Comparing long-term care recipients in urban and rural municipalities in Japan and Sweden.

Japan and Sweden both have national systems of long-term care (LTC) and face similar challenges. This study compared various indicators of disability in LTC recipients in nine large urban, midsize urban, and rural municipalities in both countries. The aim was to establish whether urban-rural differences exist and whether they follow similar patterns in Japan and Sweden. It was found that LTC recipients in large urban municipalities in both countries were on average significantly less disabled than those from the other types of municipalities, regardless of the indicator for disability. Fewer persons in large urban municipalities live in extended families, which may increase the propensity to apply for LTC. The number of older people living alone in Japan is increasing, which means that the formal LTC system will come under increased pressure.

Future Costs of Long-term Care in Japan and Sweden.

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.

Provision of long-term care in relation to needs in urban and rural municipalities in Japan and Sweden.

AIM: The aim of the study was to establish whether there are differences in long-term care (LTC) provision with regard to needs between rural and urban municipalities in Japan and Sweden, and we propose possible causes for these differences. METHODS: Using comparable datasets from Japan (n = 20 699) and Sweden (n = 17 576), the care systems have been compared on an individual level. The datasets each contain information from nine large urban, midsize urban and rural municipalities regarding disability levels and the LTC services provided. RESULTS: LTC users in the large urban municipalities in both countries are, on average, less disabled than users in the midsize urban and rural municipalities. In both countries, per capita costs for LTC were lower in the large urban municipalities than in the rural municipalities (10% and 14%, respectively). However, when standardized for the level of disability, the per capita costs were higher in the large urban municipalities (4% in both cases). Multivariate analysis showed that there were significant per capita cost differences between the large urban and the rural municipalities in Japan. In Sweden, there were no significant per capita cost differences between the different types of municipality when age, sex and disability differences were accounted for. CONCLUSION: The findings seem to reflect the effect of differences in household structure, which in the large urban municipalities result in less access to informal LTC, thereby influencing the propensity to apply for formal, public LTC - especially for those with lesser needs. In Japan, where the number of extended family households is decreasing, this gives an idea of the future challenges facing LTC provision.