Differences in spatial patterns of long-term care depending on severity in Hokkaido, Japan

Submitted: 31 January 2022
Accepted: 18 April 2022
Published: 16 May 2022
Abstract Views: 1047
PDF: 393
HTML: 20
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


The increasing demand for long-term care (LTC) among the ageing population is a serious problem worldwide, which has greatly increased also in Japan since the introduction of the LTC insurance system there. Since there is a difference between insurers with respect to the proportion of people needing LTC, this study aimed at clarifying the spatial patterns of LTC. Insurer (n=156) LTC data for the period 2012-2019 were obtained from Ministry of Health, Labour, and Welfare and those needing LTC were classified into three classes: total, mild and severe with ageand sex-adjusted proportions needing LTC. Global and local Moran's I statistics were calculated for each 2-year period to clarify the trends of global and local spatial clusters. From 2012 to 2019, the mean proportion of mild class cases increased (10.6% to 11.6%), whereas that of severe class cases decreased slightly (5.9% to 5.7%). The spatial pattern of the proportion of each class revealed positive spatial autocorrelation. Based on analysis by local Moran's I, differences in spatial patterns were emphasised between the mild and severe classes. In Hokkaido, High-High clusters of mild cases were identified in the central and southern parts and severe ones in the northern and southern parts. Spatial patterns differed depending on the LTC class. Some insurers had distinctly higher or lower certification rates than those of their neighbourhoods.


Erratum in:

Geospatial Health, DOI: 10.4081/gh.2022.1137



PlumX Metrics


Download data is not yet available.


Anselin L, 1988. Spatial econometrics: methods and models. Kluwer, Dordrecht, The Netherlands. DOI: https://doi.org/10.1007/978-94-015-7799-1
Anselin L, 1995. Local indicators of spatial association-LISA. Geogr Anal 27:93-115. DOI: https://doi.org/10.1111/j.1538-4632.1995.tb00338.x
Bakx P, Douven R, Schut FT, 2021. Does independent needs assessment limit use of publicly financed long-term care? Health Policy 125:41-6. DOI: https://doi.org/10.1016/j.healthpol.2020.09.003
Campbell JC, Ikegami N. 2000. Long-term care insurance comes to Japan: a major departure for Japan, this new program aims to be a comprehensive solution to the problem of caring for frail older people. Health Aff 19:26-39. DOI: https://doi.org/10.1377/hlthaff.19.3.26
Choi J, Joung E. 2016. The association between the utilization of long-term care services and mortality in elderly Koreans. Archiv Gerontol Geriatr 65:122-7. DOI: https://doi.org/10.1016/j.archger.2016.03.013
Feng J, Wang Z, Yu Y. 2020. Does long-term care insurance reduce hospital utilization and medical expenditures? Evidence from China. Soc Sci Med 258:113081. DOI: https://doi.org/10.1016/j.socscimed.2020.113081
Fengming C, Yoshida H. 2019. An empirical study on the determinants of certification rate for long-term care need-focusing on lifestyle habits. TERG Discuss Papers 409:1-9.
Hokkaido Government, 2018. Hokkaido healthcare plan. Available from: https://www.pref.hokkaido.lg.jp/hf/cis/iryokeikaku/aratanairyoukeikaku.html Accessed: 19 January 2022 [In Japanese].
Hokkaido Government, 2020. Hokkaido data book 2020. Available from: http://www.pref.hokkaido.lg.jp/ss/tkk/databook/2020/0102.htm Accessed: 17 June 2021 [In Japanese].
Ito T, Mori T, Takahashi H, Shimafuji N, Iijima K, Yoshie S, Tamiya N, 2021. Prevention services via public long-term care insurance can be effective among a specific group of older adults in Japan. BMC Health Serv Res 21:531. DOI: https://doi.org/10.1186/s12913-021-06495-0
Iwamoto Y, Kohara M, Saito M, 2010. On the consumption insurance effects of long-term care insurance in Japan: evidence from micro-level household data. J Japanese Int Econ 24:99-115. DOI: https://doi.org/10.1016/j.jjie.2009.12.009
Jenks GF, 1967. The data model concept in statistical mapping. Int Yearbook Cartogr 7:186-90.
Kuzuya M, Masuda Y, Hirakawa Y, Iwata M, Enoki H, Hasegawa J, Iguchi A, 2006. Day care service use is associated with lower mortality in community-dwelling frail older people. J Am Geriatr Soc 54:1364-371. DOI: https://doi.org/10.1111/j.1532-5415.2006.00860.x
Lamb SE, Bruce J, Hossain A, Chen J, Longo R, Lall R, Bojke C, Hulme C, Withers E, Finnegan S, Sheridan R, Willett K, Underwood M; Prevention of Fall Injury Trial Study Group, 2020. Screening and Intervention to prevent falls and fractures in older people. N Engl J Med 383:1848-59. DOI: https://doi.org/10.1056/NEJMoa2001500
Masui H, Otaga M, Moriyama Y, Matsushige T. 2019. Current issues in long-term care policy and research: Toward the promotion of evidence-based policy. J Natl Instit Public Health 68:34-44.
Ministry of Health, Labour and Welfare, 2001. Status Report on long-term care insurance (annual report) in FY2000. Available from: https://www.mhlw.go.jp/youkei/saikin/hw/kaigo/jokyo00/hyo5.html Accessed: 15 June 2021 [In Japanese].
Ministry of Health, Labour and Welfare, 2013. Regional differences in long-term care by prefecture in Japan. Available from: https://www.kantei.go.jp/jp/singi/shakaihoshoukaikaku/wg_dai1/siryou4-5.pdf Accessed: 15 June 2021 [In Japanese].
Ministry of Health, Labour and Welfare, 2018. The current status and future role of the public long-term care insurance system. Available from: https://www.mhlw.go.jp/content/0000213177.pdf Accessed: 15 June 2021 [In Japanese].
Ministry of Health, Labour and Welfare, 2019a. Patient survey. Available from: https://www.e-stat.go.jp/statistics/00450022 Accessed: 25 August 2021 [In Japanese].
Ministry of Health, Labour and Welfare, 2019b. Status report on long-term care insurance (annual report) in FY2018. Available from: https://www.mhlw.go.jp/topics/kaigo/osirase/jigyo/18/index.html Accessed: 15 June 2021 [In Japanese].
Mitsubishi UFJ Research and Consulting Co., Ltd., 2016. Report on simplification and efficiency of administrative work for certification of long-term care needs. Available from: https://www.mhlw.go.jp/file/06-Seisakujouhou-12300000-Roukenkyoku/5_UFJ.pdf Accessed: 15 June 2021 [In Japanese].
Miyawaki A, Kobayashi Y, Noguchi H, Watanabe T, Takahashi H, Tamiya N, 2020. Effect of reduced formal care availability on formal/informal care patterns and caregiver health: a quasi-experimental study using the Japanese long-term care insurance reform. BMC Geriatr 20:207. DOI: https://doi.org/10.1186/s12877-020-01588-7
Miyazawa H, 2003. Uneven nursing care service opportunity and the behavior of service providers under the long-term care insurance system. Geograph Rev Japan 76:59-80 [In Japanese]. DOI: https://doi.org/10.4157/grj.76.59
Morii Y, Osanai T, Fujiwara K, Tanikawa T, Houkin K, Songzi G, Ogasawara K. 2021. Analyzing cost-effectiveness of allocating neurointerventionist for drive and retrieve system for patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 30:105843. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105843
Naruse T, Matsumoto H, Fujisaki-Sakai M, Nagata S, 2017. Measurement of special access to home visit nursing services among Japanese disabled elderly people: Using GIS and claim data. BMC Health Serv Res 17:377. DOI: https://doi.org/10.1186/s12913-017-2322-0
Sato K, Ikeda T, Watanabe R, Kondo N, Kawachi I, Kondo K, 2020a. Intensity of community-based programs by long-term care insurers and the likelihood of frailty: Multilevel analysis of older Japanese adults. Social Sci Med 245:112701. DOI: https://doi.org/10.1016/j.socscimed.2019.112701
Sato K, Zhang J, Kazawa K, Moriyama M, 2020b. Patterns of elderly people’s long-term care risks and determinants: a methodological study in a Japanese city. Geriatr Gerontol Int 20:674-9. DOI: https://doi.org/10.1111/ggi.13936
Sekimoto M, Ii M. 2015. Supplier-induced demand for chronic disease care in Japan: multilevel analysis of the association between physician density and physician-patient encounter frequency. Value Health Regional Issues 103-10. DOI: https://doi.org/10.1016/j.vhri.2015.03.010
Shinkai S, Yoshida H, Taniguchi Y, Murayama H, Nishi M, Amano H, Nofuji Y, Seino S, Fujiwara Y, 2016. Public health approach to preventing frailty in the community and its effect on healthy aging in Japan: frailty prevention trial in a community. Geriatr Gerontol Int 16:87-97. DOI: https://doi.org/10.1111/ggi.12726
Sohn M, O’Campo P, Muntaner C, Chung H, Choi M. 2020. Has the long-term care insurance resolved disparities in mortality for older Koreans? examination of service type and income level. Social Sci Med 247:112812. DOI: https://doi.org/10.1016/j.socscimed.2020.112812
Statistics Bureau Ministry of Internal Affairs and Communications, 2015. Census in 2015. Available from: https://www.stat.go.jp/data/kokusei/2015 Accessed: 20 October 2021.
Teixeira H, Freitas A, Sarmento A, Nossa P, Gonçalves H, Pina MF, 2021. Spatial patterns in hospital-acquired infections in Portugal (2014-2017). Int J Environ Res Public Health 18:4703. DOI: https://doi.org/10.3390/ijerph18094703
Tsutsui T, Muramatsu N, 2005. Care-needs certification in the long-term care insurance system of Japan. J Am Geriatr Soc 53:522-7. DOI: https://doi.org/10.1111/j.1532-5415.2005.53175.x
Umegaki H, Yanagawa M, Nonogaki Z, Nakashima H, Kuzuya M, Endo H, 2014. Burden reduction of caregivers for users of care services provided by the public long-term care insurance system in Japan. Archiv Gerontol Geriatr 58:130-3. DOI: https://doi.org/10.1016/j.archger.2013.08.010
Vilinová K, 2020. Spatial autocorrelation of breast and prostate cancer in Slovakia. Int J Environ Res Public Health 17:4440. DOI: https://doi.org/10.3390/ijerph17124440
Vivaldini SM, Pinto FKA, Kohiyama IM. Almeida EC, Mendes-Correa MC, Santos AF, Ribeiro RA, Mendes Pereira GF, Araujo WN, 2019. Exploratory spatial analysis of HBV cases in Brazil between 2005 and 2017. Rev Brasil Epidemiol 22:e190007. DOI: https://doi.org/10.1590/1980-549720190007.supl.1

How to Cite

Ohashi, K., Fujiwara, K., Tanikawa, T., Bando, K., Aoki, T., & Ogasawara, K. (2022). Differences in spatial patterns of long-term care depending on severity in Hokkaido, Japan. Geospatial Health, 17(1). https://doi.org/10.4081/gh.2022.1077

List of Cited By :

Crossref logo