population enters a period of decline, changes in regions and households affect nationwide trends such as the declining birth rate and longevity, and develop with a synergistic effect, which requires deeper analysis of population and household trends reflecting recent research, a future projection model incorporating a new perspective that puts more emphasis on provided information on the future of regions/households and integrates the tendency of declining birth rates and longevity nationwide, and policy simulation using the future projection of demography and households.

Specifically, the research focused on three areas: (1) Analysis of comprehensive population and household trends in the period of declining population by applying state-of-the-art technology, (2) Fundamental research on a next-generation future projection model with emphasis on regional and household projections, and (3) Research relating to policy simulations using future projections.

The pool model was used to project the future population by prefecture for the research on the next-generation future projection system. The research showed that it is possible to calculate a stable projection with no inconsistencies in population migration, that there is a possibility that results can be obtained close to where the net migration rate is reduced in a single region model, and that it is possible to quantitatively evaluate the impact of each assumption on the projection results including other regions.

As an application for policy simulation, a financial simulation was conducted on the impact of the incorporation of the foreign population on the public pension. The figure on the left shows the effect of the income substitution rate on the public pension when taking in foreign workers, and pattern 1 shows the case of accepting male low-wage workers. The horizontal axis shows the incorporation cases where A, B1, B2 are the integration for the public pension system, while A' and B' are the national pension for the basic case not to expand the integration of foreigners. As A shows the integration of foreign workers only, B is the accompaniment or calling of dependents or family. B1 and B2 are the wage levels of workers from the second generation onward where B1 is low wages and B2 are high wages.The level of decline in the basic pension level is reduced in applying the integration of foreigners to the national pension system. Thus, attention should be given to the fact that in discussing the integration of foreigners, in addition to the impact on long-term population trends, there is an effect on the problem of declining basic pension levels.

13

In-House Projects

Projects by MHLW Grant

Projects by MEXT Grant

Other Research Projects

4. Comprehensive study of population aging and migration in Eastern Asian and ASEAN countries

(2015-2017) [Project by MHLW Grant]

South Korea and Taiwan are suffering from significantly lower fertility than in Japan, while China and Singapore have low fertility rates as low as Japan. Japan currently has the most aging population in the world, but in the future South Korea and Taiwan will overtake Japan, while other Eastern Asian and ASEAN countries will certainly approach Japan. Such an acute fertility decline and the aging of the population are thought to activate domestic migration with rural areas depopulating and gathering in urban centers, and international migration incorporating foreign workers including healthcare and long-term care workers, international marriages and invited retirees. This research aims to grasp and analyze drastic fertility decline, population aging, and various migration in this region. 0

10

20

30

40

50

2010

(%)

2020 2030 2040 2050 2060 2070 2080 2090 2100

JapanROKTaiwanChinaSingapore

●Percentage of population aged 65 or older

Calculated based on United Nations Population Division, World Population Prospects, 2015 Revision

●Comprehensive research on strengthening local governments through advanced case study analysis and lateral deployment (FY2017-FY2019) ●Comprehensive research aimed at realizing the "Plan for Dynamic Engagement of All Citizens" (FY2017) ●Comprehensive research from a demographic viewpoint on the longevity revolution (FY2017-FY2019)

●Comprehensive study on population aging and migration in East Asian/ASEAN countries (FY2015-FY2017) ●Research on the improvement of statistics to understand social insurance finances macroscopically (FY2015-FY2017) ●Analysis study on the poverty situation in Japan (FY2016-FY2018) ●Research on population analysis, future projections, and its application corresponding to new trends in declining birthrates and aging from an international and regional perspective (FY2017-FY2019) ●Survey of demographic dynamics on aggregation and analysis methods using composite cause of death information from death certificates (FY2017)

●Comprehensive study on trends in marriage, divorce, remarriage, and the transformation of Japanese society (FY2013-FY2017) ●Empirical research aimed at the sustainability of healthcare insurance supporting diverse people in a super-aged and shrinking society (FY2015-FY2017) ●Escaping from an unjust gender society: A comparative study of the division of gender roles in labor and birth in Japan, Germany and the Netherlands (FY2015-FY2018) ●The demography of sexual orientation and sexual recognition - Construction of a research base in Japan (FY2016- FY2020) ●The savings behavior of small-scale households: Prepatory savings and strategic legacy motives (FY2016- FY2018) ●Study on the building stage of an elderly care system in East Asia and the propagation of Japanese experience (FY2016-FY2018) ●Study of "Domesticated Social Nursing:" A comparison of Japan and Italy (FY2016- FY2018) ●Building a junior baby-boom generation retirement living expenses model - Research on the division of public and private roles of the pension system - (FY2017- FY2019) ●Construction of a panel survey focusing on the "new" migration process of newcomer immigrants in modern Japan (FY2017-FY2020)

14

International CooperationOrganizing the Foreign Scholar Lecture Series and International Workshops

Promoting International Research Cooperation

Receiving Visitors from Overseas

Collaborating through International Organizations on Population and Social Insurance Issues

The Foreign Scholar Lecture Series and International Workshops are organized to invite internationally renowned researchers in the fields of population and social security. These seminars and workshops are held in the IPSS conference room and are open to the public. In FY2015-FY2016, special lectures were given on the subjects of population bonuses, population declines, population trends in North and South Korea, mathematical demographics, work and family balance, and longevity. International workshops with East Asian countries were also conducted.

We are engaged in cooperative research based on a memorandum of understanding with the Korea Institute for Health and Social Affairs (KIHASA), the French Institute for Demographic Studies (INED), and the Ministry of Civil Affairs of the People's Republic of China, while we promote information exchanges and joint research with international organizations such as the OECD, World Bank (WB), Asian Development Bank, UNICEF, the United Nations Population Fund (UNPF), along with universities and research institutes in their respective countries. We also participate in international scientific conferences on population and social security, and issue reports.

We receive delegations and study tour groups from around the world and outline the current situation of population and social security in Japan for them. In FY2015-FY2016, through the JENESYS Japanese government exchange program and others, we received visits from groups from around the world, and from global populat ion development delegat ions f rom countries such as China, South Korea, Mongolia, Taiwan, USA, Australia, the UK, Denmark, and others.

We are engaged in ongoing cooperation about issues on a global scale such as population problems and the building of an international social security system through the Commission on Population and Development held at the UN headquarters, and participation in various meetings held at the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP). We are also offering expertise and data on population and social security in Japan through short-term dispatches to OECD headquarters and participation in expert meeting held by the OECD.

15

SeminarsThe 21st IPSS Annual Seminar (December 1, 2016)Visions for the Future Japanese Society and Social Security System - Social Security System for a Sustainable Society in the Era of Population Decline -

<Date> 13:30-16:30 on December 1, 2016 <Venue> Hibiya Convention Hall

<Keynote Speech>Ryuichi KANEKO Deputy Director-General, National Institute of Population and Social Security Research

<Panelist Speech>Akiko OISHI Professor, Faculty of Law, Politics & Economics, Chiba UniversityNaoko SOMA Associate Professor, International Social Sciences Section at the Graduate School of International Social Sciences, Yokohama National UniversityKeiko KATAGIRI Associate Professor, the Graduate School of Human Development and Environment, Kobe UniversityYukimitsu NISHIMURA Senior Researcher, Department of Empirical Social Security Research, National Institute of Population and Social Security Research

<Moderator>Akira MORITA Director-General, National Institute of Population and Social Security Research (then)

The 18th IPSS Annual Seminar (October 31, 2013)“New Trends in International Migration – Towards a Japanese Model”

The 20th IPSS Annual Seminar (December 15, 2015)“Challenging Issues over Regional Depopulation and Social Security in Japan”

The 19th IPSS Annual Seminar (October 31, 2014)“Women’s Diversifying Life-Course Patterns and Social Security – Social Security System for a Sustainable Society in the Era of Population Decline –”

16

Publication, Database

LibraryThere are many statistical publications, especially on demographics and social policy, in the collection.Opening hours: 10:00 to 12:00 13:00 to 17:00, Weekdays onlyReference service: TEL: +81(0)3-3595-2988 FAX: +81(0)3-3591-4818Loans: Loaning is possible upon presenting personal identifi cation and registrationOver 130,000 book and magazine titles are available for researchers as well as for the general public and government administrators. Interested parties can also access all information on our website through our library search at the following link: www.ipss.go.jp/tosho/tosho-lx.html. Valuable historical documents have also been compiled, and are available for public use.

■ Detailed reports on the surveys and estimates are published and available to download on our website.

Periodicals

Reports, Research Series & Survey Series

■ The Quarterly of Social Security Research (SYAKAIHOSYO KENKYU)Publishes papers related to social development and welfare state themes, and papers on social security systems of other countries, with a focus on social security (published four times a year).

■ Journal of Population Problems (JINKO MONDAI KENKYU)Focuses on papers and statistical materials on population, birth, death, population migrations, and households (published four times a year).

■ Social Security Statistics (SYAKAIHOSYO TOKEI NENPO)An edited collection of a wide range of statistical materials on social security (published annually).

■ Population Statistics (JINKO TOKEI SHIRYOSYU)A collection of selected important statistics with an aim to contribute to research on population trends and issues from population statistics (published annually).

The results of research projects are published as a series and widely distributed.

■ Integrated Community Care System (March 2013)

■ Theory and analysis of social security cost statistics (March 2014)

■ Population trends in Japan and the future of society (April 2017)

17

Director-General

Deputy Director-General Coordination Officerfor Policy Studies

Research on specific policies,coordination of policy research anddissemination of research outcomes.

General Affairs Division

Personnel management; budget; support of research; publication of research■ Major work related to support of research:

publication of journals and research reports; management of conference and other activities.

Department of ResearchPlanning and Coordination

Overall planning and coordination of research on social security and population.■ Major projects: Collection of statistics on social security finances

Department of InternationalResearch and Cooperation

Research on population and social security in international perspectives; international cooperation of research.■ Major projects: National Survey on Migration, international

comparative study on social security and population, research on global issues

Department of InformationCollection and Analysis

Analysis of statistical information on social security and population; development and management of databases; bibliography of related studies.■ Major projects: statistical analysis of social security and population■ Collection of publication (library)

Collecting and maintaining domestic and foreign publications (database) related to social security and population.

Department of TheoreticalSocial Security Research

Research on theory related to the function of social security, and relationships with socioeconomic structure.■ Major projects: Theoretical research on the function of social security,

institutional models of social security, and economic models of social security

Department of EmpiricalSocial Security Research

Empirical studies on social security such as medical care, long-term care, social welfare and pension.■ Major projects: Empirical research on functions, institutional models,

economic models, medical care, long-term care, social welfare of social security and pension

Department of PopulationStructure Research

Research on the basic structure of population, migration and spatial distribution of population, household structure, projections of sub-national population and household.■ Major projects: migration; regional distribution of population; structure

of the household and the family; projection of regional populations and household.

Department of PopulationDynamics Research

Research on fertility and mortality; changes in the functions of the family.■ Major projects: estimation and projection of fertility, mortality and life

expectancy at birth; survey of family functions, marriage, fertility; projections of national population.

Organization

18

Masami Iwata Honorary Professor, Japan Women’s University

Masahiko Iwamura <Vice-Chair> Professor, University of Tokyo Graduate School

Senichi Obayashi Professor, Teikyo University

Naoto Kunitomo Research Professor, Meiji University

Osamu Saito <Chair> Honorary Professor, Hitotsubashi University

Takao Suzuki Professor, J. F. Oberlin University Graduate School

Eiji Tajika Research Professor, Seijo University

Noriko Tsuya Professor, Keio University

Nobuko Nagase Professor, Ochanomizu University

Masago Minami Managing Director at The Yomiuri Shimbun Tokyo Headquarters and Chief Officer at the the Yomiuri Research Institute

Hisashi Inaba Professor, University of Tokyo Graduate School

Takashi Inoue Professor, Aoyama Gakuin University

Toshihiro Ihori Distinguished Professer, National Graduate Institute for Policy Studies

Masahiro Umezaki Professor, University of Tokyo Graduate School

Machiko Osawa Professor, Japan Women’s University

Hiroya Ogata <Deputy Chair> Project Professor, Policy Alternatives Research Institute

Daiji Kawaguchi Professor, University of Tokyo Graduate School

Yoshimi Kikuchi Professor, Faculty of Law, Waseda University

Yasuhiko Saito Professor, Nihon University University Research Center

Sawako Shirahase Professor, University of Tokyo Graduate School

Shogo Takegawa Professor, University of Tokyo Graduate School

Yasuko Hayase Honorary Researcher, Institute of Developing Economies, Japan External Trade Organization

Toshihiko Hara <Chair> Professor, Sapporo City University

(As of end of June, 2017)

The Board of Councilors provides advice on the basic policies on the Institute’s survey research activities and other important matters.

(As of end of June, 2017)

The Research Evaluation Committee provides evaluation on the Institute’s overall operation, research issues, and the status of research conducted by researchers.

Advice and Evaluation by External ExpertsBoard of Councilors

Research Evaluation Committee

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National Institute of Population and Social Security Research