以人口结构和家庭结构的变迁、经济和财政形势恶化以及原有制度的步履维艰为建制背景的日本护理保险制度是以用更少的资金为更多的老人提供更好的护理保障为制度目标的。围绕此目标,其制度设计主要遵循四大理念:事权上的地方分权、责权上的福利多元主义、保障对象上的普享原则和制度给付上的费用控制,但回顾十几年来制度的运行状况,这4个理念分别遭遇了不同程度的挑战或问题。理性看待并且积极思考如何应对这些挑战或问题是日本护理保险制度完善发展所必须重视的课题,也是审慎推进中国老年护理保障制度完善与发展值得借鉴的经验。 The Japanese nursing insurance system based on changes in population structure and family structure, deteriorating economic and financial conditions and the difficult performance of the existing system is based on the goal of providing better nursing support to more elderly people with less capital . Around this goal, the system design follows four major concepts: decentralization of powers in matters of authority, welfare pluralism in rights and interests, the principle of universal enjoyment on the protection of objects and the cost control on the payment of the system. However, Operating conditions, these four concepts have suffered different degrees of challenges or problems. Consideration and positive thinking on how to deal with these challenges or problems are the issues that must be taken seriously to improve the development of Japan’s nursing insurance system. It is also worth learning from the perspective of improving and perfecting China’s aged care security system.