The Uneven Structure of Home Care Service Provision Between for-Profit and Non-Profit Organizations in a Quasi-Market System

The Japanese Long Term Care Insurance (LTCI) was implemented in 2000, aiming the promotion of user’s choice and the competition among different kinds of providers (i.e. such as for-profit, non-profit). It was expected that a quasi-market system would facilitate the effective competition among providers and improve the quality of care, though the price of each service was regulated as “legal price” by the government. However, it is not clear that such competitions can be realized, because different providers have different motivations in providing care services. Especially, non-profit organizations (NPOs) have altruistic motivations to meet the needs of local residents. Thus, the different motivations of providers may result in segregation among them rather than the effective competition over the quality of care.

  Thus, this study investigates the structure and mechanism of segregation of providers, focusing on care workers’ motivations in NPOs based on the analysis of the data from 12 in-depth interviews with care workers and a questionnaire survey of 34 NPOs

  The findings are as follows: First, among the services of the LTCI, NPOs tend to undertake lower-priced domestic work, while for-profit providers take higher-priced physical care. NPOs cover the deficit in domestic work in spite of large costs. Second, NPOs provide the older people with additional services in order to meet their needs outside of the LTCI rubric, even though the income from the additional services is smaller than the services under the LTCI. Third, the altruistic motivation makes NPOs’ workers content with long working hours of additional services.

  NPOs have tendency to deliver their services in spite of small profit, as long as users need them. This allows for-profit providers to choose the services with larger profit, that is, cream-skimming. The different motivations of providers create the uneven and uncompetitive structure of the elderly care system in Japan.