中国人应该从日本的老龄化危机中看到什么？

中国人应该从日本的老龄化危机中看到什么？

长期照护保险制度。

中国各大官媒经常报道日本养老金危机、老龄少子化，但对中国即将到来的老龄化危机的可怕图景从来闭口不谈。

日本是世界有名的高龄国家，但日本的长照是走在世界前端的，日本是亚洲第一个实施“长期照护保险制度”的国家，仅次于德国、荷兰。

为应对高龄社会，日本于1989年实行高龄者保健福祉推进10年战略计划，通称“黄金十年计划”，其目的为统整并建置以市町村单位（相当于中国的乡镇）的长期照护相关资源。

由于老龄化加剧，日本老人照护费用近年来不断上升，2000年只占GDP的0.7%，2024年已经超过GDP9%，25年来增长超过10倍。

日本应对老龄化的另一个办法是让经济能创造（保留）一些适合老年人的职位，养老金不够用的老人能自己养自己。很多健康年龄长的老人甚至可以工作到80岁。

日本总务省的统计显示，2022年65岁以上老年人就业人数为912万人，连续19年同比增加。 全社会就业人口中的老年人占比为13.6%，相当于每7个就业人员中就有1人年过65岁。

部分老年人能工作，大大降低了日本实际的“老年抚养比”，减轻了政府和年轻劳动者的负担。

老年抚养比是指人口中非劳动年龄人口数中老年部分对劳动年龄人口数之比，用以表明每100名劳动年龄人口要负担多少名老年人。

目前日本的老年抚养比是50%，全球最高。

目前，日本老年男性的贫困率为18.4%，老年女性的贫困率为24.8%，如果将范围缩小至独居家庭，则该数字更是分别攀升至38.3%和52.3%，这个资料来自高华彬2024年翻译的一本书《老人漂泊社会》（日本NHK特别节目录制组编著）

高华彬说，当初在修改译稿时，自己和妻子都被文章内容打动，忍不住伤心落泪。

日本是发达资本主义，“富了才老”，都被老龄化祸害成这样。

如果中国老人的寿命普遍接近或超过80岁，到2040年代中期，中国的“老年抚养比”可能会突破90%，这是中国社会无法承受的比例，除非社会选择“弃养”，让一部分老人自生自灭。

中国老龄化的一个麻烦是中国经济无法创造适合绝大多数老人的工作岗位，让延迟退休的作用大打折扣，劳动力结构性过剩严重，青年失业率高，45岁高龄失业现象普遍，而老人更没工作机会，养老金、医疗费不够花？自己想办法吧。

中国老龄化的另一个麻烦是政府几乎没办法应对，自2021年以来，长期护理保险（下称“长护险”）连续第5年被写入政府工作报告中，但各级政府行动缓慢，钱都哪里去了？大基建、中国制造2025、中国式现代化，新质生产力，都拿去实现中国梦了。

而建立“长期护理保险制度”的前提是政府要先投钱，建立并完善老年护理系统，而不只是收取保险费。

世界卫生组织（WHO）估计，中国2040年就会有4.02亿老人，由于生活工作压力大，环境污染，食物和饮用水不安全，生活方式不健康，中国有3亿烟民，政府禁烟不力，50%的男性经常喝烈性酒……2019年中国75%的60岁以老人患有非传染性疾病，心血管病、糖尿病、高血压、阿尔兹海默症……医疗照护费用未来将急剧上升。

《中国养老服务蓝皮书（2012—2021）》提到，预计2025年中国失能和半失能的老年人口预计将增至7279万人，2030年将达1亿人。

2025年两会期间，【华夏时报】发表文章，题目是：5年后我国失能半失能人口将达1亿人 谁来守护？政府工作报告再提“长护险”……

2013年7月，人民网发表文章，中国每13个人就有一个是精神病患者，现在是2025年，精神病是增加了还是减少了？

2030年，一个国家有接近10%的人口失能，还有10%的国民患有精神病，这国家也太特么吓人了。

中国各级地方政府由于土地财政崩溃、经济长期增长放缓导致税收减少，维持基本运作都困难，更别说建立社会照护系统、提升公共服务水平了——财政上不允许，时间上来不及，人口老化速度太快。

我一直把2040年作为中国的一个重要历史节点。

2040年代，中国的老龄化将“从量变到质变”，会非常惨烈，如果处理不当，极大概率会引发大规模的人道灾难。

What Should the Chinese Learn from Japan’s Aging Crisis?

Long-Term Care Insurance System

Chinese state media frequently reports on Japan’s pension crisis and aging population, yet it remains silent on the impending aging crisis in China.

Japan is known for its aging population, but it has also become a global leader in elderly care. It was the first country in Asia to implement a "long-term care insurance system," following Germany and the Netherlands.

To address the challenges of an aging society, Japan introduced the 10-Year Strategy for Promoting Health and Welfare for the Elderly in 1989, commonly known as the Golden Decade Plan. The goal was to establish a structured long-term care system at the municipal level (equivalent to townships in China).

As aging accelerates, Japan’s elderly care costs have risen significantly. In 2000, they accounted for just 0.7% of GDP, but by 2024, this figure had surpassed 9%—a tenfold increase in 25 years.

Another approach Japan has taken is creating and maintaining jobs suitable for elderly workers. Many elderly Japanese continue working, with some remaining employed even into their 80s.

According to Japan’s Ministry of Internal Affairs and Communications, in 2022, the number of employed individuals aged 65 and above reached 9.12 million, marking 19 consecutive years of growth. Elderly workers accounted for 13.6% of the total workforce—one in every seven employees was over 65.

The ability of some elderly individuals to work has significantly reduced Japan’s effective elderly dependency ratio, easing the financial burden on the government and younger workers.

The elderly dependency ratio refers to the proportion of elderly individuals relative to the working-age population, indicating how many elderly people each 100 working-age individuals must support.

Currently, Japan’s elderly dependency ratio is 50%, the highest in the world.

However, despite these efforts, poverty among Japanese seniors remains a serious issue. As of 2024, 18.4% of elderly men and 24.8% of elderly women lived in poverty. For those living alone, the rates soared to 38.3% for men and 52.3% for women. This data comes from the book Elderly Drifting Society, translated by Gao Huabin in 2024, based on an NHK documentary.

Gao Huabin noted that while revising the translation, both he and his wife were deeply moved by the content, even to the point of tears.

Japan is a wealthy capitalist nation that "aged after becoming rich," yet it still suffers from severe aging-related issues.

China’s Looming Aging Crisis

If the average lifespan of Chinese seniors reaches or exceeds 80 years, China’s elderly dependency ratio could surpass 90% by the mid-2040s—an unsustainable level for Chinese society. Unless society chooses to "abandon care," some elderly individuals may be left to fend for themselves.

A major challenge in China is the inability to create sufficient jobs for elderly workers, making delayed retirement ineffective. Structural labor surplus is severe, youth unemployment is high, and job opportunities for older individuals are scarce. Many workers over 45 already struggle to find jobs, making it even harder for retirees to re-enter the workforce. With insufficient pensions and rising medical expenses, many elderly individuals will be left to manage on their own.

Another significant challenge is the government’s lack of preparedness. Since 2021, the long-term care insurance system (LTCI) has been mentioned in government work reports for five consecutive years, yet implementation has been slow. Where has the funding gone? Into infrastructure projects, Made in China 2025, Chinese-style modernization, and new productive forces—all in pursuit of the Chinese Dream.

However, establishing a long-term care insurance system requires initial government investment to build and improve the elderly care system—not just collecting insurance premiums.

The Future of Elderly Care in China

The World Health Organization (WHO) estimates that by 2040, China will have 402 million elderly people. Due to high work stress, environmental pollution, food and water safety issues, and unhealthy lifestyles—including the world’s largest smoking population (300 million smokers) and widespread alcohol consumption among men—health conditions among Chinese seniors are concerning.

As of 2019, 75% of Chinese people over 60 suffered from non-communicable diseases such as cardiovascular disease, diabetes, hypertension, and Alzheimer’s. Medical care costs are expected to rise sharply.

The Blue Book of China’s Elderly Care Services (2012–2021) predicts that by 2025, the number of elderly individuals with disabilities or partial disabilities will reach 72.79 million, growing to 100 million by 2030.

During the 2025 National People’s Congress, Huaxia Times published an article titled:"In Five Years, China’s Disabled and Partially Disabled Population Will Reach 100 Million—Who Will Care for Them? The Government Work Report Mentions LTCI Again..."

Additionally, a People’s Daily article from July 2013 stated that one in 13 Chinese people suffered from mental illness. Now in 2025, has the situation improved or worsened?

By 2030, nearly 10% of China’s population could be disabled, while another 10% could suffer from mental illnesses—an alarming scenario.

The Financial and Social Crisis

With the collapse of land finance (revenue from land sales), slowing economic growth, and declining tax revenue, local governments are struggling to maintain basic operations. Expanding social care systems and improving public services are nearly impossible—fiscal constraints won’t allow it, time is running out, and aging is happening too fast.

2040: A Turning Point

I have long viewed 2040 as a crucial historical turning point for China.

By the 2040s, China’s aging crisis will shift from quantitative to qualitative change, leading to potentially catastrophic consequences. If not handled properly, it could trigger a large-scale humanitarian disaster.