合併地域における介護保険の事業特性に関する旧市町村間の差異 : 「介護保険事業状況報告」による保険者別データの比較から  [in Japanese] Differences in Characteristics of Long-term Care Insurance Services among Municipalities under Recent Municipal Mergers in Japan  [in Japanese]

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Abstract

介護保険に関して,近年の市町村合併は,旧自治体ごとの負担(保険料)を均一化する一方で受益(サービス給付)を必ずしも平準化できない点で地域的公正の観点から問題を生じさせている.本稿は,旧自治体別の介護保険について,新自治体となる合併地域全体との間の量的・質的差異を全国スケールで分析した.主な結果は次の通りである.①新自治体とのサービス給付水準の差異が顕著な旧自治体を抱える新自治体は概して非都市的な地域特性を多く含み,高齢者人口規模などからみた首位都市としての地位が相対的に高い旧自治体による編入合併が多い.②合併によって新自治体との間で著しい給付水準の差異を有する旧自治体は全国的に分布するが,特に県境地帯の山間部や離島など周辺性を有する地域に多い.③それらの旧自治体は合併前の数年間をみても事業特性に大きな変化がなく,合併後も受益と負担の不均衡による地域的公正の問題が新自治体内で存続する可能性が示唆される.

Recent municipal mergers, often called “the great Heisei merger,” have increased drastically in Japan, especially between 2004 and 2006. The number of municipalities decreased by more than 40%. These municipal mergers have also affected territorial justice concerning long-term care insurance because, although a flat premium for Category 1 insured persons (senior citizens 65 and over) is applied throughout the each newly merged municipality, differences remain in the characteristics of long-term care insurance services among former municipalities. This paper examines the differences in quantitative/qualitative characteristics of long-term care insurance services between each former municipality and the newly merged municipalities, which consists of all former municipalities in each merged territory, from the viewpoint of territorial justice.<br>The main findings are summarized as follows.<br>1) To examine the differences in the quantitative characteristics of long-term care insurance services among former municipalities before merger, a quantitative index (IBI), which denotes the differences in insurance benefits, is adopted to examine the differences in the amount of insurance benefits per Category 1 insured person between the former and new municipalities. In addition to this quantitative index, two qualitative indices are defined: long-term care requirement certification (RCI) and services at facilities (SFI). The former denotes the differences in the rate of the long-term care requirement certification between the former and new municipalities. The latter denotes the degree of detachment of a component ratio of services at facilities between the former and new municipalities. Analysis showed that the quantitative index is related to the qualitative indices, especially to the RCI.<br>2) The geographical characteristics of the merged municipalities where marked differences in quantitative characteristics exist between the former and new municipalities were investigated using the IBI. Among 465 new municipalities, 93 with the most prominent IBIs were extracted. These 93 municipalities share the following basic characteristics: they were merged by more former municipalities, are mountainous or island regions with lower population density and were absorbed by mergers. In addition, several former municipalities had maintained the IBI level for some years before the merger. In particular, in most former municipalities where the IBI was markedly low, insurance benefits are estimated not to increase after the merger and the index will decrease. This means that the imbalance between low benefits and heavy burden of premiums in these former municipalities will continue. The new municipalities including these former municipalities have serious problems from the viewpoint of territorial justice.

Journal

  • Geographical review of Japan series A

    Geographical review of Japan series A 82(3), 188-211, 2009-05-01

    The Association of Japanese Geographers

References:  28

Cited by:  1

Codes

  • NII Article ID (NAID)
    10028265771
  • NII NACSIS-CAT ID (NCID)
    AA11591990
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    18834388
  • NDL Article ID
    10334476
  • NDL Source Classification
    ZG1(歴史・地理) // ZM41(科学技術--地球科学)
  • NDL Call No.
    Z8-571
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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