Changes in Inter-governmental and Government-Private Relations under the Long-Term Care Insurance System in Japan

10.6265/TJSW.2009.8(1)1

Yuko Suda

Long-Term Care Insurance System ； inter-government relations ； government-private sector relations ； Japan

臺灣社會福利學刊

8卷1期（2009 / 08 / 01）

1 - 28

英文

The Long Term Care Insurance (LTCI) system that was introduced in 2000 privatized the provision of public services for the first time in Japan. The author and her colleagues have conducted multiple studies to examine how inter-governmental dynamics have changed through the introduction of the LTCI system, and how these changes influence government-private sector relations. The purpose of this paper is to integrate the outcomes of these studies to draw a bigger picture of the effects brought about by LTCI. The outcomes of our research indicate that although LTCI promoted devolution and privatization, the central government has still maintained ultimate control. The centralized nature of the LTCI system stemmed from the history of government-private sector relations as well as the dilemma created by the need to compromise between the principles of decentralization and equity. The development of an additional service market was expected to serve as a counterforce to centralization, but the demand for services did not increase. The author then turns to the outcomes of an empirical study of 209 managers of LTCI providers operating in the Tokyo Prefecture. The results indicate that under the LTCI system, for-profit providers behave like nonprofit providers. This finding contradicts the results of previous studies in Western countries, which suggest that nonprofit providers become increasingly like for-profit providers in the area of privatized human services. The outcomes presented in this paper shed a light on how Japan's post-welfare state regime has evolved. The author concludes by emphasizing the importance of further exploring the Asian model of civil society.

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