Regional Disparity of Visiting Care for People with Severe Disabilities: Focus on Individuals with Amyotrophic Lateral Sclerosis

Abstract

Visiting care for people with severe disabilities [Jūdo Hōmon Kaigo] is among the most important welfare services. However, it has been widely argued that some individuals have not received satisfactory service levels. Although previous research has attributed this inadequacy to municipal financial vulnerability and poor service delivery capacity, there are some methodological drawbacks such as a lack of stratification by the severity of the disability and the ecological fallacy. In order to address this issue, this study analyzes the data from service users with amyotrophic lateral sclerosis. Such data also include detailed information on their location and impairment, which previous studies have failed to explore. The findings show that the municipality’s population and supply capacity have an impact on the service levels, but the impact varies according to the impairment of the disabled individual. Moreover, the level of provision tends to be lower in large municipalities, probably due to the reference to precedents. It is hoped that the results will be useful for evaluating existing policies and considering future interventions.