In contrast to the health insurance system, which has a fragmented structure with different insurers covering different segments of population, the LTCI system has a uniform structure: it is administered by municipal governments (there are three categories of municipal governments, namely cities, towns and villages depending on the population size). All residents aged 40 years or older are insured by municipal governments where he or she resides.

For example a 45 year old male worker of Sony corporation will be insured by Sony health insurance society for health insurance but will be insured by the municipal government where he resides for the LTCI. He will have to switch to different insurer for health insurance coverage if he switches the company but will continue to be insured by the same municipal government for the LTCI as long as he does not move somewhere else.

Because all beneficiaries are consolidated to municipal governments, it became possible for municipal governments to draw a long range plan to cope with the LTC. All municipal governments are required by the LTCI law to develop a strategic plan with 5 year time frame to make a sound actuarial prospect.

Municipal governments also administer their own health insurance [Kokumin Kenko Hoken]. However it is difficult for municipal governments to draw a long range plan because only a fragment of residents are insured by the municipal governments and the number of insured residents varies depending on the economic situation (for example, a huge lay off will deprive workers of health insurance coverage and they will migrate to the Kokumin Kenko Hoken system which are administered by municipal governments).