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

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.

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.

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

Neutron-capture elements in the very metal-poor star HD88609: another st ar with excesses of light neutron-capture elements

We obtained a high resolution, high signal-to-noise UV-blue spectrum of the extremely metal-poor red giant HD88609 to determine the abundances of heavy elements. Nineteen neutron-capture elements are detected in the spectrum. Our analysis revealed that this object has large excesses of light neutron-capture elements while heavy neutron-capture elements are deficient. The abundance pattern shows a continuously decreasing trend, as a function of atomic number, from Sr to Yb, which is quite different from those in stars with excesses of r-process elements. Such an abundance pattern is very similar to that of HD122563 that was studied by our previous work. The results indicate that the abundance pattern found in the two stars could represent the pattern produced by the nucleosynthesis process that provided light neutron-capture elements in the very early Galaxy.Comment: 18 pages, 6 figures, accepted for publication in Ap

Singular behavior of the macroscopic quantities in the free molecular gas

Steady behavior of the free molecular gas is studied with a special interest in the behavior around a convex body. Two types of singular behavior are shown to occur at the level of the macroscopic quantities. Their occurrence and the strength of singularity are discussed in detail both numerically and analytically. A universal law behind them is revealed by the consideration of the local geometry of the boundary

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