LEE, Sun-Young
(Ph.D. Student , Doshisha University)
The 3rd seminar on East Asian Social Welfare
Doshisha univ. and Chung-Ang Univ.
June 25, 2011
Contents
1. Background and Purpose of the presentation
2. Definition of Quasi-Market by Le Grand
3. Factors of “Quasi-Market” in Long-term Care service
4. Comparative structure of Quasi-Market, Japan and
Korea
1) Regulation of suppliers’ entry to the market
2) Setting the official price table
5. Concluding remarks
2
Background(1)
◎ A number of reforms surrounding supply system of long-term
care for the elderly are being carried out around the world.
◎ Japan: as part of “Social Welfare Basic Structure Reform”,
Long-term Care Insurance Act was legislated in 1997.
◎ Korea: introduced Long-term Care Insurance for the elderly in
2008. It is well known that it was formulated based on
Japan‟s Long-term Care Insurance Schemes, and it
has very similar structure to Japan‟s care service.
⇒Quasi-Market mechanism begins(expands) to function in
welfare service supply system.
4
Background(2) & Purpose
◎ Great Britain first introduced Quasi-Market mechanism into
welfare supply system. The representative study of the Great
Britain on Quasi-Market is the one by J. Le Grand and W.
Bartlett in 1989.
◎
The purpose:
To compare Japan‟s Long-term Care Insurance
Schemes with Korea‟s counterpart in the framework of QuasiMarket.
5
What is Quasi-Market?
The final responsibility to provide the social welfare
service : The government
◎ Accordingly, while service is supplied in market
principle, but perfect competition could not be expected.
◎ There exist competition in service supply and the
government places various limitation with laws for
guaranteeing rights of users, which is called “QuasiMarket”.
7
Definition of Quasi-Market
by J. Le Grand (1)
◎ Definition of “Quasi-Market” was first formulated
by J. Le Grand.
◎ “Market”, because they replace monopolistic state
providers with competitive independent ones.
◎ “Quasi”, because they differ from conventional
markets in a number of key ways. The differences
are on both supply and demand sides.
(Le Grand 1993:10) 8
Definition of Quasi-Market
by J. Le Grand (2)
- On the supply side, there exist non-profit organizations
which competed against profit organizations for users.
- On the demand side, consumer‟s purchasing power is
not expressed in money terms in a quasi-market.
Instead, either it takes the form of „voucher‟ or „need‟.
Services are bought by purchasing agent and then
distributed to users.
(Le Grand 1993:10) 9
1. Factors of “Quasi”
2. Factors of “Market”
Factors of “Quasi” in Quasi-Market
Provider
Regulation of the
suppliers‟ entry to
the elderly care
market
Public
administrator
Assessment of
frailty grade,
Evaluation
Entitlement of
Services,
Maximum
amount
Setting the official
Service
Provider price table by longuser
term Care
Remuneration
Administrative measures,
Canceled
Quasi
Provider
11
Factors of “Market” in Quasi-Market
Provider
Service user
fees
Choices
Service user
Provider
Provider
Competition among
providers for
securing users
Provider
Service user
Market
Service user
Service user
Profit seeking
12
1. Regulation of suppliers’ entry to the market
2. Setting the official price table
Regulation of the suppliers’ entry
to the market
§Japan
Profit-seeking bodies are
prohibited to participate.
Institutional
⇒exclusively delivered by the
care service
social welfare
corporations.
Profit-seeking bodies are
allowed to participate.
Residential
⇒over half of the services
care service
are delivered
by such bodies.
Quasi aspect of Quasi-Market
Market aspect of Quasi-Market
→ The dual structure of “monopoly by the non-profit bodies”
and “major occupation by the profit-seeking bodies”
§Korea
→ all area of services has allowed all types of providers including
individuals.
14
The proportion of subjects entering the
offer of the residential care service in Japan
100.0
Other
90.0
80.0
22.3
70.0
NPO
27.2
29.0
60.0
36.0 39.6
44.6
46.1
46.6 46.9
50.0
40.0
Medical
corporation
54.6
56.1
30.0
Cooperation
52.8
20.0
46.2
42.5
Profit-seeking
bodies
38.1
36.7
36.1
36.4
10.0
Social welfare
corporation
Municipality
0.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: Ministry of Health, Labour and Welfare in Japan (2000-2008)
15
The proportion of subjects entering the
offer of the residential care service in Korea
100.0
90.0
22.1
80.0
70.0
60.0
50.0
89.7
89.0
78.6
Other
77.4
Individual
72.7
40.0
30.0
Corporation
20.0
10.0
0.0
9.8
10.6
home-visit home-visit
care
bathing
care
19.1
day care
21.4
Municipality
home-visit short-stay
nursing
care
Source: Ministry of Health and Welfare in Korea (2009)
16
Setting the official price table
§Japan and Korea
◎ The fees of care services are officially set (named care
remuneration) by the Long-term Care Insurance Act.
◪ “price competition” among service providers is prohibited by
the regulation.
◪ leading to service quality competition in order to acquire the
service users.
→ These schemes are very different from the quasi-market of
NHS in Great Britain.
17
Differences of remuneration unit
between Japan and Korea
◎ Two kinds of elderly care service
(visiting care services and visiting nursing services)
The time of required
visiting care
service
visiting
nursing service
less than 30minutes
30minutes~59minutes
60minutes~89minutes
90minutes~119minutes
120minutes~149minutes
150minutes~179minutes
180minutes~209minutes
210minutes~239minutes
more than 240minutes
less than 20minutes
20minutes~29minutes
30minutes~59minutes
60minutes~90minutes
Japan
in case of
body’s care
2,540
4,020
5,840
6,670
7,500
8,330
9,160
9,990
10,820
In case of
household
‐
2,290
2,910
‐
‐
‐
‐
‐
‐
2,850
4,250
8,300
11,980
(unit: yen)
Korea
‐
748
1,128
1,495
1,869
2,114
2,345
2,562
2,765
‐
1,915
2,472
3,028
18
Low level of remuneration leads to…
Cream skimming
Low level of
remuneration
Low pay
⇒ Low quality of services
Fraud
19
Structures of Quasi-Market of Japan and Korea
Japan
Regulation of the
suppliers’ entry to the
elderly care market
Regulation of price
competition by setting
the official price table
Supervision and
assessment by the public
administrator
Entitlement of Services
based on the Assessment
of frail-grade
co-payment
right of choice of service
care manager
Korea
Residential care service: open to varieties of bodies
Institutional care service:
Institutional care service:
monopoly by the non-profit
open to varieties of bodies
bodies
possible
individuals
without
only corporate bodies
juridical(legal) person
setting the official price table
- be prohibited “price competition”
- leading to “service quality competition”
regional differences: existent
regional differences:
(0.3~0.5% premiums)
non-existent
official price’s disparity of visiting care service and visiting nursing
service: existence
- Public research and release
system
start in the year of 2011
- Assessment by the third party
Application → First step assessment by the computer → Second step
assessment based on the medical doctor’ opinion → Seven frailgrades in Japan, three grades in Korea
10% of costs for all kinds of institutional care service: 15%,
service
residential care service: 20%
choice-by-users type
21
care manager: existent
care manager: non-existent
Concluding remarks
◎ Similarities of Japan & Korea
◪ Residential care service: open to varieties of bodies
◪ Price competition is prohibited
◎ Differences of Japan & Korea
◪ Institutional care service: open to varieties of bodies
in Korea
◪ Low levels of care remuneration in Japan, especially
in Korea
22
Why such difference?
Cause1.
Insufficiency of infrastructure(quantitative &
qualitative capacity of supply)
Cause2.
Low degree of general acknowledgment
to long term care (services and schemes)
→ Quasi-Market factor does not always remain the
same, varying with era and area.
23
Thank you!
The proportion of subjects entering the offer
of the institutional care service in Japan
100.0
90.0
80.0
70.0
42.5
48.3
48.7
49.3
49.8
50.1
50.6
51.0
51.3
60.0
medical
corporation
50.0
40.0
30.0
20.0
other
39.2
Social welfare
corporation
34.6
34.8
35.4
35.6
35.9
36.0
36.2
36.3
municipality
10.0
0.0
2000 2001 2002 2003 2004 2005 2006 2007 2008
25
The proportion of subjects entering the offer
of the institutional care service in Korea
100.0
90.0
80.0
70.0
50.1
60.0
80.8
50.0
Individual
40.0
30.0
Other
Corporation
45.8
20.0
18.3
10.0
municipality
0.0
Geriatric Care Facility
Senior Congregate
Housing
26
◎ Two kinds of elderly care service
(visiting care services and visiting nursing services)
(unit: yen)
The time of required
visiting care
service
visiting
nursing service
less than 30minutes
30minutes~59minutes
60minutes~89minutes
90minutes~119minutes
120minutes~149minutes
150minutes~179minutes
180minutes~209minutes
210minutes~239minutes
more than 240minutes
less than 20minutes
20minutes~29minutes
30minutes~59minutes
60minutes~90minutes
Japan
in case of
body’s care
2,540
4,020
5,840
6,670
7,500
8,330
9,160
9,990
10,820
Korea
In case of
household
‐
2,290
2,910
‐
‐
‐
‐
‐
‐
2,850
4,250
8,300
11,980
Amount of care remuneration when minimum wage is one
Japan=1:18
Korea=1:40
‐
748
1,128
1,495
1,869
2,114
2,345
2,562
2,765
‐
1,915
2,472
3,028
27