The Quasi-Marketization of Japan’s Long-Term Care Insurance System: Achievements and Issues
Author: Shu-Hsin Lin
Abstract / Chinese PDF Download
In Japan, social welfare services are traditionally provided by the government, which support the elderly with counseling, facility support and home care services. However, entering the 21st century, there has been a significant change in the relationship between the public and private sectors, with policy implementation gradually relying on the private sector. The role and responsibility between the public and private sectors has become vague, including the supply of social welfare. The quasi-market is an alternative to the free market mechanism, which at the same time preserves the control and institutions of the public sector. Quasi-market theory stresses “the separation of supplier and purchaser”, meaning that the finance and the supply should be the responsibilities of the public and private sectors respectively. Service users may choose what they need according to the various services offered.
This study aims to review the results of Japan’s Long-term Care Insurance System through the success factors and evaluation criteria of quasi-market theory. Th study finds that the structure of long-term care services changed after the quasi-marketization of Japan’s Long-term Care Insurance System, however it is not yet a competitive free market. Though there are multiple suppliers in the long-term care industry, forbidding price competition and the fact that only large companies have provided such services has limited the success of the quasi-market mechanism. Additionally, the design of having service users act as purchasers causes asymmetric information and negatively affects the power of choice.