Abstract
Since the beginning of the Heisei era in Japan, administrative and financial management by local governments has aimed to utilize scale and economies of scale through the merger of municipalities and area expansion.
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Notes
- 1.
With regard to the mergers of municipalities, after the enactment of the Special Merger Law in 1999, following the strengthening of financial measures to support mergers in the Special Merger Law enacted in 1999, the number of municipal bodies declined from 3200 at the end of March 1999 to 1727 at the end of March 2010.
- 2.
According to the Ministry of Health, Labour and Welfare (2006) “Meeting of the Heads of the Departments Responsible for Long-term Care Insurance Nationwide”, the breakdown of municipalities conducting insurance management over a wide area was 307 municipalities in wide-area unions, 183 municipalities in partial-affairs associations, and 12 municipalities conducting joint projects for the mutual stabilization of municipal finances.
- 3.
Long-term care services include various services according to the level of necessary long-term care . If the level of necessary long-term care is low, home services such as day-care services and short-term admission services are used. As the level of necessary long-term care becomes higher, community-based services can be used, such as those that are provided even at night or early in the morning. In addition, in the event that it becomes difficult to continue long-term care at the person’s home, they can be admitted to a facility.
- 4.
The states of necessary long-term care are defined in the Nursing Care Insurance Law for the Elderly (Article 7). According to its “categories corresponding to the different levels of long-term care needed,” persons at necessary support levels 1 and 2 are eligible for preventive benefits as requiring social support. Persons at necessary long-term care levels 1–5 are eligible for long-term care benefits. Necessary long-term care level 1 is a state requiring partial long-term care , necessary long-term care level 2 is a mild state requiring long-term care , necessary long-term care level 3 is a medium-level state requiring long-term care , necessary long-term care level 4 is a serious state requiring long-term care , and necessary long-term care level 5 is the most serious state, requiring long term care. In this chapter, with reference to the “categories corresponding to the different levels of necessary long-term care needed,” the concepts of “mild” and “serious” were used. Further, in the event that a person at the necessary long-term care level 3 can move by their own efforts, it is considered that this is clearly different to the serious levels of levels 4 and 5 of necessary long-term care .
- 5.
While they did not address long-term care insurance, with regard to the management of National Health Insurance, Kishida (2002) and Izumida (2003) clarified that economies of scale in terms of the number of employees engaged in administrative work have an effect on the general affairs costs.
- 6.
Specifically “Table 2<by insurers> the number of first insured persons,” “Table 5<by insurers> number of recipients of at-home long-term care (preventive long-term care ) services,” “Table 6<by insurers>number of recipients of community-based long-term care (preventive long-term care ) services,” “Table 7<by insurers>number of recipients of facilities services,” “Table 8-2<by insurers>insurance benefits long-term care benefits ・ preventative benefits for first insured persons (number of cases, number of units, costs amount, benefit costs),” and “Table 14<by insurers>long-term care insurance special accounting deductions Insurance operations account—(expenditure)—” were used (http://www.mhlw.go.jp/toukei/list/84-1.html :View date of February 5, 2018).
- 7.
The number of insurers in fiscal 2007 was 1662, in fiscal 2008 1646, and in fiscal 2009 and fiscal 2010 the number was 1587.
- 8.
It was decided to use a logarithmic linear function in order to interpret the coefficients obtained from the estimations as elastic values.
- 9.
In the subsequent actual estimations, the quadratic term of the receipt rate was considered.
- 10.
When actually making the estimations, if the explained variables of the costs of long-term care administrative work per capita and the costs of long-term care benefits per capita were zero, these data were removed from the data used for the estimations.
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Adachi, Y. (2018). Expanding the Scope and Improving the Efficiency of Long-Term Care Insurance Operations. In: The Economics of Tax and Social Security in Japan. Springer, Singapore. https://doi.org/10.1007/978-981-10-7176-8_9
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DOI: https://doi.org/10.1007/978-981-10-7176-8_9
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