Abstract
Background
Following the introduction of the public longβterm care (LTC) insurance in Japan on 1 April 2000, funding that had been split between the health and social welfare sectors was unified. All elderly people 65 and over have become entitled to receive benefits according to their eligibility level, regardless of income or family support. Except for those assessed as in the least dependent group, individuals can choose either community care or institutional care, with only the cost of food an additional payment for the latter.
Method
Review of the development and implications of long term care insurance provision for older people and analysis of quality based on resident level data.
Results
Despite the structural changes, the impact of the new programme has had minimal impact upon the providers of institutional care. The three types of facilities that had provided LTC have continued to function independently, basically retaining the same staffing requirements and charges. For indicators adjusted for risk, the quality of care tended to be higher in designated LTC hospital beds.
Conclusions
Appropriate balance between institutional and community care and triaging among the three different types of facilities remains difficult because decisions rest with the individual. Indicators of quality must take into account differences in caseβmix among the facility types. However, there are few incentives for providers to improve quality because demand is likely to be increasingly greater than supply. Whether the generous provisions of the new programme will prove to be sustainable remains to be seen. Copyright Β© 2003 John Wiley & Sons, Ltd.