The Politics of Social Care in Japan: How Central–Local Interactions Shaped Child Allowances and Elderly Medical Care

ABSTRACT This study examines why Japan's social care reforms of the early 1970s led to a generous elderly care system but only modest and narrowly targeted support for children. Although child allowances and free medical care for the elderly were introduced almost simultaneously, they followed sharply divergent paths. Both policies were initially blocked at the national level owing to fiscal constraints imposed by the Ministry of Finance. They first gained traction in progressive local governments, notably under Governor Ryōkichi Minobe's Tokyo administration. These local precedents prompted the central government to adopt similar measures and shaped the final design of national policies. For child allowances, the central government incorporated local government contributions that exceeded Tokyo's benefit levels, thus reducing the national fiscal burden. For elderly care, the Ministry of Finance tried to impose a 10% beneficiary co‐payment, but dramatic international economic shifts weakened its control, eventually enabling fully subsidised medical care. Subsequent shocks, particularly the Oil Crisis, curbed further expansion and cemented a care regime heavily favouring older citizens. By highlighting a two‐way iterative dynamic between central and local actors, this study contributes to debates on welfare state formation, historical institutionalism, and policy diffusion, challenging traditional one‐directional models of policy diffusion.