Abstract

Background and Objectives: This paper examines how municipalities behave to coordinate with in the Care-Needs Certification for Japan’s long-term care insurance (LTCI) programs. Japan represents an ideal case study, as it tried to address the challenges posed by the most rapidly aging population in the world with a public long-term care insurance system in 2000. In addition, the government has delegated part of the process of determining eligibility to non-state professional actors in different fields and has provided various incentives to encourage these actors to participate in LTCI administration. How municipalities coordinate with inter-professional and multi-disciplinary cooperation? How municipalities’ local officials collaborate with non-state professions? The existing literature generally considers the Care-Needs Certification system of Japan to be “centralized” and no variations of Care-Needs Certification are supposed, leaving the possibility of variations unexamined. However, the governance on how municipalities connect these non-state professional and what extent municipal governments control the professions, vice versa let them autonomous under severe austerity on LTC finance.

Method: In order to focusing on these questions, I conducted the four comparative municipal case studies of the Care-Needs Certification for LTCI programs within Fukui Prefecture, Japan. For each municipalities, I use data from an original survey and interviews with public officials, LTCI assessors and professional boards’ members composed of experts in different fields. All the survey’s response rates are over 60%.

Results and Conclusions: I inductively analyze these cases in terms of profession’s bureaucratization and the government reputational management through controlling professional identities. These four cases correspond with four typologies. There were there especially notable results from this research. First, assessor’s bureaucratization may be different from the municipalities who collaborate with and manage assessors. Second, the level of mutual trust between the LTCI assessors and the local officials who supervise them has a significant influence on the relationship between the assessors and the clients. Third, professional board members are affected not only by their experience and personal attributes (gender, age, field, etc.) but also by the peer effect in different directions, leading to accentuated risk-taking or risk averse tendencies in collective decision making during policy implementation. Thereby, local officials in the high performance municipality behaved to get the reputation from these non-state actors through addressing professional identities and tried to coordinate them by decreasing the transaction cost. This paper concludes by discussing theoretical and practical implications of the results.