A cross-sectional study of 1,494 Japanese municipalities examined how use of home-based services under Japan's universal long-term care insurance varied geographically and what predicted that variation. Despite universal coverage, utilization varied widely with significant spatial clustering, higher in western Japan and lower in central and northern regions. A spatial regression model explained 71.3% of variance, with significant associations found for certified care needs, educational attainment, municipal financial strength, care manager availability, rurality, institutional care capacity, and non-institutional care provider density.
Why it is interesting: Shows that universal insurance alone does not eliminate geographic disparities in how older people access home-based care, and that local resources and context matter substantially.