Nonprofit and For-profit Providers in Japan's At-home Care Industry: Evidence on Quality of Service and Household Choice

In 2000, government deregulation along with the introduction of the long-term insurance scheme for the first time allowed for-profit providers of at-home care for the elderly to compete directly with nonprofit operators. According to the contract failure hypothesis, we would expect consumers to prefer nonprofit providers over their for-profit counterparts as a result of information asymmetry and non-distributional constraints. This study takes advantage of household level data to examine whether households' choice of care provider is biased toward nonprofits. We find that nonprofit providers to command a larger market share, but this is at least partly explained by having operated in the market longer and by continuing restrictions in medical and institutional care that confer various advantages on nonprofit providers. However, we do find that user with better knowledge of providers tend to favor for-profit providers, suggesting that measures to reduce information asymmetries may help to provide a more level playing field.

The Determinants of Exit from Nursing Homes and the Price Elasticity of Nursing Home Care: Evidence from Japanese Micro-level Data

This study examines how the price mechanism affects the length of residents' nursing home stay and their destination after exit. The purpose of this analysis is to evaluate policy options to reduce the number of socially institutionalized elderly nursing home residents in Japan. To address these issues, we take advantage of micro-level data from The Survey on Care Service Providers compiled by the Japanese government. Our duration estimates show that the price elasticity of the hazard of exit from welfare care facilities was 1.7 (95% CI: 0.4-3.0) and 1.8 (95% CI: 0.0-3.8) from health care facilities. The probit estimates show that a 1 percentage point increase in copayments leads to an increase in the probability of returning home by 0.04% for patients of welfare care facilities and 3.7% for those of health care facilities. In contrast, the price elasticity of the probability of being re-hospitalized is -3.3% for patients of health care facilities and -1.9% for those of medical care facilities. An appropriate price policy may work well to shorten patients' length of stay and to reduce the number of the socially institutionalized. Since the effects of the introduction of a price mechanism may differ for different types of facilities, public policies aimed at broadening residents' range of choices need to be designed with care and incorporate an appropriate risk adjustment system to provide a safety net for those elderly highly at risk of being socially institutionalized.

Do Non-Profit Operators Provide Higher Quality of Care? Evidence from Micro-Level Data for Japan's Long-term Care Industry

Along with the introduction of the long-term care insurance scheme, the Japanese government in 2000 for the first time allowed for-profit operators to compete head-on with non-profit operators in the provision of at-home care services. This study examines quality differentials between the nonprofit and the for-profit sector in Japan's elderly care industry, concentrating on home helpers and staff nurses. Taking advantage of a unique and rich micro-level survey, the study finds that although nonprofit operators provide higher quality of care, as measured by simple averages of workers' characteristics, the advantage of nonprofits disappears once their higher wage is corrected for. This finding confirms that the seemingly higher quality of care provided by nonprofit operators is due to the nonprofit wage premium, resulting from their preferential status which provides non-distributional constraints and favorable tax treatment.Japanese long-term care insurance, long-term care, nursing homes, home helpers, staff nurses, nonprofit wage premium, quality of care, treatment effect approach

Nonprofit and for-profit providers in JapanÂfs at-home care industry: evidence on quality of service and household choice

In 2000, government deregulation along with the introduction of the long-term insurance scheme allowed for-profit providers of at-home care for the elderly to compete directly with nonprofit operators. According to the contract failure hypothesis, we would expect consumers to prefer nonprofit providers over their for-profit counterparts as a result of information asymmetry and non-distributional constraints. We take advantage of household level data to examine whether householdsÂf choice of care provider is biased toward nonprofits. We find that nonprofit providersÂf larger market share is at least partly explained by having operated in the market longer and by continuing restrictions in medical and institutional care that confer various advantages on nonprofit providers. However, we do find that user with better knowledge of providers tend to favor for-profit providers, suggesting that measures to reduce information asymmetries may help to provide a more level playing field.asymmetry of information

Nonprofit/For-Profit Status and Earning Differentials in the Japanese At-home Elderly Care Industry: Evidence from Micro-level Data on Home Helpers and Staff Nurses

In April 2000, Japan embarked on a reform of its health care market. Along with the introduction of the long-term care insurance scheme, the government for the first time allowed for-profit operators to compete head-on with non-profit operators in the provision of at-home care services. Taking advantage of a unique and rich micro-level survey, this study is the first to examine wage differentials between the nonprofit and the for-profit sector in Japan's nursing care industry, concentrating on home helpers and staff nurses. Controlling for nonrandom unobserved selection biases, our results show that a nonprofit wage premium exists. This finding supports the hypothesis that nonprofit providers operate under non-distributional constraints.Japanese long-term care insurance, long-term care, nursing home, home helpers, staff nurses, nonprofit wage premium, quality of care, Heckman's two-stage approach

Effectiveness of Government Policy: An Experience from a National HealthCare System

This paper examines the trade-off between the length of treatment days and the units of service provided per day for elderly patients in the context of the initiative taken by the Ministry of Health and Welfare of Japan to discourage lengthy hospital treatment and/or stay by elderly patients. By using three leading diseases among the elderly in Japan (cancer, heart related disease and mental illness) and separating care utilization into an episode by types of treatment, our results suggest that the government measures function but they do not effectively work to reduce increases in medical expenditures by the elderly under the fee-for-service basis. The evidence shows the interdependency between days and quantity of services, and the larger impact of services on days than days on services. Providers are more able to raise their revenue by additional services, than by additional treatment days, under the government's current cost containment policy toward the elderly care. For the so-called skilled type of treatment services (injection, general treatment, consultation and operation), the results on all elderly ages 65 and over without disease classification show some statistically significant positive impact on length of treatment in days and quantity of services provided per day. For the so-called material type of service (medication and examination), medical service providers are likely to prescribe more drugs as the price of drugs falls under the current strict drug price control by the Japanese government.

Relation between Mental Health Status and Psychosocial Stressors among Pregnant and Puerperium Women in Japan: From the Perspective of Working Status

Mental health problems during pregnancy and postpartum periods are one of the alarming health issues among women in Japan. This study analyzed data on the Japanese version of the Kessler 6 (K6), specific psychosocial stressors, and working status of pregnant and puerperium women (n=1126) from respondents in the Comprehensive Survey of People’s Living Conditions (CSPLC) conducted in 2007 by Ministry of Health, Labour and Welfare in Japan. Multiple logistic analyses showed the significant associations between mental health and psychosocial stressors: “family relationship,” “pregnancy and birth,” and “incomes/ family budgets/ debts”, regardless of “employed” or “unemployed”. After stratified by working status, whereas “one’s job” stressor had an association with mental health only for employed females, stressors for “one’s disease/long -term care” and “housework” had associations only for unemployed ones. For employed women, the primary factor for mental health was “family relationship” stressor. Although mental health status measured by K6 was not different between employed or unemployed female population, primary stressors related mental health was revealed to differ with working status. Especially, “family relationship” stressor was the highest risk factor of mental health in employed women. More importantly, the results provided evidence on the differences in associations between mental health and specific psychosocial stressors by working status. Psychosocial risk assessments and interventions on working status among pregnant and puerperium women should be imperative to pay attention for social politics.DOI: http://dx.doi.org/10.11591/ijphs.v1i2.80

Health Impacts on Labor Participation of Elderly Japanese Males

The main object of this study is to investigate the relationship between individuals’ health status and labor participation among middle-aged and elderly males in Japan using a unique panel dataset. Our analysis focuses on three types of health indicators based on respondents’ medical history in the three years preceding the survey. To adjust for the potential endogeneity of the health variables, we use individuals’ body mass index at age 30 and their parents’ medical history as instrumental variables. Our empirical results show that a deterioration in health increases the probability of not working and being retired and, moreover, tends to decrease individuals’ average working hours per week. Further, splitting our sample, we find that, compared with males under 60 years of age, the work status of males aged 60 or over is significantly more likely to be affected by having one additional illness and suffering from a lifestyle disease than that of under 60s

The relationship between perceived social support and depressive symptoms in informal caregivers of community-dwelling older persons in Chile

AIM: Depression among caregivers of older persons is a serious concern, but it is often overlooked and neglected in developing countries. The aim of this study was to examine the relationship between perceived social support and depression in informal caregivers of community-dwelling older persons in Chile. Methods: We analyzed cross-sectional secondary data on 377 dyads of community-dwelling older persons and their informal caregivers from a nationwide survey in Chile. The Duke-UNC Functional Social Support Questionnaire (FSSQ) was used to measure caregivers’ perceived social support, and the Center for Epidemiologic Studies Depression Scale assessed their depression. Results: In this study, 76.9% of the caregivers perceived a high level of social support, and 46.9% were assessed as having depression. Based on multivariable analysis, factors that decrease the likelihood of being depressed are a high level of social support (odds ratio (OR) = 0.311, 95% confidence interval (CI): 0.167–0.579) and having taken holidays in the past 12 months (OR = 0.513, 95%CI: 0.270–0.975). Factors that increase the likelihood of being depressed are being a female caregiver (OR = 2.296, 95%CI: 1.119–4.707), being uninsured (OR = 4.321, 95%CI: 1.750–10.672), being the partner or spouse of the care recipient (OR = 3.832, 95%CI: 1.546–9.493), and the number of hours of care (OR = 1.053, 95%CI: 1.021–1.085). Conclusion: Higher levels of perceived social support and holidays were associated with lower levels of depression. However, being female, being the care recipient's partner or spouse, being uninsured, and having long care periods had detrimental effects. Interventions to preserve and enhance perceived social support could help improve depressive symptoms in informal caregivers. Additionally, support should be available to caregivers who are women, uninsured, and the care recipient's partner or spouse, as well as those who provide care for long hours, to ensure they have respite from their caregiving role