中國人應該從日本的老齡化危機中看到什麼？

中國人應該從日本的老齡化危機中看到什麼？

長期照護保險制度。

中國各大官媒經常報道日本養老金危機、老齡少子化，但對中國即將到來的老齡化危機的可怕圖景從來閉口不談。

日本是世界有名的高齡國家，但日本的長照是走在世界前端的，日本是亞洲第一個實施“長期照護保險制度”的國家，僅次於德國、荷蘭。

為應對高齡社會，日本於1989年實行高齡者保健福祉推進10年戰略計劃，通稱“黃金十年計劃”，其目的為統整並建置以市町村單位（相當於中國的鄉鎮）的長期照護相關資源。

由於老齡化加劇，日本老人照護費用近年來不斷上升，2000年只佔GDP的0.7%，2024年已經超過GDP9%，25年來增長超過10倍。

日本應對老齡化的另一個辦法是讓經濟能創造（保留）一些適合老年人的職位，養老金不夠用的老人能自己養自己。很多健康年齡長的老人甚至可以工作到80歲。

日本總務省的統計顯示，2022年65歲以上老年人就業人數為912萬人，連續19年同比增加。 全社會就業人口中的老年人佔比為13.6%，相當於每7個就業人員中就有1人年過65歲。

部分老年人能工作，大大降低了日本實際的“老年撫養比”，減輕了政府和年輕勞動者的負擔。

老年撫養比是指人口中非勞動年齡人口數中老年部分對勞動年齡人口數之比，用以表明每100名勞動年齡人口要負擔多少名老年人。

目前日本的老年撫養比是50%，全球最高。

目前，日本老年男性的貧困率為18.4%，老年女性的貧困率為24.8%，如果將範圍縮小至獨居家庭，則該數字更是分別攀升至38.3%和52.3%，這個資料來自高華彬2024年翻譯的一本書《老人漂泊社會》（日本NHK特別節目錄製組編著）

高華彬說，當初在修改譯稿時，自己和妻子都被文章內容打動，忍不住傷心落淚。

日本是發達資本主義，“富了才老”，都被老齡化禍害成這樣。

如果中國老人的壽命普遍接近或超過80歲，到2040年代中期，中國的“老年撫養比”可能會突破90%，這是中國社會無法承受的比例，除非社會選擇“棄養”，讓一部分老人自生自滅。

中國老齡化的一個麻煩是中國經濟無法創造適合絕大多數老人的工作崗位，讓延遲退休的作用大打折扣，勞動力結構性過剩嚴重，青年失業率高，45歲高齡失業現象普遍，而老人更沒工作機會，養老金、醫療費不夠花？自己想辦法吧。

中國老齡化的另一個麻煩是政府幾乎沒辦法應對，自2021年以來，長期護理保險（下稱“長護險”）連續第5年被寫入政府工作報告中，但各級政府行動緩慢，錢都哪裡去了？大基建、中國製造2025、中國式現代化，新質生產力，都拿去實現中國夢了。

而建立“長期護理保險制度”的前提是政府要先投錢，建立並完善老年護理系統，而不只是收取保險費。

世界衛生組織（WHO）估計，中國2040年就會有4.02億老人，由於生活工作壓力大，環境汙染，食物和飲用水不安全，生活方式不健康，中國有3億菸民，政府禁菸不力，50%的男性經常喝烈性酒……2019年中國75%的60歲以老人患有非傳染性疾病，心血管病、糖尿病、高血壓、阿爾茲海默症……醫療照護費用未來將急劇上升。

《中國養老服務藍皮書（2012—2021）》提到，預計2025年中國失能和半失能的老年人口預計將增至7279萬人，2030年將達1億人。

2025年兩會期間，【華夏時報】發表文章，題目是：5年後我國失能半失能人口將達1億人 誰來守護？政府工作報告再提“長護險”……

2013年7月，人民網發表文章，中國每13個人就有一個是精神病患者，現在是2025年，精神病是增加了還是減少了？

2030年，一個國家有接近10%的人口失能，還有10%的國民患有精神病，這國家也太特麼嚇人了。

中國各級地方政府由於土地財政崩潰、經濟長期增長放緩導致稅收減少，維持基本運作都困難，更別說建立社會照護系統、提升公共服務水平了——財政上不允許，時間上來不及，人口老化速度太快。

我一直把2040年作為中國的一個重要歷史節點。

2040年代，中國的老齡化將“從量變到質變”，會非常慘烈，如果處理不當，極大機率會引發大規模的人道災難。

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.