2009 年 21 巻 E1 号 p. 247-264
It is often said that the market mechanism does not enhance service quality in the care market because there is information asymmetry between users and providers. This research investigates the three arguments for this proposition by using the data of Group Home providers’ service quality performance index in the Japanese Long- Term Care Insurance（LTCI）market. The three argument models are
a）The Contract Failure model that claims users perceive nonprofit providers as a sign of good service quality.
b）The Medical Arms Race（MAR）model that argues the competition in the care market tends to lower the service quality.
c）Suzuki and Satake’s（2001）model that claims new entries in the care market do not contribute to improvement in the market’s service quality.
Analyzing the quality performance by attributes, research has revealed that none of the three models was fully supported in the Japanese LTCI market. After testing the Contract Failure model, there was no significant difference in the service quality between for-profit and nonprofit providers but it reflected the market share of each type of provider. Regarding the MAR model, the service quality of the providers in competitive markets was significantly better than that of those in non-competitive markets. As for Suzuki and Satake’s （2001）model, although new entry does not bring a more qualified service into the market for the initial year, new market entry providers improve the service quality more than old （existing）entry providers do. Moreover, the research uncovered implications for each model. First, the service quality of nonprofit providers may appear better from the viewpoint of the care recipients, but this may be opposite to that of the family. Second, bridging the information gap prevents the market competition from MAR syndrome. This also creates an incentive for the providers in non-competitive markets to improve the service quality. Third, the weakness of new entry in service quality is care management rather than care service itself.
The research concluded that the market mechanism overall worked efficiently for the improvement of service quality in the Japanese LTCI market. This was attributed to the government’s policies including a providers’ third-party evaluation system that bridged the information asymmetry in the market.
