Uneven Nursing Care Service Opportunity and the Behavior of Service Providers under the Long-term Care Insurance System

Abstract

The Long-term Care Insurance System (LCIS) has been implemented to establish a new nursing care system in Japan since April 2000. This new system differs from the previous one in the following points: facilitating various providers such as private-sector companies and medical institutions to enter the nursing care service market; enabling service users to choose care services and providers; and basing these services on an agreement between each service user and provider. Therefore it is assumed that the regional distribution of service opportunities is governed by the spatial behavior of service providers under the LCIS. This article aims to analyze the uneven distribution of opportunities for nursing care service and to examine the relation between that distribution pattern and providers' behavior in the Kanto district as a case study. As the results of analysis of statistical data for the designated providers of nursing care service using GIS-assisted maps and local Moran I statistics, the following features became evident. 1) There are many opportunities for home-visit type services in and around Tokyo's wards (TW) where there are many social needs for nursing care, while sparsely populated municipalities have few. Furthermore, home-visit type services in the welfare sector are mainly provided by a large number of private-sector corporations in and around TW and by social welfare councils in sparsely populated municipalities. 2) Facility-stay (short-term and long-term stay) -type services are mainly provided by social welfare corporations and medical corporations. The combination of welfare and medical service providers has entered the market for this type of services in urban areas in the Eastern Kanto district. However, welfare-sector services are in short supply by local governments in and around TW. 3) Although these features are also observed for daily visit-type services, other features are found on the local scale. Daily visit-type services in the welfare sector are mainly provided by local governments and social welfare councils in municipalities in the northwestern mountain area. Opportunities for medical-sector services are concentrated in urban areas. These results indicate that private-sector corporations, originally expected to become the principal providers of nursing care services, tend to enter only specific service sectors and regions with high profit expectations. Implementation of the LCIS even nonprofit organizations such as social welfare corporations and councils were forces to pursue profit-oriented service provision. Future research should focus on the analysis of business operations of service providers in the regional context.