title: A gap in formal long-term care use related to characteristics of caregivers and households, under the public universal system in Japan: 2001-2010.
abstract: We investigated whether the universal provision of long-term care (LTC) under Japan's public system has equalized its use across households with different socio-economic characteristics, with a special focus on the gender and marital status of primary caregivers, and income. We used repeated cross-sectional data from national household surveys (2001, 2004, 2007, and 2010) and conducted multiple logistic regression analyses to obtain odds ratios of caregiver and household characteristics for service use, adjusting for recipients' characteristics. The results showed that the patterns of service use have been consistently determined by caregivers' gender and marital status over the period despite demographic changes among caregivers. The gap in service use first narrowed, then widened again across income levels after the global economic recession. The results indicate that the traditional gender-bound norms and capacity constraints on households' informal care provision remained influential on decisions over service use, even after the universal provision of formal care. To improve equality of service utilization, the universal LTC system needs to meet diversifying needs of caregivers/recipients and their households, by overcoming barriers related to gender norms and economic disparity.
authors.affiliation: Department of Health and Social Behavior, The University of Tokyo, School of Public Health, 7-3-1 Hongo, Bunkyo-ku Tokyo 113-0033, Japan. Electronic address: mutt-tky@umin.ac.jp.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Tokunaga
authors.affiliation: Department of Health and Social Behavior, The University of Tokyo, School of Public Health, 7-3-1 Hongo, Bunkyo-ku Tokyo 113-0033, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.affiliation: Department of Health Service Research, Graduate School of Human Care Services, Tsukuba University, Japan.
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003469:Culture; D057172:Economic Recession; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D012923:Social Class; D066262:Social Norms
keywords: Gender norms; Japan; Long term care; Universal provision of care; Utilization gap