Abstract
Background: In 2000, Japan predicted the coming of a super-aging society and established the Long-term Care Insurance System as a mechanism to provide a universal care system for long-term care risks. In the 20 years since this system was established, various revisions have been made to the system: in 2006, a project by municipalities to support the continuous community life of older adults was established, and in 2015, this project was enhanced. These systemic revisions led to regional disparities in premiums set by the municipalities that administered long-term care insurance. To deal with this, the Japanese government introduced new system in 2018 that evaluates the management initiatives of the 1,714 municipalities in managing the Long-term Care Insurance System and provides financial incentives according to the results of these evaluations. The role of the 47 prefectures in providing support to the municipalities was clarified, and a system of financial incentives was also established. The evaluation items and scores for municipalities were 62 items and 2,185 points in FY2023 (77 items and 2,475 points in FY2021) (values in parentheses below are for 2021). The evaluation items consist of three major parts, and the number of evaluation items and scores are as follows. I: Establishment of a system to strengthen insurer functions through the PDCA cycle: 170 points for 7 items (215 points for 7 items); II: Promotion of measures to support the independence of older adults requiring long term care and to prevent them from becoming more severely disabled: 1,775 points for 44 items (1,395 points for 52 items); III: Promotion of measures to stabilize Long-term Care Insurance System administrations: 240 points for 11 items (295 points for 18 items).
Purpose: In this study, we use data from the uniform nationwide assessment conducted in FY2021 and FY2023 to provide financial incentives to reveal changes in management initiatives in the Long-term Care Insurance System by municipalities: toward the promotion of a community-based integrated care system in Japan.
Results and main findings: The average scoring rate was 52.9% (51.4%) in FY2023. The scoring rate for each of the five categories of residents aged 65 years and older was 66.1% (64.7%) for 100,000 or more, 60.5% (56.5%) for 50,000 to 100,000, 56.4% (54.0%) for 10,000 to 50,000, 51.1% (50.4%) for 3,000 to 10,000, and 46.7% (46.1%) for less than 3,000 %). Corresponding T-tests showed significant differences in scoring rates only in the "50,000 to less than 100,000" and "10,000 to less than 50,000" groups.
Conclusion: Management initiatives by municipalities in the Long-term Care Insurance System, as evaluated by the financial incentive system, increased from 2021 to 2023. Initiatives by municipalities with very large or small elderly populations showed no change. The former may have already implemented many initiatives, while the latter may not have enough staff and budget to implement new initiatives. These results suggest the need for measures to promote the initiative to municipalities, considering their size. This would require new schemes for financial incentives and support for municipalities by various organizations.