Health care insurance in Japan: Beyond a binary vision of State and family

Despite significant regional diversity in household structures and the existence of community solidarity in Japan, caring for elderly dependent persons has traditionally been considered an exclusively family, and female, responsibility. However, as a result of socio-demographic changes during the second half of the twentieth century, a public system of health care insurance was introduced in 2000. The objective of this development was to "socialize" family and female care activities. This article presents a critical analysis of Japan's health care insurance system and the context that gave rise to its introduction. An important issue is whether the system meets the needs of the elderly and their carers (family and non-family). A further issue is whether the system can take account of regional diversity, diversity in household situations (above and beyond financial concerns), and societal values and beliefs. The article concludes by arguing that demographic ageing presents a societal requirement for the ongoing adjustment of behaviour patterns and living arrangements.