Can an ageing Malaysia take inspiration from super-aged Japan’s LTC insurance?

Picture for illustration purposes. Japan introduced its long-term care insurance just a few years before it became super-aged, with residents required to start paying this insurance’s premium from age 40. — Picture by Raymond Manuel

By Ida Lim

First Published: Friday, 13 Nov 2026 7:00 AM MYT

KUALA LUMPUR, Nov 13 — It is very likely that a significant proportion of Malaysians will need long-term care as Malaysia becomes an aged nation in 2048 — just 22 years away — when one in every seven Malaysians will be at least 65 years old.

Before that, can we put in place a long-term care insurance? And what can we learn from super-aged Japan’s experience?

In 2000, Japan introduced its national long-term care insurance via a mandatory social insurance system, and was described by the International Labour Organization (ILO) as the first in Asia to do so.

Here’s a summary of how it works (based on information mostly from Japan’s Ministry of Health, Labour and Welfare and other resources such as the Global Observatory of Long-Term Care, Japan Care Concierge and the Japan International Cooperation Agency):

1. Who must contribute and be covered by this insurance?

When they turn 40, Japan’s residents (both citizens and non-citizens) are automatically included in this insurance and must start paying premiums.

2. How is the insurance funded?

The insurance cost is split in half between:

• the government via tax revenue (with the municipal, prefectural and national governments sharing the bill); and
• residents via insurance premiums (27 per cent from those aged 40 to 64, and 23 per cent from those aged 65 and above).

The premium amount depends on your income and your municipality, with low-income earners paying less than the standard rate and higher-income persons paying more.

Apart from the premium, you also have to pay between 10 to 30 per cent of the care services bill. This co-payment will kick in only when you use the insurance for care services.

3. Conditional care coverage if below 65; care for 65 onwards not limited to 16 diseases

If you are aged 40 to 64, the insurance will pay for your support or long-term care needs, only if it is due to 16 age-related diseases.

For those aged 65 or older, you will have insurance coverage as long as you are certified to need support or long-term care, even if it is not due to any of the 16 diseases.

4. Assessment of whether you need care services

To get the insurance to cover your care or support services, you will first need to apply to be certified as requiring such care.

Officers from your municipal government will visit your home to evaluate your physical and mental condition, and your primary doctor has to provide a written opinion of your condition to the municipal government.

A committee of experts will then decide whether you need care and what care or support level you are in.

5. What level you are will decide what services you can get under insurance

In total, there are seven categories which a person can possibly fall under, which comes with different maximum limits on the monthly care costs that the insurance covers.

There are also different support and care levels stated.

6. Co-payment comes with a cap

When you use care services, you still have to share the bill by paying out of your own pocket: 10, 20 or 30 per cent of the care costs (depending on your income level).

Based on your income and age, there will be a maximum limit on the co-payment amount you have to pay.

Picture in Ipoh, Perak for illustration purposes. Preventive care such as community-led exercise classes could help older persons continue to live in their communities as they grow older. — Picture by Farhan Najib

7. Beyond just money: Having a complete system within the community to support ageing in place

Apart from featuring insurance, Japan’s long-term care system also requires municipal governments to set up a “Community-based Integrated Care System”.

The system aims to provide services accessible within 30 minutes’ walk from older persons’ residences in communities — such as medical care, nursing care, support for daily lives, activities to prevent frailty and long-term care, and to enable continued active and healthy living.

At the recent National Long-Term Care Financing Dialogue 2026 held here, healthcare consultancy Mediva Inc CEO Kanoko Oishi said these three concepts are linked to the long-term care system in Japan: maintaining older persons’ dignity, independence and ability to continue living where they spent their whole lives.

For example, instead of thinking of using wheelchairs immediately for an older person, she said the thought process would be: “If that person can walk a little bit, how can we support them [so] that they can walk more? Or how can we support [so] that they can take care of themselves? So keeping that independence of the elderly is a very important concept.”

Mediva Inc founder Kanako Oishi also said avoiding frailty and addressing chronic diseases would help older persons stay independent, adding that Japan has a mandatory health check at age 40 along with mandatory counselling to change eating and exercise habits. — Picture by Sayuti Zainudin

8. Keeping it sustainable: Costs and manpower

Based on ILO’s profile on Japan’s long-term care insurance, the government had introduced measures to cope with rising costs, including by introducing higher co-payment levels for higher-income persons from 2015 onwards (20 per cent) and from 2018 (30 per cent).

According to ILO, Japan had previously tried addressing its shortage of care workers by improving pay via subsidies; expanding training and certification programmes; and accepting migrant workers.

News reports indicate that the shortage is an ongoing problem, and that Japan is currently studying plans to increase premiums for high-income earners aged 65 and above.