Abstract
Recent municipal mergers, often called “the great Heisei merger,” have increased drastically in Japan, especially between 2004 and 2006. The number of municipalities decreased by more than 40%. These municipal mergers have also affected territorial justice concerning long-term care insurance because, although a flat premium for Category 1 insured persons (senior citizens 65 and over) is applied throughout the each newly merged municipality, differences remain in the characteristics of long-term care insurance services among former municipalities. This paper examines the differences in quantitative/qualitative characteristics of long-term care insurance services between each former municipality and the newly merged municipalities, which consists of all former municipalities in each merged territory, from the viewpoint of territorial justice.
The main findings are summarized as follows.
1) To examine the differences in the quantitative characteristics of long-term care insurance services among former municipalities before merger, a quantitative index (IBI), which denotes the differences in insurance benefits, is adopted to examine the differences in the amount of insurance benefits per Category 1 insured person between the former and new municipalities. In addition to this quantitative index, two qualitative indices are defined: long-term care requirement certification (RCI) and services at facilities (SFI). The former denotes the differences in the rate of the long-term care requirement certification between the former and new municipalities. The latter denotes the degree of detachment of a component ratio of services at facilities between the former and new municipalities. Analysis showed that the quantitative index is related to the qualitative indices, especially to the RCI.
2) The geographical characteristics of the merged municipalities where marked differences in quantitative characteristics exist between the former and new municipalities were investigated using the IBI. Among 465 new municipalities, 93 with the most prominent IBIs were extracted. These 93 municipalities share the following basic characteristics: they were merged by more former municipalities, are mountainous or island regions with lower population density and were absorbed by mergers. In addition, several former municipalities had maintained the IBI level for some years before the merger. In particular, in most former municipalities where the IBI was markedly low, insurance benefits are estimated not to increase after the merger and the index will decrease. This means that the imbalance between low benefits and heavy burden of premiums in these former municipalities will continue. The new municipalities including these former municipalities have serious problems from the viewpoint of territorial justice.
