J. Home Econ. Jpn. Vol. 52 No. 8 729 ` 736 ( 2001 ) Report Input-Output Analysis of Economic Effect in Nursing Care Insurance Hiroshi MURATA, Sin YAMAZAKI, * Masanobu MAEDA ** and Akinori HISASHIGE ** * Department of Occupational Health Economics, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyusyu 807-8555, Japan School of Medicine, Toyama Medical and Pharmaceutical University, Toyama 930-0194, Japan Department of Systems Physiology, Institute of Industrial, Ecological Sciences, University of Occupational and Environmental Health, Kitakyusyu 807-8555, Japan School of Medicine, University of Tokushima, Tokushima 770-8501, Japan The prefectural welfare budget for the aged continues to increase in the growing aging society, and the rate of increase is expected to be accelerated by the nursing insurance system which was introduced in April 2000. Then, it should be pointed out that no significant study has yet been made on how much the newly introduced system affects the local economy. Taking up as the model case the prefectures of Tochigi, Kyoto and Fukuoka where the population ratio of the senior citizens is very close to the national average, we attempted to work out the economic effect of the nursing insurance system. As the basis of our estimate, the 1990 inter-industry relation table drawn up by the respective prefectures was referred to along with the market scales of the nursing service published by the Ministry of Health and Welfare for 2000 and 2010 respectively. The employment thereof was also estimated. Our estimate of the market scale of the nursing service for the year 2000 resulted 68.4 billion yen, 90.5 billion yen and 171 billion yen in Tochigi, Kyoto and Fukuoka respectively. The economic effect thereof is estimated to be respectively 51.3 billion yen, 80.1 billion yen and 178.7 billion, and the related employment to be produced would come to the level of 8,900, 12,600 and 25,600 respectively, of which the number of people required for the nursing service was 5,600, 7,400 and 14,000. The size of the nursing service market should increase by 35.7 billion yen, 53 billion yen and 96.7 billion yen from the year 2000 to the year 2010. The economic effect should be increased by 26.8 billion yen, 46.9 billion yen and 155.5 billion yen, and the employment including the area of the economic effect should grow by 4,700, 7,400 and 18,100 respectively. The labor population required for the nursing service, i.e., the number of people engaged in the area of nursing service, is estimated to increase by 2,900, 4,300 and 7,900 respectively. (Received July 3, 2000; Accepted in revised form May 31, 2001) Keywords: inter-industry relation table, nursing insurance, labor population, employment, economic effect. PREFACE The budget allotted to the welfare of the aged in local governments has been constantly on an increase; 1) increase of 1.93% in 1990 to 2.35% in 1996 for instance. 2) This trend should be interpreted to mean that the demands for services for the aged population have been met by the administrations year after year, and their welfare budget had to be further increased when the nursing insurance system was introduced nationwide in April 2000. As for the market scale of the nursing service, it is to be noted that the initial year has only eleven months as against the twelve months in regular years because the new system was introduced in April 2000 and the payment started from May the same year. The national yearly total was \4,300 billion (Table 1 released in September 1999). The staying-at-home service cost \2,800 billion requiring the labor of 705,000 people as against \1,490 billion involving 1,984,000 people in the sector of the facilities service. It is to be also noted that the cost is shared by three ( 729 ) 41
J. Home Econ. Jpn. Vol. 52 No. 8 ( 2001 ) Table 1. Estimate of nursing insurance cost Excerpt from Ministry of Health and Welfare Elderly Person Welfare Bureau: "Outline of Budget Request Related to Elderly Person Health Welfare in 2000." parties of individuals, central government and local (prefectural) governments: \500 billion by individuals and \3,800 billion by central and local governments. It is estimated that the cost will be \6,900 billion in the year 2010 (*S). As for the economic effect, the public investments into the sector of the welfare for the aged (Medical Treatment, Health, and Social Security as per the industrial classification) are expected to become more and more important in the future; the ratio, however, would be only 3-10. We aimed to analyze an economic effect at the administrative level. We found the manpower estimated for the execution of the nursing insurance system by Tochigi, Kyoto and Fukuoka where the ratio of the aged over 65 years of age nearly equal to the national average; we chose the three local administrations for our study. METHOD Policy of analysis It was not easy to obtain the necessary data affecting the total cost of the nursing service at the local administrations. The population of the aged over 65 in each of those three prefectures as against the national average was 11-12 rating (Table 2), and it is to be noted that three administrations based their estimates of the market scale on the nationwide service demand estimated by the Ministry of Health and Welfare for the fiscal years 2000 and 2010. The local administrations estimate the economic effect or the final demand for the nursing service (11-15) on the basis of the inter-industry relations table prepared by respective administrations. The rate of the aged population over 65 in the three prefectures (15.7-15.8%) may be compared with the national average (15.7%) as targeted (*0) in their analysis of 1997. As for the inter-industry relations table of Tochigi we used (*0) as well as that of two other prefectures (Table 3), the table listed as a main economic indicator 90 sections in 1990 and 91 sections in 1995. Procedure of analysis The procedure is as follows (Fig. 1): (1) Population composition in 2000: No change between 1997 and 2000. For 2010, we calculated the proportion of population in accordance with that of the national meter. (2) (*S) is to be the target (*0) for each local administration to look after the aged over 65 on the basis of the market scale of the nursing service nationwide as calculated by the Ministry of Health and Welfare by the process (1) for the staying-at- 42 ( 730 )
Input-Output Analysis of Economic Effect in Nursing Care Insurance Table 2. It is a population by 65 years old or more of administrative divisions Excerpt from the Management and Coordination Agency: "Estimate Population" and National Social Security and Institute of Population Problems: "Administrative Divisions Prospective Estimate Population" (estimate in May, 1997). ( 731 ) 43
J. Home Econ. Jpn. Vol. 52 No. 8 ( 2001 ) Table 3. Social economic indicators of three prefectures Making from various statistical material. home service and the facilities service. (3) An economic effect is estimated by the retrogression row table of 1990 output industry relations of the three prefectures (1-(1-MA) A-1 type), direct effect. In that case, all demands were categorized in the "Social Security" sector, and as to the facilities service, all demands were registered under the heading of "Medical Treatment" and "Health." The staying-at-home service was treated as the final demand vector. (4) Indirect effects are to be worked out as an outcome of an economic effect. In other words, a cause-and-effect relation should be considered; an increase of production to meet new demands, which are to be generated as an outcome of an increase of remuneration of workers to be expected as production activities grow, which is to be supported by the sound household economy leading to increased consumption, etc., etc. (5) The employment coefficient announced by the Ministry of International Trade and Industry in its 1995 output industry relation table (extension table) was used as the basis of obtaining the number of employers; 0.65% of all industries was expediently assumed for obtaining the market scale of the nursing service, which was to be 0.082% of the sectors under the heading of Medical Treatment, Health and Social Security. The ratio of the staying-at-home service against the facilities service for the year 2000 was 0.347 against 0.653. This ratio was applied in breaking down the total cost of \69 billion as estimated by the Ministry of Health and Welfare. Similarly, for the year 2010, the ratio of 0.738 against 0.262 was assumed for the total of four million service users. In this research, the input-output analysis of the inter-industry relations for the years 2000 and 2010 was carried out on the basis of the 1990 output industry relation table that showed the industrial structure of that year. Various factors were considered to influence the economic effect of the new system; the industrial structure in each of the three prefectures was affected in the 1990s by the factors 44 ( 732 )
Input-Output Analysis of Economic Effect in Nursing Care Insurance Fig. 1. Method of input-output analysis of inter-industry relationships such as the domestic de-industrialization due to the appreciation of the yen, the continuing plunge of the real estate value, and the promising rise of information industry. As it was difficult to forecast how much the industrial structure would be affected by which factors in the coming decades, we assumed that the ( 733 ) 45
J. Home Econ. Jpn. Vol. 52 No. 8 ( 2001 ) Table 4. Result 46 ( 734 )
Input-Output Analysis of Economic Effect in Nursing Care Insurance industrial structure would remain more or less the same for 1990, 2000 and 2010 before starting our analysis (*0). RESULT Result in Tochigi Prefecture The market scale of the nursing service in Tochigi for the year 2000 amounts \68.4 billion, the breakdown of which is \23.7 billion for the staying-athome service and \44.7 billion the facilities service. Thirty-eight point one billion yen is marked as an indirect effect of the personal consumption, which has been supported by the increased remuneration workers will have received as a result of the growing production in the industrial field. Thirteen point two billion yen results by the production pushing coefficient in the retrogression row table: 1.195 of medical treatment and 1.1827 as social security. A direct economic effect totals \13.2 billion or 1.75 times as large as the demand for the nursing service. Economic effects total \119.7 billion or 1.75 times as large as the nursing service demand. Table 4 shows the outline of the result. The market scale of the nursing service is estimated to grow to \119.7 billion or 1.75 times in 2010, and the total effect is estimated to be \182.1 billion; the increase rate is \62.4 billion in the year 2000 to \78 billion in 2010. Thanks to an cxpanded field of work, the number of working population will increase by 13,600 in 2010 which may be compared to an increase of 8,900 in 2000. (*S) is somewhere around 5,600 in the year 2000 while the number to be employed in the nursing service in 2010 will be 8,500. Result in Kyoto Prefecture The market scale of the nursing service in Kyoto is in the order of \90.5 in the year 2000, the breakdown of which is \31.4 billion for the staying-at-home service and \59.1 billion for the facilities service. An indirect effect by the personal consumption is estimated to be \50.7 billion; the personal consumption is supported by an increase of income as a result of the production increase. The direct effect of the nursing service comes to \29.4 billion of which the production pushing coefficient in the retrogression row table is 1.3398 for Medical Treatment and 1.2956 for Social Security. The total economic effect is \170.6 billion or 1.89 times as large as the nursing service demand. The market scale of the nursing service comes to the order of \143.5 billion or 1.6 times as large in 2010, and the economic effects total \270.4 billion, with an increase of \99.8 billion in 2000 is estimated to reach \126.9 billion in 2010. The number of the employed including those in the newly created places of work has been increased to 20,000 in 2010 from 12,600 in 2000. (*S) is in the neighborhood of 7,400 in the year 2000 while it will reach the figure of 11,800 in the year 2010 thanks to an increase of working population due to the expanding nursing service. Result in Fukuoka Prefecture The market scale of the nursing service in Fukuoka reaches the order of \170.9 billion in the year 2000, of which \59.2 billion is for the staying-at-home service and \111.7 billion for the facilities service. An indirect effect brought about by the increased personal consumption benefiting from the augmented remuneration in the industrial sector, which enjoys increased production amounts to \131.8 billion. The nursing service produces \46.9 billion in direct effect with the production pushing coefficient in the retrogression row table recording 1.2677 of medical treatment and 1.2872 of Social Security. The total economic effect comes to \349.6 billion or 2.05 times as large as the demand for the nursing service. The market scale of the nursing service is calculated to reach \267.7 billion or 1.6 times as large in 2010, with an increase of \252.2 billion in 2000 to be further raised to \334.7 billion in 2010 as a result of economic effects of the nursing service. The working population to be augmented by the newly created place of work is worked out to be 43,700 in 2010 from 25,600 in 2000. (*S) is estimated to be in the vicinity of 14,000 in 2000 to become as large as 22,000 in 2010 as the nursing service is expected to require more people to work in the related sector. CONSIDERATION The following four points should be considered studying the effect of the nursing insurance at the prefectural level. In other words, how the economy of cities, towns and villages would be affected by the introduction of the nursing insurance. The second point is the use of the inter-industry relations table of 1990; how the industrial structure was going to change by the introduction of the insurance was not fully taken into account when the table was used for research; the future change was estimated by RAS and other methods. The third point is, therefore, the need to obtain detailed data on the nursing service such as transportation to and from home as one of in ( 735 ) 47
J. Home Econ. Jpn. Vol. 52 No. 8 ( 2001 ) the specific field of service in the facilities service as well as the staying-at-home service to be included in the overall Medical Treatment and Health service. The fourth point is how better, if not best, respective administrations, i.e., cities, towns and villages, correctly classify the degree of nursing needs (*0). Our research served its purpose even admitting that there is room for improvement, i.e., we are now fully aware what should be done in which sector to better our research. Evidently the inter-industry relations table and some other data should be updated, and all administrations are doing their best to put the new system into effect as well as studying how to correctly evaluate the extent of its economic effects in order to reflect the actualities of the nursing service. about 1.8 times as large demand in the three prefectures under study. The economic effect is estimated to be expanded by 1.5 times from the year 2000 to 2010, and the work force expansion from 2000 to 2010 is estimated to be from approx. 25,600 to approx. 43,700 in Fukuoka, from approx. 8,900 to approx. 13,600 in Tochigi, and from approx. 12,600 to approx. 20,000 in Kyoto. The nursing service requires more and more manpower from 5,600 in 2000 to 8,500 in 2010 (Tochigi), from 7,400 in 2000 to 11,800 in 2010 (Kyoto), and from 14,000 in 2000 to 22,000 in 2010 (Fukuoka). Furthermore, it should be pointed out that the nursing service is definitely understaffed; an average of 180 nurses had to look after 1,000 service recipients in 2000 while an average of 200 will be nursing in 2010. CONCLUSION It was estimated that the nursing service created 48 ( 736 )