介護保険地域密着型サービスの地域差とその要因 Reasons for Regional Disparities in Care Insurance Community-Based Services

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本稿は,2006年の介護保険制度改正に伴い新設された地域密着型サービスの地域差の実態とその要因について明らかにした.地域密着型サービスの地域差は,従来の介護保険サービスに比べて大きく,小規模市町村を中心としたサービスの未実施市町村と,充足指数の高い人口1~5万人程度の中規模町村の存在が要因となって生じていた.サービスの未実施市町村は小規模市町村に多いが,これは市町村による整備目標の未設定という,市町村の意向が反映された結果である.一方で大都市圏の中核都市では整備目標を設定したにもかかわらず,事業の採算性を考慮した事業者の消極的な参入という,事業者の地域的な参入行動が大きく影響していた.このように,サービスの地域差には市町村施策が少なからず影響しているものの,最終的なサービス供給量を規定している事業者の参入行動が大きな影響を与えていることが明らかとなった.

This paper investigates the realities and causes of regional disparities in community-based services that were newly established in line with the 2006 reforms in the nursing care insurance system. Since the new services strengthened the authority of municipalities as compared with traditional nursing care services, the regional participatory activities of service operators were considered to be the reason for regional disparities in traditional nursing care insurance services. This paper also examines this issue from the perspective of policies, ideas, and financial situations of municipalities.<br>After using the Gini coefficient to understand regional disparities in services, we found that there were significant regional disparities in services, all of which were greater than 0.7 with the exception of cohabitation and nursing care to cope with dementia. This is clear when compared with the fact that all traditional nursing care insurance services had disparities of less than 0.5. The reasons for these regional disparities were municipalities without services, comprising mainly small municipalities, and medium-sized municipalities with populations of approximately 10,000–50,000 which have high contentment indexes due to more satisfactory services than those of small municipalities. Compared with traditional nursing care insurance services, an overwhelming majority of municipalities did not have community-based services, which has markedly increased regional disparities in community-based services compared with traditional nursing care insurance services.<br>Because of the concept that municipalities in their position as the closest administrative body to residents should play an important role in community-based services, not only were they able to set facility maintenance targets in nursing care insurance operation plans, which was the role of municipalities with traditional nursing care insurance services, but they were also granted the authority to specify, supervise, and advise service operators. However, very few municipalities were able to exert this authority. Conversely, in many cases municipalities decided not to implement services, and in some cases they did not assent to the principles of national community-based services. Meanwhile, in municipalities that were able to implement services, the result depended greatly on the participatory activities of service operators, such as profit-making corporations or social welfare corporations, as with the case of traditional care insurance services. However, because schemes such as nursing care benefits and staffing were unattractive to service operators, their participation was passive, resulting in an increase in regional disparities in service provision.

収録刊行物

  • 地理学評論 = Geographical review of Japan

    地理学評論 = Geographical review of Japan 85(1), 22-39, 2012-01-01

    公益社団法人 日本地理学会

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各種コード

  • NII論文ID(NAID)
    10030364508
  • NII書誌ID(NCID)
    AA11591990
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    18834388
  • NDL 記事登録ID
    023436517
  • NDL 請求記号
    Z8-571
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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