Do Non-Profit Operators Provide Higher Quality of Care? Evidence from Micro-Level Data for Japan's Long-term Care Industry

Along with the introduction of the long-term care insurance scheme, the Japanese government in 2000 for the first time allowed for-profit operators to compete head-on with non-profit operators in the provision of at-home care services. This study examines quality differentials between the nonprofit and the for-profit sector in Japan's elderly care industry, concentrating on home helpers and staff nurses. Taking advantage of a unique and rich micro-level survey, the study finds that although nonprofit operators provide higher quality of care, as measured by simple averages of workers' characteristics, the advantage of nonprofits disappears once their higher wage is corrected for. This finding confirms that the seemingly higher quality of care provided by nonprofit operators is due to the nonprofit wage premium, resulting from their preferential status which provides non-distributional constraints and favorable tax treatment.