Wataru Suzuki

The long-term care insurance (LTCI) of Japan was introduced in year 2000. While the restrictions on the entry on the home-care suppliers have been removed, the supply of institutional care service is still limited to social welfare corporations, medical corporations, and municipal government agents. In contrast to the surge in the demand for institutional care, following the introduction of LTCI, only limited increases in the supply capacity have been realized. This has resulted in overwhelming excessdemand and long waiting-list for admission. Reflecting this severe constraint on the supply of institutional care, the fastest growth the in LTCI benefits is currently observed in such quasi-institutional services as group homes or care-houses, which are relatively its close substitutes in the home-care menu. This double standard between two kinds of institutions causes problems such as inequities between the aged, a failure of quality control.

Expenditures on terminal care are estimated to account for more than 20% of the total medical care expenses of the elderly population in Japan. This paper, however, is the first effort in Japan to investigate the determinants of patients' decisions concerning terminal care. Using self-designed survey data, this paper sheds light on the determinants of elderly patients' decision on whether to write a "living will" for terminal care denial. As a result, the price elasticity of demand for a "living will" of elderly patients is not significantly different from zero. In other words, increase in the self-pay burden would not encourage elderly patients to write a "living will" for terminal care denial.<br>On the other hand, using an approach of Conjoint Analysis, we find that other non-price factors are more important for the decision regarding making of a "living will". For example, the probability of writing a "living will" would rise by 6.0% if the effectiveness of a "living will" were to be ensured systematically. Additionally, the probability of writing a "living will" would increase by 11.2% if elderly patients were permitted to enter a hospice or receive palliative care when needed. This probability would also rise 3.2% given cautious certification concerning the need for terminal care were warranted. Finally, this probability would increase 9.1% if physicians were to fully inform elderly patients of their health condition. Hence, the most effective strategy toward the high medical expenses of terminal care is not to raise self-pay burden but to improve legislation and medical care environment to encourage more "living wills" for terminal care denial.

在宅健康管理システムを有料(月額2500円)で提供している釜石市のユーザー296名と,無料で提供している西会津町のユーザー498名を対象として,システムへの「支払意思額」およびシステムに関する4つの効果(生活不安の解消,健康意識の高まり,健康状態・病状の安定,医療費の減少)を聞き取り調査した.その結果,いずれの調査項目についても両地域の回答内容に有意差は認められなかった.このことから,2500円程度有料にしたとしてもシステムへの評価は変わらないのではないかと考えられた

We interviewed 348 users of a home telemonitoring system and asked questions about their willingness to pay (WTP). Assuming that the functional form of demand was logistic, the best estimate of the WTP was yen 4519 per user per month. We also analysed how the benefits of the system (expressed in terms of WTP) were attributed to four factors: stabilizing illness; enhancement of health consciousness; less anxiety in day-to-day life; and a decrease in medical expenditures. All except the last were significant. According to the resulting model, individual users should bear yen 2763 in costs, while society should reimburse yen 349. Surprisingly, the value of yen 2763 obtained here is very close to the amount ( yen 2500) actually charged by Kamaishi City.