2007 Volume 53 Issue 3 Pages 237-264
The Long-term Care Insurance System has been operating in Japan since April 2000. The scheme is thought to be confronted with a critical situation in the near future because of a recent increase in service provisions that would press heavily upon the finances of long-term care insurance. While in principle each municipality is considered to be a separate insurer, the government also permits joint administrations of the system by several municipalities, mainly out of consideration for small-sized municipalities that often have fiscal and personnel weaknesses. From a geographical viewpoint, joint administrations of the system are important because there are inconsistent relationships between benefits and burdens among each constituent municipality of the extended insurer. In this context, benefit means the amount of service use, and burden means the premiums for Category 1 insured persons (aged 65 and over) in each municipality. Thus, this paper aims to examine the joint administrations and to analyze the imbalance of benefits and burdens among constituent municipalities of the extended insurers. The important findings were as follows: 1. Through a survey of some extended insurers, it was observed that joint administration or forming an extended insurer was considered to have important merits by many insurers. They can be summarized as: 1) increasing the efficiency of an insurer's finances, 2) facilitating business duties, for example, convening the long-term care approval board, and 3) achieving equalization of Category 1 insurance premiums among municipalities. However, the third point was notable in this paper because it was incompatible with an uneven basis for provision of long-term care services among constituent municipalities. 2. Nearly 80% of the municipalities in Japan has adopted the strategy of joint administration or forming an extended insurer, and it has been most prevalent among depopulated and aging towns and villages rather than cities. The number of extended insurers was 69, which included 523 municipalities, in 2003. In some prefectures, most municipalities participate in an extended insurer, while in others no municipalities have joined one. 3. To analyze the imbalance of benefits and burdens among constituent municipalities of an extended insurer, the author devised an original index, a ratio of individual premiums to the whole of an extended insurer's premiums. Examined on 30 extended insurers for which the data can be used, the ratios are not related to the number of constituent municipalities or the population size of Category 1 insured persons. On the other hand, some municipalities with a considerably low ratio, which means the burden of the premiums has become serious by joining an extended insurer, are remarkable among small-sized municipalities. 4. By investigation of five extended insurers for which the above ratios vary widely in each municipality, the combinations of municipalities are analyzed in order to classify them based upon the number of Category 1 insured persons. Consequently, three types of combinations were discovered as follows: 1) those with polarization, in which constituent municipalities were divided into beneficiary and heavy burden, 2) those with good stability, in which the ratios concentrated nearly at an average, and 3) those with a marked asymmetrical polarization, which has the secondary feature that the ratios of a few municipalities were considerably low or high.
