Care service utilization among frail elderly in Japan

Since the national long-term care insurance (LTCI) system was introduced in 2000, Japanese elderly have become “consumers/users” of care services. They can choose services and providers themselves. Under the system, there are a variety of services on the menu and insurance covers 90% of the payment for the service use, up to the benefit limit that is set by the level of support required.

Still, it has been suggested that the system is under-utilized by the frail elderly. One of the factors associated with the under-utilization may be the uneven distributions of the care service providers across communities (e.g., urban vs. rural). For instance, hospitals and clinics are typically concentrated in the urban areas under the national health insurance system in Japan. Similarly, care-service providers may concentrate in the urban areas, so that the limited service provision may prevent the rural elderly from using those services.

Nevertheless, there are not many studies which have examined the factors affecting service use of the elderly under the system, especially community-level factors such as the level of service provisions in the community. This study explores how individual and community level factors affect care service utilization among the frail elderly living in various cities, towns, and villages by analyzing the LTCI receipt data using multi-level modeling.