challenges and lessons to scaling up policy …challenges and lessons to scaling up policy...
TRANSCRIPT
Challenges and Lessons to Scaling up Policy InnovationThe process of inst i tut ional izat ion in long-term care pol icy in Japan
Subtheme: Managerial Innovation -Improving Governments and Governance
EROPA 2015 @Shanghai2015/10/20
Kyoko OHTA, Ph.D.Project Researcher
Policy Alternatives Research Institute, University of [email protected]
Table of Contents1. Challenges for Japanese local governance
Background: Japan’s aging society
National Long-term Care Insurance and elderly care policy
2. Scaling up of policy innovation Policy making in Japanese local governance
Scaling up
Special Zones: institutionalization of niche innovation?
3. “Toyama model” of multi-generation day care
4. Lessons learned
2
Challenges and Lessons to Scaling up Policy Innovation
1. Challenges for Japanese local governance• Background: Japan’s aging society
• National Long-term Care Insurance and elderly care pol icy
3
Challenges and Lessons to Scaling up Policy Innovation
Background: Japan’s aging society
4
Population aging rate: 25.1%(65 or older, 2013)
“2025 crisis” (baby-boomers become 75 or older)
Aging in rural area (e.g. depopulation)→ Aging in urban areaGrowth rate of population of 65 or older, 2010→2025: Shimane 8%, Akita 10% (rural areas); Saitama 35%, Chiba 34%, Kanagawa 34% (suburbs of Tokyo)
Depopulation impact→ Local municipalities could become extinct??
Challenges and Lessons to Scaling up Policy Innovation
5
Change of Demographic Breakdown
65 and older
15 ~ 64
Under 15
Challenges and Lessons to Scaling up Policy Innovation
National Long-term Care Insurance and elderly care policy 1950s~: family care and residualized care with welfare placement
(“Sochi” system)= state subsidy + decision of placement by municipalities
Elderly care/welfare became agenda in 1970s~: Failure of free medical care policy for elderly leaded bed blocking in hospital
National Long-term Care Insurance Act 1997, implementation from 2000; 40 and older are insured and municipalities (cities, 1st tier gov) as insurer
Post-Long-term Care Insurance legislation: Implemented in 2000, amended in every 3-5 years
6
Challenges and Lessons to Scaling up Policy Innovation
7
Financial structure of National Long-term Care Insurance
Type I insured Type II insured
厚生労働省ホームページ(http://www.mhlw.go.jp/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/gaiyo/dl/hoken.pdf)より一部改変
Tax
Insurance
Municipalities (Insurer)
Municipalities Prefectures State government
Financial stability fund
Challenges and Lessons to Scaling up Policy Innovation
After 2000
Age-related policies coordinated in local community, preparing for “2025 crisis”
Community integrated care (Insurance-based synthesis of medicine, nursing and care policies) and “small-size multi-functional care facility” are strongly encouraged in National Long-term Care Insurance program
Proximity of housing policy, community living e.g. special residence with life support for elderly, organized by Ministry of Health (MHLW) and Ministry of Land/Infra/Trans (MLIT)
However… Financial pressure (National Health Insurance, pension, payment fee for
home medical care…)
8
National Long-term Care Insurance and elderly care policy
Challenges and Lessons to Scaling up Policy Innovation
Care team
Image of Community General Support Center / Community Integrated Care
Person insured
Team approach
Social workers, care workers
Care manager etc.
Public health nurse etc.
Family doctor
Care manager
Integrated and continuous support of care management
General advice and support
Preventing abuse, advocacy
Various local bodies (town hall, health center,
child care bureau, volunteer center, adult
guardianship bureau etc.
Cross-sector support
Family doctor
Prevention
Community General Support Centre’s Management Council
Establish per “community” Establish per
municipality
Support, networking and evaluation
Securing neutrality, support for human
resources
Source: MHLW website, edited by author
9
Challenges and Lessons to Scaling up Policy Innovation
介護費用と保険料の推移
10
出典:厚生労働省ホームページ(http://www.mhlw.go.jp/topics/kaigo/zaisei/sikumi.html)より
Increasing fees and insurance premiums for elderly care
Total expenses
Insurance premium per person over 65
Challenges and Lessons to Scaling up Policy Innovation
2. Scaling up of policy innovation• Pol icy making in Japanese loca l governance
• Sca l ing up
• Specia l Zones: inst i tut ional izat ion of n iche innovat ion?
11
Challenges and Lessons to Scaling up Policy Innovation
Delegation and the division of policy making in bureaucracy Central bureaucracy as “the biggest think-tank in Japan”
Functional division of labor in bureaucracy: division (each Ministry) and coordination (Cabinet Office)
Policy making processin central government in Japan
12
Policy making in Japanese local governance
出典: 秋吉他2010, p48 に加筆修正
Policy issues Ministries
Public policy B’ E’
A B C D E Cabinet
DietDeliberation and
Legislation
Enforcement
Implementation Planning, implementation, project
Ministries
Local authorities
Decision in Cabinet
Analysis, Examinationand policy making
Challenges and Lessons to Scaling up Policy Innovation
Policy making in Japanese local governance In line with Care Insurance, Local Government Decentralization Reform(implemented in 2000) ─ Another background for the local government as a insurer of long-term care insurance
Inter-governmental relations in Japan: distinguished as a different actor, each has its own purpose and preferences. A kind of interest group politics, but still many “rules of the game”.
National plan as a “institution”: In this perspective, inter-gov relations is not a pure game, but many parts of its result are already decided as a kind of “national plan”. It is often difficult for local government to draft its policies freely from the beginning. Also the regulations conducted by different Ministries (and conflict among them) prevent them from making innovative policies.
Policy making competency of local government: we can find a certain progress since Local Government Decentralization Reform in 2000, with regard to delegation of authority, but not of financial resources.
13
Challenges and Lessons to Scaling up Policy Innovation
Policy making in Japanese local governance There’s a correlation between the progress of decentralization and that of policy making competency, so the development of the latter is essential for the quality of the decentralization.
Challenges The cities (except capital city Tokyo) across Japan shared the same issues of
aging, shrinking population and financial deficit. How they become sustainable, and how to manage transition to the sustainability in urban habitation, economic activity, resilient infrastructure and feasible administration?
Especially, how we can understand the innovation and the transformation from “solid” and “stable” institutional frames towards something more flexible that guarantees the economic sustainability of the city?
And what is the potential of the citizens, or the local governance, for the transition?
14
Challenges and Lessons to Scaling up Policy Innovation
Scaling up Sustainable transition based on “city” Theory: Transition management and transition governance(Grin et al. 2010)
Basic ideas: Three-tier structure, stages of transition (take-off, acceleration, stabilization), transition arena
“Strategic niche” perspective
Scaling up
Experiment and learning
Transition = how to sustain or scale-up niche innovation
Sustainability ≠ inertia nor routine
15
Transition phases
Sustainable
society?
health care
energywaste
waterconstruction
mobility finance
predevelopment
take-off
acceleration
stabilisation
Based on Rotmans et al, 2001Based on Rotmans et al. 2001, edited by Loorbach’s presentation in 2013/7/12
Challenges and Lessons to Scaling up Policy Innovation
Scaling up 移行の三層構造(Multi-level perspective)
16
Scale up
Landscape*
(macro-level)
Regimes
(meso-level)
Niches
(micro-level)
* By J.Rotmans, R.Kemp, F.Geels, D.Loorbach, et al., edited by S. Murakami
Challenges and Lessons to Scaling up Policy Innovation
Scaling up Bottom-up and scale-up effects from niche level to the strong and stable regime level (Geels 2011, pp27-8)1. Articulation of expectations or visions
2. Building of social networks and the environment of more actors
3. Leaning and articulation processes on various dimensions
However… Regime acts as a barrier which prevents niche innovation to have bigger
opportunity
Niche must have an alternative development strategy in the multi-regime interaction (Konrad et al 2008; Grin et al. 2010; Raven and Verbong 2007)
Role of micro-level actors/individuals Policy entrepreneur
Key actors sometimes link the geographical scales (Raven et al. 2012, p68)
Hybrid actors who go across multiple levels and contribute to the scaling up of niche experiment (Kivisaari et al. 2013, p190)
17
Challenges and Lessons to Scaling up Policy Innovation
Special Zones: institutionalization of niche innovation? Special Zones for Structural Reform (構造改革特区) In the Zone, the project which used to be prohibited can be carried out
because of the deregulation.
Implemented from 2003, led by Cabinet Office (not by the Ministries)
Comprehensive Special Zones (総合特区) Deregulation plus budgetary support and tax treatment
Implemented from 2011, led by Cabinet Office (not by the Ministries)
As a tool for experiment of innovative policy → lessons learned
Diffusion and institutionalization if needed
18
Challenges and Lessons to Scaling up Policy Innovation
3. “Toyama model” of multi-generation day careA case of scal ing up of local innovative policy
19
Challenges and Lessons to Scaling up Policy Innovation
20
Toyama city
Population
Size
Budget ¥152 bil≒ $1.3 bil
Regional core city
Challenges and Lessons to Scaling up Policy Innovation
Background: since 1980s, niche services of “day home for elderly” (similar to the nursery) were develop by local government and NPOs across Japan.
Unique multi-generation day care facility “Takurou-sho” in Toyama
Small-size multi functional care facility
21
3. “Toyama model” of multi-generation day care
Takurou-sho “Konoyubi-tomare” (multi-generation day care facility) in Toyama, established in 1993
Challenges and Lessons to Scaling up Policy Innovation
Characteristics of “Toyama model” Small size. Utilize second-hand residence in the local community.
Cohabitation care. The elderly is supposed to be the main user, but adultphysically handicapped, mentally handicapped, as well as handicapped children can use. Various services are provided under the same roof, and users share the same space.
22
3. “Toyama model” of multi-generation day care
Challenges and Lessons to Scaling up Policy Innovation
23
3. “Toyama model” of multi-generation day care
In 1993, retired hospital nurses start small-size and homely day care service for the elderly.
Then started nursery services for infants and disabled children. The improvement of mental condition of the elderlies.
There is a possibility of various types of subsidy by central government.
However, the functionally divided regulation by central administration is the barrier to the subsidy for "everybody"
The founders approach Toyama City to develop the new grant project which cover both the elderly and the handicapped, and they managed.
There is the limitation for City's budget, so the founders encouraged prefecture government (Toyama prefecture) as well to develop the flexible grant program.
In 1997, "Toyama civil day service development project" initiated by Toyama prefecture. The grant covers "everybody".
Challenges and Lessons to Scaling up Policy Innovation
24
3. “Toyama model” of multi-generation day care
"Toyama model" becomes famous for its small-size multi-functional services which goes across administrative division. Lots of visitors from central and local governments.
In 2000, National LTCI starts and central government subsidy for "elderly" section.
In 2003, Toyama Prefecture and Toyama City become approved as Special Zones for Structural Reform(構造改革特区) by Cabinet Office.
In 2006, new legislation for supporting handicapped people. The "handicapped" section of Toyama model becomes institutionalized across Japan.
In 2006, amendment of LTCI Act. Toyama model is introduced in the LTCI scheme (those facilities become paid by LTCI fee) and institutionalized across Japan.
Challenges and Lessons to Scaling up Policy Innovation
26
Outcome of Scaling up: Institutionalization of small-scale multi-functional care in the community Conjunction point: new legislation for supporting handicapped people on the one hand, and amendment of Long-term Care Insurance Act on the other, both in 2006
Shift of long-term care policy in 2006 towards autonomous community care, rather than “paternalist” insurance-based care. Introduction of small-size multi-functional care by central government.
Characteristics of scaling up of Toyama model The original idea (in Toyama) is to cover the gap between divided services.
Hybrid services and hybrid resources: the strategy to draw central subsidy whoever (elderly, handicapped or handicapped child) uses the facility.
Challenges and Lessons to Scaling up Policy Innovation
27
Key to the scaling up There must be various channels for local niche to persuade upper levels of
government (municipality, prefecture, central Ministry and Cabinet Office) to understand the necessity of deregulation
These channels are: elected politicians (member of the Diet), mayors, and personnel exchange of officials (between central and local government)
In central government, there is a typical contrast between Ministries who try to avoid deregulation and Cabinet Office (and Prime Minister) who prefers deregulation. (Conflict of regimes)
Special Zones for Structural Change is a kind of resolution between Ministries and Cabinet Office.
For Ministries (such as Ministry of Health), they can learn important lessons from the “experiment” carried out in Special Zones.
← Potential for scaling up of strategic niche.
Outcome of Scaling up: Institutionalization of small-scale multi-functional care in the community
Challenges and Lessons to Scaling up Policy Innovation
Thank you very much!
28
Challenges and Lessons to Scaling up Policy Innovation
Kyoko OHTA, Ph.D.Project Researcher
Policy Alternatives Research Institute, University of [email protected]