Analysis of the mechanism and effect of NPOs’ participation in providing old-age services in Japan
【Abstract】The mechanism for the participation of Japan’s non-profit organizations in the provision of old-age services was developed based on spontaneous formation in society, and through accreditation on the legal personality of non-profit organizations and the passive regulation of long-term care insurance system. On the one hand, the establishment of such a mechanism has promoted the spontaneous formation of a function in society—provision of old-age services, and on the other hand, it fails to help the government to proactively regulate and control Japan’s non-profit organizations. This has led to the following actual operating effects: non-profit organizations significantly assimilate with the public long-term care insurance system in the provision of old-age services, and have no significant comparative advantage in service price. The enlightenment from Japan’s practice is that although the formation of a mechanism for non-profit organizations’ participation in provision of specific old-age services should be based on stimulating the self-organizational willingness and behavior of citizens, inappropriate public policies and institutional arrangements will not help non-profit organizations exert their own independence and efficiency advantages. Therefore, the government must pay attention to and prevent the failure or ineffectiveness of non-profit organizations in order to guarantee the strategic space for self-adjustment of social old-age service system.
【Keywords】 old-age service supply; non-profit organization; long-term care insurance; Japan; social security;
(Translated by HE wenshan)
. ① The qualification as long-term care insurance service providers can be accredited at the two levels: the NPOs identified by at the prefectural administrative level as service providers must have the independent legal personality; that is, they must be legal persons engaged in specific non-profit activities. However, the NPOs identified at the municipal administrative level according to self-established standards (reference standards) may be any organizations. [^Back]
. ① For more details, please refer to the report on the status quo and future tasks of the public long-term care insurance system released by the Ministry of Health, Labour and Welfare of Japan in 2015. [^Back]
. ② There are many problems arising from the practice of not conducting classified statistics of any organizations. For example, the classified counting with the “social welfare associations” to which other types of any NPOs belong separately regarded as “social welfare corporations” actually leads to double confusion in counting and type. For the specific data classification, refer to the statistical data of the Ministry of Health, Labor and Welfare of Japan: the related content on the proportions of old-age care service establishments classified by entity in the Outline of the Survey of Institutions and Establishments for Long-term Care. [^Back]
. ③ The survey data from the Survey on Private Non-profit Institutions over the years are based on the availability of the total number of NPOs in Japan, and are generally from the sampling surveys of about 3000 samples. The surveys on the participation in the provision of long-term care insurance services were mainly conducted in the form of qualitative inquiries about the categories of NPOs and their main business. For details, please refer to the statistical data by the Cabinet Office of Japan: the statistical data on the implementation status of long-term care insurance in the Survey on Private Non-profit Institutions. [^Back]
. ① When the statistical scopes for relevant data are inconsistent, it is technically difficult to make a comprehensive and detailed estimation of each category of old-age care service providers in terms of scale, the number of providers, operating cost and development trend, due to the complexity of relevant content of the old-age care services. Therefore, the quantitative analysis in this paper is still macro and overall analysis. [^Back]
. ② All the NPOs here include corporate-type NPOs and any-group-type NPOs. However, the statistical report makes no distinction between the two types. Therefore, many subsequent valuations and calculations are analyzed based on the precondition that “there is no significant functional difference between corporate-type NPOs and any-group-type NPOs in the provision of old-age care services.” [^Back]
. ① Here, the statistical calculations of four categories of long-care insurance services are made: home-visit long-term care, daytime care, short-term admission for long-term care and assistance in receiving preventive long-term care. [^Back]
. ② Takahashi only estimated the proportion of corporate-type NPOs in the total NPOs in 2000. His estimated value is 19.8%, and the estimated value in this paper is 20.3%. [^Back]
. ③The specific calculation method is as follows. First, the number of each category of establishments participating in long-term care insurance and the total number of corresponding establishments surveyed in the data are used to estimate the relative ratio of NPOs involved in the long-term care insurance. Then, the relative ratio is multiplied by the total number of corresponding organizations in classification, to generate the estimated number of all the NPOs participating in the long-term care insurance. Subsequently, the number of all the NPOs participating in the provision of social old-age care services is estimated separately based on the path for analysis of mechanism in Figure 1. The relevant data here are omitted due to the complexity of the diagram, and only the conclusions in Table 5 are presented. [^Back]
. ④ It should be noted that due to the small number of organizations participating in long-term care insurance excluding the NPOs offering “old-age welfare services” and “other social insurance services,” only the two main categories of NPOs involved are included for estimation to ease the calculations. [^Back]
. ① As the demands for long-term care services are diverse, an individual that has such demands tend to need a plurality of service content and providers for support. Therefore, it is inappropriate to say that the growth in the number of service providers higher than that in the number of service users is unreasonable. However, this paper does not explore the reasonable quantitative proportion due to the limitation of research topic. [^Back]
. ① In fact, from the perspective of institutional sustainability, the Japanese government will not have further expectations about high coverage of the long-term care insurance system in the existing old-age care service supply and the number of rapidly growing service providers, because this means that the expenditures on long-term care insurance will bring a greater burden. [^Back]
. ② The main problem is that the related statistical data on long-term care insurance only include the distinction of NPOs by the attributes of service organizations, but no distinction in the directions of expenditures on long-term care costs. Therefore, it is not possible to estimate the proportion of long-term care costs in the total expenditures of NPOs. [^Back]
. ① This conclusion is made based on the result that the average cost and variation coefficient of NPOs are higher than those of long-term care service providers in the statistical data. [^Back]
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