Book excerpt: Ageing population poses a set of complex policy and dilemmas for social security systems, intensifying the concerns about rising expenditures in health care and long-term care for elderly. In this context, ageing societies has many valuable lessons to learn by studying Japan's experience dealing with its hyper-aged society and particularly from its strategies to ensure the financial sustainability of the Long-Term Care Insurance (LTCI) system. Based on an exhaustive literature review, and the results from six original researches on long-term care expenditures in Japan (LTCE) conducted during a doctoral program, the book provides a comprehensive view in analyzing trends and factors associated with increasing expenditures in the Long-Term Care Insurance system in Japan. The book address relevant topics such as; the main socio-demographic changes experienced by the Japanese society during the last three decades, predictors of the LTCE, measuring efficiency in nursing homes, the impact of the LTCI 2005-reform to contain expenditures, cost-effectiveness of the in-home and community based services and institutional LTCE in the last year of life. The book end with a discussion on futures challenges and strategies oriented to contribute with the sustainability of LTCI system in Japan.