Table 1.

Relevant regulatory differences among three facility types

	Institutional facilities (Japan)	Private nursing homes (Japan)	Institutional facilities (Germany)
Market entrance	-Supply control: authorities can reject approvals in terms of their referring levels capping bed density [28] -Service provision planning by each municipality as insurer & prefecture	-Not subject to authorities’ provision planning (-2006)	-No supply control under LTCI: LTCI funds must contract with any provider who meets quality standard [24].
		-No supply control (-2006)	-Need planning: abolished
Providers	-Not-for-profit; small minority is municipal	- Majority is for-profit	-Mixed: for-profit & not-for-profit; minority is municipal
Financing LTCI	-Half by contributions & half by taxation [32] (Public payers: state, prefecture & municipality)	-Half by contributions and half by taxation [32] (Public payers: state, prefecture & municipality)	-Financed solely by contributions
Financing care fees	-Fees: publicly fixed	- Fees: publicly fixed under LTCI	-Before LTCI: fully financed based on cost- recovery-principle [23]
	-Co-payment before LTCI: according to ability-to- pay principle	-Different according to eligible levels	-Fees: bargained between providers & social-assistance (SA) sponsor/LTCI funds etc.; reflecting facility’s individual costs for each eligible level
	-Co-payment under LTCI: 10% of fees	- Co-payment: 10%	-Benefits under LTCI: publicly fixed and capped, according to eligible levels
	-Different according to eligible levels under LTCI	-Care fees for PNHs are lower than that for IFs	-Users who cannot co- payment: eligible for SA
Financing hotel costs (accommodation & meals)	-Fees: Publicly fixed; not adjusted to local price/rent level	-Fees: market-based; set by facility	-Before LTCI: fully financed based on cost- recovery-principle [23]
	- Co-payment: depending on room type and income	-Fully paid out-of-pocket	-Fees: individually bargained between LTC fund and facility (provider) based on costs [33]
	-After 2005, middle and high income users are no longer subsidized & pay full price set by facility out-of-pocket	-Not subsidized	-Fully paid out-of-pocket -Users who cannot co- payment: eligible for SA
	-Users who cannot co-payment eligible for SA
Interests of insured persons	Preferable to other residential facilities due to higher subsidies, not-for-profit status & no time-limits [34]	More expensive alternative to IFs	-SA-recipients: preferable to other services due to higher subsidies
			-Not-SA-recipients: more expensive than home care due to considerable out- of-pocket payments [24]
Interests of authorities (J) & LTCI funds (G)	Economic incentive to constrain IF supply & fees, but politically for need-oriented provision	Economically preferable due to lower benefits & almost no subsidy compared to IFs	No strong economic incentive to constrain fees & expenditures
Subsidy for (initial) capital costs	- Amount is based on a national standard [28]	Rarely	-Before LTCI: directly paid (only to not-for-profit facilities)
	-Paid directly by state		-Under LTCI: capital costs are fully financed by users separately from hotel costs; low- income users are subsidized for capital costs
	-Sometimes additionally subsidized depending on municipal decision
	-Land acquisition subsidized decreasingly
Significance	-24% of LTC beneficiaries use IFs (2009; calculated based on official data [35])	-4% of LTC beneficiaries (2009; incl. PNH-similar facilities; calculated based on official data [35])	-30% of LTC beneficiaries (2009) [27]
		-LTCI gave a boost in development of PNHs
Clientele with LTCI benefits	- Eligible persons assessed as heavily independent	All LTC eligible persons	-All LTC eligible persons
	- Low-income users as majority		- SA-recipients: about 80/30% of users (before /under LTCI) [24,36]