Background
Methods
Design
Institutional background for comparison
Institutional facilities (Japan) | Private nursing homes (Japan) | Institutional facilities (Germany) | |
---|---|---|---|
Market entrance | -Supply control: authorities can reject approvals in terms of their referring levels capping bed density [28] -Service provision planning by each municipality as insurer & prefecture | -Not subject to authorities’ provision planning (-2006) | -No supply control under LTCI: LTCI funds must contract with any provider who meets quality standard [24]. |
-No supply control (-2006) | -Need planning: abolished | ||
Providers | -Not-for-profit; small minority is municipal | - Majority is for-profit | -Mixed: for-profit & not-for-profit; minority is municipal |
Financing LTCI | -Half by contributions & half by taxation [32] (Public payers: state, prefecture & municipality) | -Half by contributions and half by taxation [32] (Public payers: state, prefecture & municipality) | -Financed solely by contributions |
Financing care fees | -Fees: publicly fixed | - Fees: publicly fixed under LTCI | -Before LTCI: fully financed based on cost- recovery-principle [23] |
-Co-payment before LTCI: according to ability-to- pay principle | -Different according to eligible levels | -Fees: bargained between providers & social-assistance (SA) sponsor/LTCI funds etc.; reflecting facility’s individual costs for each eligible level | |
-Co-payment under LTCI: 10% of fees | - Co-payment: 10% | -Benefits under LTCI: publicly fixed and capped, according to eligible levels | |
-Different according to eligible levels under LTCI | -Care fees for PNHs are lower than that for IFs | -Users who cannot co- payment: eligible for SA | |
Financing hotel costs (accommodation & meals) | -Fees: Publicly fixed; not adjusted to local price/rent level | -Fees: market-based; set by facility | -Before LTCI: fully financed based on cost- recovery-principle [23] |
- Co-payment: depending on room type and income | -Fully paid out-of-pocket | -Fees: individually bargained between LTC fund and facility (provider) based on costs [33] | |
-After 2005, middle and high income users are no longer subsidized & pay full price set by facility out-of-pocket | -Not subsidized | -Fully paid out-of-pocket -Users who cannot co- payment: eligible for SA | |
-Users who cannot co-payment eligible for SA | |||
Interests of insured persons | Preferable to other residential facilities due to higher subsidies, not-for-profit status & no time-limits [34] | More expensive alternative to IFs | -SA-recipients: preferable to other services due to higher subsidies |
-Not-SA-recipients: more expensive than home care due to considerable out- of-pocket payments [24] | |||
Interests of authorities (J) & LTCI funds (G) | Economic incentive to constrain IF supply & fees, but politically for need-oriented provision | Economically preferable due to lower benefits & almost no subsidy compared to IFs | No strong economic incentive to constrain fees & expenditures |
Subsidy for (initial) capital costs | - Amount is based on a national standard [28] | Rarely | -Before LTCI: directly paid (only to not-for-profit facilities) |
-Paid directly by state | -Under LTCI: capital costs are fully financed by users separately from hotel costs; low- income users are subsidized for capital costs | ||
-Sometimes additionally subsidized depending on municipal decision | |||
-Land acquisition subsidized decreasingly | |||
Significance | -24% of LTC beneficiaries use IFs (2009; calculated based on official data [35]) | -4% of LTC beneficiaries (2009; incl. PNH-similar facilities; calculated based on official data [35]) | -30% of LTC beneficiaries (2009) [27] |
-LTCI gave a boost in development of PNHs | |||
Clientele with LTCI benefits | - Eligible persons assessed as heavily independent | All LTC eligible persons | -All LTC eligible persons |
- Low-income users as majority |
Geographical background for comparison
Conceptual model
Hypotheses
Data sources
Dependent variables
Explanatory variables
Analytical models and regression analysis
Analysis period
Results
Variables
|
IF in Tokyo
|
PNH in Tokyo
|
NRW
| |||
---|---|---|---|---|---|---|
Mean | (Standard deviation) | Mean | (Standard deviation) | Mean | (Standard deviation) | |
Dependent variables
| ||||||
Overall bed-densitya
| 34.82 | (41.53) | 7.48 | (6.15) | 47.46 | (6.72) |
Explanatory variables
| ||||||
Costs/cost relevant
| ||||||
Average facility size (beds) | 92.08 | (18.28) | 61.41 | (20.27) | 77.3 | (14.74) |
LTA land price for T (¥1000 s)/LTA rent-level for N | 382.54 | ( 249.39) | 336.49 | (254.12) | 3.11 | (1.02) |
LTA wage of elderly care nurse for T (¥1000 s)/LTA duration for care nurse search for Nb (days) | 205.05 | (8.92) | 205.05 | (8.92) | 54.3 | (15.08) |
Need
| ||||||
LTA percent elderlyc needing LTC | 13.04 | (1.97) | 15.48 | (1.96) | 15.7 | (2.07) |
LTA growth rate of elderlyc needing LTC | - | - | 8.65 | (2.52) | - | - |
Profit/political intervention (control variables)
| ||||||
LTA bed-densitya of IF | - | - | 24.14 | (19.98) | - | - |
Densitya of subsidized beds | 5.71 | (6.77) | - | - | - | - |
Demand (control variables)
| ||||||
LTA percent elderlyc
| 14.09 | (3.86) | 18.12 | (4.46) | 15.9 | (1.59) |
LTA growth rate of elderlyc
| 4.61 | (1.83) | 4.15 | (1.95) | 1.31 | (0.67) |
LTA residential tax for T (¥1000 s)/LTA disposable income for N (€1000 s) | 107.38 | (53.60) | 107.16 | (60.78) | 14 | (1.51) |
N | 54-56 | 47-56 | 54 |
Variables
|
IF in Tokyo
|
IF in NRW
| ||
---|---|---|---|---|
Mean | (Standard deviation) | Mean | (Standard deviation) | |
Dependent variables
| ||||
Change in bed-densitya
| -0.95 | (9.56) | -0.64 | (5.89) |
Explanatory variables
| ||||
Costs/cost relevant
| ||||
Average size of new facilities (beds) | 95.54 | (26.98) | 89.7 | (67.55) |
LTA land price for T (¥1000 s)/LTA rent-level for N | 341.03 | (285.98) | 3.11 | (1.02) |
LTA wage of elderly care nurse for T (¥1000 s)/LTA duration for care nurse search for Nb (days) | 205.05 | (8.92) | 54.3 | (15.08) |
Need
| ||||
LTA percent elderlyc needing LTC | 15.70 | (1.94) | 14.5 | (1.87) |
LTA growth rate of elderlyc needing LTC | 7.01 | (2.21) | 2.89 | (5.24) |
Profit/political intervention (control variables)
| ||||
Initial bed-densitya of IF | 32.21 | (43.59) | 48.3 | (8.79) |
LTA bed-densitya of PNH | 3.95 | (4.11) | - | - |
Densitya of subsidized beds | 1.45 | (2.94) | - | - |
Demand (control variables)
| ||||
LTA percent elderlyc
| 18.12 | (4.46) | 18 | (1.50) |
LTA growth rate of elderlyc
| 4.16 | (1.95) | 2.04 | (0.76) |
LTA residential tax for T (¥1000 s)/LTA disposable income for N (€1000 s) | 117.63 | (64.52) | 17.7 | (1.72) |
N | 46-56 | 50-54 |
Explanatory variables
|
Dependent Variables
| ||
---|---|---|---|
Overall bed-densityaof IF 2010 Japan | Overall bed-densityaof PNH 2008 Japan | Overall bed-densityaof IF 2009 Germany | |
Coefficient (95% CI) | Coefficient (95% CI) | Coefficient (95% CI) | |
Constant | 149.55 (80.55; 218.55) | -1.30 (-14.46;11.85) | 25.34 (12.42; 38.26) |
Need
| |||
LTA percent of elderlyb needing LTC | -8.80 (-14.03;-3.56) | 0.57 ('-0.28; 1.41) | 1.41 (0.59; 2.22) |
R2 | 0.17 | 0.03 | 0.19 |
Adjusted R2 | 0.15 | 0.01 | 0.17 |
F | 11.36**
| 1.81 | 12.00**
|
N | 56 | 56 | 54 |
Explanatory variables
|
Dependent variables
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Overall bed-densityaof IF 2010 Tokyo | Change in bed-densityaof IF 2002-2010 Tokyo | Overall bed-densityaof PNH 2008 Tokyo | Overall bed-densityaof IF 2009 NRW | Change in bed-densityaof 1999 -2009 NRW | ||||||
Coefficient (95% CI) | β | Coefficient (95% CI)b
| β | Coefficient (95% CI) | β | Coefficient (95% CI) | β | Coefficient (95% CI) | β | |
Constant | -27.85 (-211.13; 155.43) | - | 22.69 (0.44; 44.94) | - | 43.80 (-3.66; 91.26) | - | 32.55 (15.18; 49.91) | - | 39.36 (26.61; 52.10) | - |
Explanatory variables
| ||||||||||
Costs/cost relevant
| ||||||||||
Average facility size (beds) | 0.47 (0.03; 0.92) | 0.20* c
| 0.03 (-0.02; 0.09) | 0.10 | 0.11 (0.04; 0.18) | 0.39** c
| -0.07 (-0.19; 0.05) | -0.15 | Eliminated | - |
LTA land price (¥1000 s)/ LTA rent-level for N | -0.08 (-0.15;-0.02) | -0.47*
| Eliminated | - | -0.01 (-0.02;0.00) | -0.23 | Eliminated | - | Eliminated | - |
LTA wage of elderly care nurse for T (¥1000 s)/ LTA duration for care nurse searchd for N (days) | 0.22 (-0.59; 1.04) | 0.05 | Eliminated | - | -0.19 (-0.37;-0.01) | -0.30*
| Eliminated | - | Eliminated | - |
Need
| ||||||||||
LTA percent elderlye needing LTC | -8.96 (-13.31;-4.61) | -0.37***
| -66.26 (-160.91; 23.40) | -0.14 | 1.16 (0.04; 2.28) | 0.32*
| 1.46 (0.63; 2.28) | 0.45***
| Eliminated | - |
LTA growth rate of elderlye needing LTC | - | - | -0.82 (-1.87; 0.22) | -0.14 | 0.88 (0.03;1.74) | 0.25*
| Eliminated | - | Eliminated | - |
Profit/political intervention
| ||||||||||
Initial bed-densitya of IF | - | - | -0.21 (-0.30;-0.13) | -0.82***
| - | - | - | - | -0.39 (-0.52;-0.26) | -0.59**
|
LTA bed-density of IF for PNH/LTA bed-density of PNH for IF in T | - | - | Eliminated | - | Eliminated | - | - | - | - | - |
Density of subsidized bedsa
| -0.64 (-1.99; 0.72) | -0.10 | 0.52 (0.29; 0.76) | 0.19***
| - | - | - | - | - | - |
Demand
| ||||||||||
LTA percent elderlye
| 6.96 (5.15; 8.77) | 0.62***
| Eliminated | - | -1.26 (-2.17;-0.36) | -0.38**
| Eliminated | - | Eliminated | - |
LTA growth rate of elderlye
| Eliminated | - | -1.09 (-1.94;-0.23) | -0.20*
| -0.99 (-2.31; 0.34) | -0.29 | -2.20 (-4.86; 0.48) | -0.22 | - 1.85 (-3.36;-0.35) | - 0.24*
|
LTA residential tax for T (¥1000 s)/LTA disposal income for N (€1000 s) | 0.25 (-0.02; 0.52) | 0.32 | Eliminated | - | Eliminated | - | Eliminated | - | -0.98 (-1.64;-0.31) | -0.29**
|
R2 | 0.74 | - | 0.82 | - | 0.56 | - | 0.24 | - | 0.56 | - |
Adjusted R2 | 0.70 | - | 0.79 | - | 0.48 | - | 0.19 | - | 0.53 | - |
F | 18.70***
| - | 29.92***
| - | 7.17***
| - | 5.13**
| - | 20.82***
| - |
N | 54 | - | 51 | - | 47 | - | 54 | - | 54 | - |
Explanatory variables
|
Dependent variables
| |||||||
---|---|---|---|---|---|---|---|---|
Bed-density of IF Tokyo | Bed-density of PNH Tokyo | Bed-density of IF NRW | ||||||
Hypothesized | Result: overall | Result: change | Hypothesized | Result: overall | Hypothesized | Result: overall | Result: change | |
Costs/cost relevant
| ||||||||
Average facility size | + | + | 0 | 0 | + | 0 | 0 | 0 |
LTA land price | - | - | 0 | 0 | 0 | 0 | 0 | 0 |
LTA wage | - | 0 | 0 | - | - | 0 | 0 | 0 |
Need
| ||||||||
LTA percent elderly needing LTC | 0/- | - | 0 | + | + | + | + | 0 |
LTA growth rate of elderly needing LTC | 0/- | 0 | 0 | + | + | + | 0 | 0 |