Comparison of public and private care management agencies under public long-term care insurance in Japan: A cross-sectional study

Aim:   Long-Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long-term care services which had been provided by social welfare corporations or public agencies in the previous long-term care scheme. This study compared differences in care management plans for community-dwelling frail elderly people between public care management agencies and private care management agencies.
Methods:   The subjects were 309 community-dwelling frail elderly people living in a suburban city with a population of approximately 55 000 and who had been using community-based long-term care services of the LTCI for 6 months from April 2000. The characteristics of the care management agencies (public/private) were identified using a claims database. After comparing profiles of users and their care mix between those managed by public agencies and by private agencies, the effect of the characteristics of care management agencies on LTCI service use was examined.
Results:   Public care management agencies favored younger subjects ( P  = 0.003), male subjects ( P  = 0.006) and people with a higher need for care ( P  = 0.02) than private agencies. The number of service items used was significantly larger in public agencies than in their private counterparts. In multivariate regression analysis, the utilization of community-based long-term care service was significantly greater among beneficiaries managed by private agencies than those managed by public agencies ( P  = 0.02).
Conclusion:   Private care management agencies play an important role in promoting the use of care services, but their quality of care plans might be questionable.