1. ^aDepartment of Economics, Rutgers University, the State University of New Jersey, Camden, New Jersey 08102, U.S.A. E-mail: tyamada@crab.rutgers.edu
2. ^bDepartment of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027-6625, U.S.A. E-mail: cc2004@columbia.edu
3. ^cGraduate School of Humanities and Social Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki Prefecture, 305-8573, Japan. E-mail: tyamada@sk.tsukuba.ac.jp
4. ^dGraduate Program in Urban Public Health and Brookdale Center on Aging of Hunter College, School of Health Sciences, Hunter College, City University of New York, 425 East 25 Street, New York, NY 10010, U.S.A. E-mail: mfahs@hunter.cuny.edu
5. ^eNational Institute of Population and Social Security Research, Minister of Health, Labor and Welfare of Japan, 2-2-3 Uchi-Saiwai Cho, Chiyoda-ku, Tokyo 100, Japan. E-mail: fukawa@ipss.go.jp

Abstract

The Japanese public long-term care insurance for the elderly is unequivocally a problem both for the health care system and as a social issue. The issues for the socially hospitalized and institutionalized are still unsolved due to a lack of family and community support. A central feature is to investigate the behavioral choices among elderly formal/informal home care and nursing home care. This study uses the General Survey on Actual Living Conditions of Elderly People as a natural experiment to analyze behavioral decision-making between the nursing home care and community-based formal/informal home care among the elderly. A logit model analysis that controls for socio-economic, demographic and physical/mental health influential factors was conducted. Developing community-based formal/informal home care would lead to economic gains. A provision of compensation to family health caregivers for their informal home care for the elderly is a key factor and a viable option.