through increasing tax deferred investmentopportunities and improving the overallinvestment environment for retail investors. TheGovernment should consider increasing limits ondefined contribution plans and allowing matchingin addition to top-up schemes. DC plan defaultinvestment options should be designed toencourage investment. NISA schemes shouldcontinue to evolve to be more inclusive with a widedegree of investment options and longer-termfocus. All retail investment options, both taxableand tax deferred, should be evaluated to ensurethat products and distribution offer investors themost efficient and transparent experiencepossible, allowing investors to optimize theirinvestment decisions and retain as much of theirinvestment returns as possible.RECOMMENDATION 5 SECURE THE NECESSARY FINANCIAL RESOURCES TO SUSTAIN JAPAN’S SOCIAL SECURITYSYSTEM, DETERMINING APPROPRIATE INDIVIDUAL BURDENS BASED ON ABILITY TO PAY,WHILE PROVIDING NEW OPTIONS FOR TAX-DEFERRED INVESTING Japan's outstanding public debt (as a percentage of GDP) is over200%, and the state of fiscal and social security finances isextremely concerning. On the other hand, the number of peoplereceiving public assistance has increased from a low of 880,000 in1995 to 2.14 million in 2017, and poverty is rapidly increasing inJapan, especially among the older generation.For efficient and effective redistribution, market mechanisms(including the expansion of private savings) should be used andfinancial support should be concentrated on those who are really inneed, while a slight reduction of financial support should be madefor those with high incomes and certain assets, yet we have yet tosee this happen.Even if we try to offset some of the increased out-of-pocket costs ofmedical and nursing care with private savings, Japan does not havea medical investment account system, and there are nocorresponding tax measures available.From the perspective of determining burdens based on ability topay, Japan should consider measures to appropriately set individualburdens (out-of-pocket costs and taxation, etc.), in accordance withan individual’s level of income and assets, while actively utilizing theMy Number System, etc.In line with the concept of setting burdens based on ability to pay,Japan should consider appropriate burdens for households withhigh financial capacity in reviewing the high-cost medical carebenefit system, uninsured combined medical care benefit systemand the level of "income equivalent to that of an active worker." Atthat time, it will be important to consider the expansion of privateinvestments (e.g., iDeCo and NISA), as well as mechanisms(including tax measures) to partially offset the increased out-of-pocket expenses for medical and nursing care costs, with referenceto the medical savings account systems of overseas countries.CURRENT ISSUES RECOMMENDED DIRECTIONACTION 2 |PAGE | 09RECOMMENDATION 6FURTHER EXPLORE OPPORTUNITIES TOACCELERATE INNOVATION IN HEALTHCARE BYBETTER UNDERSTANDING AND OPTIMIZINGEXPENDITURES FROM A SYSTEM-WIDEPERSPECTIVECurrently, once a medical fee, medicaltechnology, or other reimbursed service hasbeen added to Japan’s national health insurancesystem, there are few opportunities tothoroughly reassess its appropriateness. Toensure the continued advancement of patientcare, it is important to create a marketenvironment that encourages the activereplacement of outdated medical treatments orservices with new ones, by more deeply
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