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Changing Relationships Between Nonprofit and For-profit Human Service Organizations Under the Long-Term Care System in Japan

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Abstract

In Japan, a nonprofit organization system enacted in the late 1990s and the later introduction of privatization policies in human services were expected to overturn government dominance of nonprofit organization activities. By focusing on the long-term care insurance (LTCI) system, which privatized public human services for the first time in the country, this study empirically examines whether, and to what extent, nonprofit–government relationships in Japan have actually changed as a result of this new system. In addition, because LTCI newly allows for-profit organizations to provide services, the influence of such organizations were incorporated into the analysis. The outcomes of this study demonstrate that the government continues to extend its sphere of influence over nonprofit and for-profit organizations through LTCI. In addition, for-profit organizations appear to be more successful than nonprofit organizations, in that the former organizations have overcome their lack of experience as public service providers by taking over the roles that nonprofit organizations have traditionally occupied.

Résumé

(Au Japon, un système d’associations à but non lucratif entré en vigueur à la fin des années 1990 ainsi que l’introduction ultérieure de politiques de privatisation des services sociaux étaient supposés inverser la domination de l’état dans les activités des associations à but non lucratif. Cet article se concentre sur le système d’assurance de soins de longue durée (ASLD), premier service social public du pays à avoir été privatisé. Il examine empiriquement si, et dans quelle mesure ce nouveau système a réellement modifié les relations entre les associations à but non lucratif et l’état au Japon. Comme l’ASLD permet désormais aux organisations à but lucratif de proposer des services, l’analyse prend aussi en compte l’influence de ces organisations.Les résultats de cette étude démontrent que l’ASLD n’empêche pas la sphère d’influence des pouvoirs publics de continuer à s’étendre par rapport à celles des organisations à but non lucratif et à but lucratif. En outre, les organisations à but lucratif semblent mieux réussir que les associations à but non lucratif; elles ont surmonté leur manque d’expérience comme fournisseurs de services publics en prenant les rôles occupés traditionnellement par les associations à but non lucratif.

Zusammenfassung

Man ging davon aus, dass ein in Japan Ende der neunziger Jahre eingeführtes System von gemeinnützigen Organisationen und die spätere Einführung von Privatisierungsrichtlinien im sozialen Dienstleistungsbereich die staatliche Dominanz im Bereich der Aktivitäten der Nonprofit-Organisationen überkommen würden. Die vorliegende Studie konzentriert sich auf das langfristige Pflegeversicherungsprogramm, im Rahmen dessen öffentliche soziale Dienstleistungen in dem Land zum ersten Mal privatisiert wurden, und führt eine empirische Untersuchung dazu durch, ob und wieweit sich die Beziehungen zwischen den gemeinnützigen Organisationen und der Regierung in Japan infolge dieses neuen Systems tatsächlich geändert haben. Da es gewinnorientierten Organisationen im Rahmen des langfristigen Pflegeversicherungsprogramms neuerdings gestattet ist, Dienstleistungen bereitzustellen, wurde auch der Einfluss dieser Organisationen in die Analyse miteinbezogen. Die Ergebnisse dieser Studie zeigen, dass die Regierung durch das langfristige Pflegeversicherungsprogramm weiterhin verstärkt Einfluss auf gemeinnützige und gewinnorientierte Organisationen ausübt. Zudem erscheinen gewinnorientierte Organisationen erfolgreicher zu sein als gemeinnützige Organisationen, insofern als sie Erfahrung als Anbieter öffentlicher Dienstleistungen gesammelt haben, indem sie die Funktionen übernehmen, die traditionell von Nonprofit-Organisationen ausgeführt wurden.

Resumen

En Japón, se confió en que un sistema de organización para las asociaciones sin ánimo de lucro promulgado a finales de los años 1990 y la tardía introducción de políticas de privatización en los servicios sociales diesen la vuelta a la dominación por parte del gobierno de las actividades de las organizaciones sin ánimo de lucro. Centrándose en el sistema de seguro médico a largo plazo (LCTI, del inglés long-term care insurance), que privatizó los servicios sociales públicos por primera vez en el país, el presente estudio examina empíricamente si, y en qué medida, las relaciones gobierno-organizaciones sin ánimo de lucro en Japón han cambiado realmente como resultado de este nuevo sistema. Asimismo, dado que el LCTI ha permitido recientemente que las organizaciones con ánimo de lucro proporcionen servicios, la influencia de dichas organizaciones se ha incorporado al análisis. Los resultados del presente estudio demuestran que el gobierno continúa ampliando su esfera de influencia sobre las organizaciones sin ánimo de lucro y con ánimo de lucro a través del LCTI. Asimismo, las organizaciones con ánimo de lucro parecen tener más éxito que las organizaciones sin ánimo de lucro, ya que las primeras han superado su falta de experiencia como proveedores de servicios públicos asumiendo los papeles que han ocupado tradicionalmente las organizaciones sin ánimo de lucro.

在日本,非盈利组织体系于二十世纪90年代末期建立,稍后推出的公共事业私有化政策预计会颠覆政府对非盈利组织活动的主导。通过专注于首次私有化国家公共事业的长期保健保险(LTCI)体系,本研究以经验检查了日本非盈利组织-政府关系是否以及在多大程度上受本全新体系影响而改变。此外,由于LTCI最近允许盈利组织提供服务,因此此类组织的影响也被结合到分析。 本研究结果表明,政府正通过LTCI继续扩展其对非盈利和盈利组织的影响范围。此外,对于盈利组织似乎比非盈利组织更加成功,原因在于通过接管非盈利组织传统占据的角色,前一种组织克服了缺乏公共服务经验的缺点。

في اليابان ، صدر نظام منظمة غير ربحية في أواخر 1990 كان من المتوقع في وقت لاحق من إدخال سياسات الخصخصة في الخدمات الإنسانية لإلغاء هيمنة الحكومة على أنشطة المنظمة الغير ربحية. من خلال التركيز على نظام تأمين الرعاية الطويلة الأجل (LTCI) ، الذي خصخص الخدمات الإنسانية العامة للمرة الأولى في البلاد ، فإن هذه الدراسة تفحص تجريبيا˝ ما إذا كان ، وإلى أي مدى ، علاقات المنظمات الغير الربحية- الحكومة في اليابان قد تغيرت في الواقع نتيجة لهذا النظام الجديد. بالإضافة إلى ذلك، لأن الرعاية الطويلة الأجل (LTCI) يسمح حديثا˝ لمنظمات الربح أن تقدم خدمات ، وأدرجت تأثير هذه المنظمات في التحليل.تثبت نتائج هذه الدراسة أن الحكومة تستمر في توسيع دائرة نفوذها على المنظمات الغير ربحية و التي تسعى للربح من خلال تأمين الرعاية الطويلة الأجل (LTCI). بالإضافة إلى ذلك، تظهر المنظمات التي تسعى للربح لتكون أكثر نجاحا˝ من المنظمات الغير ربحية، في هذا المنظمات السابقة تغلبت على إفتقارها إلى الخبرة و مقدمي الخدمات العامة من خلال تولي الأدوار التي شغلتها المنظمات الغير الربحية تقليديا˝ .

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Notes

  1. The 2005–2006 revision added a new category, constituting seven categories in total.

  2. Evolutionary theory provides a detailed explanation of the organizational evolution process as a dynamic combination of the ecological and adaptation processes. For example, Aldrich and Ruef (2010) argued that organizational evolution consists of four processes: variation, selection, retention, and struggle for scarce resources. Variation occurs through founding new types of organizations (ecological process) and through the diverging efforts of existing organizations for better problem solving (adaptation process). Selection chooses a dominant organizational form from among the alternatives that best fits a given environment (ecological process). The selected dominant form is retained by the founding of new organizations imitating that form (ecological process) and through existing organizations’ imitation of the selected form as a means of improving survival chances (adaptation process). A common thread throughout variation, selection, and retention is the struggle of organizations over scarce resources (Aldrich and Ruef 2010). Organizations seek variation or imitation of a dominant form to secure access to scarce resources (adaptation process). Organizations are also “selected out” (Hannan and Freeman 1989) by having a paucity of resources (ecological process). Since “variation, selection, retention, and struggle occur simultaneously rather than sequentially” (Aldrich and Ruef 2010, p. ), some existing organizations within a population may imitate a dominant form for retention, whereas other organizations within the same population may diverge for variation. Instead of dissecting these transformations of existing organizations into variation or retention, they are here combined as “adaptation.” This study then examines how selection and adaptation contribute to convergence and divergence between nonprofit and for-profit organizations on the basis of their characteristics.

  3. In 2005, 12.8 % of children in K municipality and 28.3 % in S municipality entered private junior high schools. The percentage of residents who were exempted from tax payment was 11.8 % in K municipality and 6.6 % in S municipality. The percentage of residents who were receiving financial assistance for living was 2.0 % in K municipality and 0.96 % in S municipality (Weekly Post 2006). As of 2010, when comparing the average yearly income per resident among the 23 municipalities in Tokyo prefecture, S municipality was ranked as the 9th wealthiest and K municipality as the 22nd (retrieved on Dec 16, 2013, from http://www16.plala.or.jp/ahoffice/archives/2010/02/entry_189.html).

  4. Seniors who cannot afford additional services often suffer from unmet needs for LTCI services. However, compared to similar systems adopted in other countries, such as Germany and South Korea, LTCI in Japan is still very comprehensive.

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Acknowledgments

I must express my deep appreciation to Professor Chester Proshan for his support, while I was tackling this writing project. I also thank Wenjue Knutsen and Ralph Brower for organizing both the symposium in Kingston, Canada, in 2012, and this special issue project. This article is based on a survey supported by a Grant-In-Aid for Science Research program provided through the Japan Society for the Promotion of Science (Grant ID: 17330127).

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Correspondence to Yuko Suda.

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For the Special Issue: Theoretical Variations for Voluntary Sector Organizing: Topping off Old Bottles with New Wine.

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Suda, Y. Changing Relationships Between Nonprofit and For-profit Human Service Organizations Under the Long-Term Care System in Japan. Voluntas 25, 1235–1261 (2014). https://doi.org/10.1007/s11266-014-9439-0

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