Changing Roles of Local Governments as the Number of Chain―affiliated Service Organizations Increases

: Long―Term Care Insurance System in Japan

Abstract

Under the Long―Term Care Insurance （LTCI） system, the provision of public human services was privatized for the first time in Japan’s history. Focusing on the LTCI system, this article examines whether or not, and how, the increased number of chain―affiliated service organizations influences the role of local governments. The data was collected from the LTCI organizations that have provided services in Municipality A, where the average of residents’ income levels was lower, and in Municipality B, where the average of residents’ income levels was higher. Both municipalities are located in the Tokyo metropolitan area. The findings indicate that chain―affiliated service organizations are less influenced by differences in local conditions, as in the case of cream―skimming, i. e., serving only users who bring profits. At the same time, stand―alone service organizations undertook important roles in supporting low―income service users in Municipality A. The findings suggest that local governments need to be aware of their decreased influence over chain―affiliated service organizations.This article argues that local governments should exercise active but varied roles depending on context, including directing the LTCI system to serve the interests of the community.