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Additional file 1: Table S1. Odds ratios of living alone in Japan 1990–2016. Table S2. Odds ratios of living alone in Sweden 1990–2016.

Additional file 2: Additional Table 1. Trends of the proportion of in-hospital deaths, by cause of death and care need levels.

Additional file 1: Additional Figure 1. Trends of the proportion of in-hospital deaths of those in care need levels 1-2 in the month before death (n= 729,847). Additional Figure 2. Trends of the proportion of in-hospital deaths of those in care need levels 3-5 in the month before death (n= 2,190,002). Additional Figure 3. Age-adjusted odds ratios for in-hospital deaths of those living at home in the month before death (n= 1,947,489). Additional Figure 4. Age-adjusted odds ratios for in-hospital deaths of long-term care health facility residents in the month before death (n= 383,522). Additional Figure 5. Age-adjusted odds ratios for in-hospital deaths of long-term care welfare facility residents in the month before death (n= 588,838).

The increase in one-person household (OPHs) in the developed world is often seen as the result of a trend where family solidarity is replaced by individualistic values and behaviours where the Nordic countries have been identified as forerunners in this development. In Asia, countries such as Japan have reached equal levels of economic development but retain elements of a strong family system and exhibit a much more asymmetric gender regime.This study compares the changes in the demographic and socioeconomic composition of OPH women in Sweden and Japan between 1990 and 2016. The probability to be an OPH-household is analysed by means of logistic regression models using microdata covering the entire population in Sweden and the Comprehensive Survey of Living Conditions in Japan.In Sweden, the growth of the female OPH-population has halted and shifted to a decline compared to Japan where it has increased rapidly since the 1990s. The analysis finds increasing similarities between the countries in the age patterns and urban-rural differences while persistent contrast in the impact of women’s socioeconomic status and family history remain salient. The findings provide evidence that the transformation of women’s economic role does not result in an ever-increasing shift towards “less” family. Rather, living arrangements depend on the extent to which gender regime adapts to increased economic self-sufficiency among women. These findings highlight the need for preparedness for continued increases of the OPH population among policy makers in economically developed strong family societies such as Japan.

Additional file 1: Method S1. (Settings detail). Table S1. Upper limits in long-term care insurance (LTCI) coverage for recipients at home by care level before and after the LTCI reform in 2006. Table S2. Effect of the long-term care insurance reform in 2006 on formal and informal care services use: an analysis using the expanded sample. Table S3. Effect of the long-term care insurance reform in 2006 on health outcomes: total sample: an analysis using the expanded sample. Table S4. Effect of the long-term care insurance reform in 2006 on formal and informal care services using samples stratified by gender and age. Table S5. Effect of the long-term care insurance reform in 2006 on health outcomes: stratified by gender and age.

The aim of this chapter is to empirically examine the impact of health problems of the elderly on their own and their household’s income. Using micro panel data from the “Survey on Health and Retirement” focusing on the elderly, we estimate the effect on an individual’s income and his household’s income of the number of illnesses respondents suffered in the three years preceding the survey, of suffering from a lifestyle disease, and of suffering from one of the three major “killer diseases” in Japan (cancer or malignant growth, heart disease, stroke or cerebrovascular disease). In order to deal with endogeneity in the health indicators, we employ survey respondents’ body mass index at age 30 and their parents’ medical history as instruments in the estimation and, when focusing on suffering from at least one of the three killer diseases, use respondents’ body height as an additional instrument. In the estimation, we focus on male survey participants. The results suggest that an additional illness in the preceding years on average significantly reduced individuals’ income. On the other hand, although the estimated coefficients on the effect of lifestyle diseases on individuals’ income or household income were as expected negative, they were insignificant in both cases. Furthermore, when dividing observations into two subsamples ? men under the age of 60 and age 60 and over ? we find that in the case of the under 60s, a deterioration in health on average has no significant effect either on the individuals’ own income or their household income. Likely reasons are that, if at all possible, such individuals will continue to work, or that any decline in income is offset by the spouse starting to work and/or the receipt of insurance payments. On the other hand, for men aged 60 and over, a deterioration in health has a significant impact on their own income, but that on household income is limited. That such individuals’ own income declines is likely due to the fact that they are much more likely to stop working as a result of health problems, while the limited effect on household income may be due to the fact that the share of such individuals’ income in total household income is relatively small.

We observed a remarkable increase in elderly care expenses in Japan after the introduction of public elderly care insurance in 2000. This study explores the possibility that a greater number of care providers under the deregulation of the entry policy stimulated care utilization. We take advantage of an original household-level survey data on care receivers to address the existence of supplier-induced demand in Japan's elderly at-home care market, by distinguishing between demand for care receivers and for suppliers. Our empirical results based on the two-phase model found little evidence of supplier-induced demand in the Japanese at-home care market. We also observed that a higher portion of for-profits did not induce care demand. JEL classification: I11 Key words: supplier-induced demand; at-home care; long-term care insurance; survey on care receivers

Percutaneous Transluminal Coronary Angioplasty, henceforth (PTCA) for patients with acute myocardial infarction (AMI)-a high-tech treatment-is more frequently used in Japan than in other developed countries. This paper adopts the two-phase model to examine whether the high PTCA use is driven by the self-interest of physicians, or by behavioral character. After controlling for a patient's detailed characteristics, we found that increases in the relative numbers of hospitals and physicians are significantly related to physician-initiated expenditures and the effect is higher for high-tech treatments. The results based on municipal-level aggregated data also support this conclusion. JEL classification: I11 Key words: health care in Japan; physician-induced demand; patient initiated choices; two-phases model; acute myocardial infarction (AMI); Tokai Acute Myocardial Infarction Study (TAMIS)

This is a revision of our previous paper (Shimizutani and Noguchi (2002) ESRI Discussion Paper Series No.60) based on a new dataset extended to 2003. This study takes advantage of micro-level information to make a projection of demand for at-home care services in Japan. We have observed a rapid increase in demand for long-term care services after 2001, a large part of which came from an increase in demand for at-home care services. Thus, an estimation of future at-home care should be useful for predicting trends in the long-term care market and be an important base for policy planning. The increase in demand for at-home care comes from four main areas: (1) the change in the number of those who need care, (2) the share of those with requirement certification, (3) the share of those who actually receive any type of care services, and (4) the cost of care per an eligible person. As discussed in the previous study, we utilize our unique survey on households with a care receiver to estimate (2), (3), and (4). Our empirical results report that the projection is slightly revised upwardly due to a higher share of the elderly to receive requirement certification. Our projection reports that the amount of at-home care demand in 2010 will be 3.6 trillion yen, or that will increase to 5.2 trillion yen in 2025. Our results demonstrate a rapid increase in at-home care services in the near future. We should seriously consider institutional reform in the public LTC insurance industry to provide sufficient services with higher quality under severe budget constraints.

It is not well known that Okinawa suffers from a severe shortage of child care services, even among non-urban areas in Japan. This study is the first micro-level examination of wage determinants of child care workers in Okinawa. We focus especially on two issues, which motivate us to draw important policy implications. (1) The wage-age profile for regular workers in public centers is very steep, while that for workers in private and licensed centers has not yet been revealed. What accounts for the difference, if any, in the profiles except for regular workers in public facilities? Is the difference in the steepness justified by human capital theory? We could draw a strategy to improve efficiency in licensed centers, which are dominant in Japan. (2) The wage determinants for workers in non-licensed centers have not been uncovered . Is the nonprofit wage premium observed between private-licensed (nonprofit) and non-licensed (for-profit)? Thus, we obtain a clue for the entry policy for for-profits. First, our empirical findings demonstrate that the wage-age profile in private and licensed centers is much less steep than that in public centers, which is applicable for general officials. However, even in the public facilities, the profiles have different steepnesses between regular and non-regular workers despite the fact that there is no natural distinction in jobs. Thus, we cannot justify the steep wage curve for regular workers in public centers. Second, we observe a nonprofit wage premium between private-licensed and non-licensed centers. Difference in management, rather than any factors associated with human capital, contributes to widen the wage differentials. In sum, though we observe large wage differentials in child care workers by type of management, the determinants are not necessarily associated with human capital, which casts doubt on the differences that could be explained by those in quality of child care.

This is the first study to take advantage of Japan's public long-term care insurance as a unique and natural experiment to evaluate how outsourcing long-term care spurs female labor supply. We utilize our unusual and rich panel data from households with an elderly person who needs care and who became eligible to use care services through the public insurance after 2000, and those who are not eligible to use care service. Our empirical results based on the difference-in-difference estimates demonstrate that the stimulating effect of the public elderly care insurance on female labor supply was observed only for households with a less-needy care receiver in care-level 1 in FY 2001, one and a half years after the initiation. However, we clearly find a large and positive effect on the female labor supply in households in FY 2002, two and a half years after the implementation. The new public scheme enhanced the probability of being employed by 30 percent to 60 percent, working days per week by 40 percent to 60 percent and working hours per day by 50 percent to 70 percent.

An increase in female labor force participation is indispensable to maintain sustainable economic growth in Japan, whose population is experiencing rapid aging and a decline in fertility. One remedy to these problems that is often proposed to be effective in stimulating the female labor supply is the provision of sufficient child care services. Surprisingly, however, there has been little micro-level empirical research in Japan on the relationship between child care provision and female labor supply. This study addresses this topic by taking advantage of a unique micro-level data set from households with children under age five in the metropolitan area around Tokyo. Our empirical results demonstrate that labor supply elasticity with respect to parents' payments for child care is estimated to be -0.2. Moreover, the elasticity of labor supply with respect to mother's wage rate is high at 1.4. On the top of these factors, female labor supply is stimulated by provision of child care leave, flexible or short working hours, and child care in the workplace. Our findings imply that a larger amount of labor supply is observed for females with higher wage rates and thus higher productivity, and that sufficient provision of child care services is an effective instrument to increase the labor supply of those female workers. Moreover, price policy for child care and welfare policy for the workplace are also significant aspects of female labor supply.

Due to rapid aging of the country's citizens, Japan faces an enormous long-term care future demand. To control care demand and maintain the current long-term care insurance, policies should be based on price and income elasticities obtained from empirical studies in Japan. This study is meant to provide valuable information that should be incorporated into actual policy-making; it aims to prevent a catastrophe due to explosion of care demand. In the paper we focus on estimating price and income elasticities of at-home care demand, which has been growing rapidly. To address these issues, this study adopts a contingent valuation method (CVM) and an estimate based on actual care demand, reflecting a unique micro-level survey data collected in 2001 and 2002 on households with a care-receiver. Our empirical results show the following.(1) According to our results based on the CVM, estimates on price elasticity of home-help services, day care / day services and short-stay services range from -0.2 to -0.4. On the contrary, estimates on income elasticity are insignificant in most cases.(2) The results based on actual care demand in the same sample show that price elasticity of home-help services is estimated to be -0.4, which is consistent with that obtained from the CVM. The magnitude of coefficients is also comparable with those in the CVM estimates, though they are not statistically significant. Estimates on income elasticities are not consistent with those in the CVM results. In sum, price elasticity of at-home care is estimated to be -0.2 to -0.4, which are reliable. On the contrary, the significance of income elasticity is ambiguous, but the magnitude is not large, despite its estimated significance in some cases. Those results demonstrate that price policy is extremely important in Japan's long-term care market; policy-makers should keep in mind those orders of price elasticity. Moreover, based on low income elasticity, policies should also address the demands of lower-income households.

The main object of this study is to investigate how treatment patterns and patient outcomes vary among medical facilities in Japan. We take advantage of a unique survey on 3,502 patients with acute myocardial infarction treated by PTCA (Percutaneous Transluminal Coronary Angioplasty) in 2003. The data include 50 medical facilities in collaboration with the CAMPAIGN Study as well as National Cost Database on Patients Treated by PTCA, collected by the Japanese Society of Interventional Cardiology (JSIC). These facilities are high-volume hospitals that hold both physical and human resources rich enough to perform high-tech treatments. We adopt the GMM (General Method of Moment) approach, using hospital-level variation in treatment intensity as an instrumental variable. Our estimates suggest that there is substantial variation in both treatment patterns and patient outcomes such as mortality rates, medical expenditures, and length of stay, even though medical facilities in the data are relatively homogeneous from structural points of view, such as physical and human capital. First, hospitals that use one drug treatment on admission aggressively tend to be aggressive on other drug treatments as well, both on admission and at discharge. Second, hospitals that perform PTCA aggressively tend to use fewer drug treatments. Third, the longer the time period after hospitalization, the larger the standard deviation in mortality rates across hospitals tends to be. Our results, however, show that the variation in treatment patterns across medical facilities does not influence mortality rates and medical expenditure, though stent use tends to shorten patient length of stay.

Japanese households in urban areas have suffered from a shortage of child care supply, especially for children age 0 to 2. Moreover, the bottleneck of child care is expected to grow more severe, due to a hike in demand for child care accompanied by an increase in female labor supply. This study is meant to provide valuable information that should be incorporated into price policy that must deal with the bottleneck of child care demand by estimating the price elasticity of child care demand and the potential amount of demand and by applying welfare analysis. To address these issues, this study adopts a contingent valuation method (CVM) to a unique micro-level survey data on households with children under six collected in 2002. Our empirical results show the following.(1) Given the current child care payment (the average is 30,000 yen per month in our survey), the potential demand of child care is estimated to be 269,000 in Tokyo, Kanagawa, Saitama, and Chiba. This amount is many times larger than the official number of people on waiting lists (14,000), and suggests a large portion of excess demand.(2) The estimated price elasticity is high at 2.0, which implies that price policy works to control excess demand. The estimated equilibrium price to clear the market is about 42,000 yen, or 40 percent larger than the average (30,000 yen).(3) The estimated amount of consumer surplus is 114 billion yen per year in the four prefectures, which is overwhelmed by that of dead weight loss, which is estimated to be 356 billion yen.

Like other developed countries, Japan currently has been experiencing a rapid increase in medical care costs. It is one of imperative interests for the government to find an effective way of balancing the quality and costs of medical care. As of 2003, the Economic and Social Research Institute (ESRI) of Cabinet Office has started a research project collecting a micro-level data on the national health separately by major disease such as heart attacks, strokes, and cancers. This project aims to look into the public health system to implement results based on micro-level empirical studies on the relation between the quality and costs of medical care. On the first stage of the project, we create the database on patients with acute myocardial infarction (AMI). In particular, we focus on effects of a major high-tech treatment - percutaneous transluminal coronary angioplasty (PTCA) on patient outcomes and medical costs, which have been examined by a number of previous studies in the United States. This discussion paper serves as user's manual to provide several findings from a basic statistics of the micro-level database on AMI. This paper informs users several key issues including background information on data collection, data structure, and definitions of key variables. The ESRI plans to make the electronic database available to the public on the website in the near future. This paper consists of two parts. Part 1 describes the public health plans conducted by the CMS (Center for Medicare and Medicaid Services) and a number of previous studies in the United States, in order to emphasize the importance of implementing results of empirical tests into the actual public policy. Part 2 is the user's manual and discusses a major statistical issue when using observational data to measure the quality of care-heterogeneity. We compare basic statistics of data on AMI patients in Japan, the United States and China. Due to serious heterogeneity problem in observational data, we have to control for various risks in order for measuring treatment effects on patient outcomes and costs correctly. Besides, the technological innovations in medical care are so rapid and complex that it is difficult to evaluate treatment effects. Therefore, as future agenda, it matters that nation-wide micro-level data including detailed chart-based information would be available not only for AMI but also other diseases which contribute to increase medical costs in Japan enormously.

This study takes advantage of micro-level information to make a projection of demand for at-home care services in Japan. We have observed a rapid increase in demand for long-term care services after 2001, a large part of which came from an increase in demand for at-home care services. Thus, an estimation of future at-home care should be useful for predicting trends in the long-term care market and be an important base for policy planning. The increase in demand for at-home care comes from four main areas: (1) the change in the number of those who need care, (2) the share of those with requirement certification, (3) the share of those who actually receive any type of care services, and (4) the cost of care per an eligible person. We utilize our unique survey on households with a care receiver to estimate (2), (3), and (4). Our empirical results report that the share of those who receive requirement certification out of all who need care will be close to 100 percent in 2005. Moreover, a longer period after receiving certification will stimulate the share of care receivers who really use care services through insurance and cost of care per person. Based on those estimates, our projection reports that the amount of at-home care demand in 2010 will be 3.4 trillion yen, or about 2.6 times as large as that in 2002. Our results demonstrate a rapid increase in at-home care services in the near future. We should seriously consider institutional reform in the public LTC insurance industry to provide sufficient services with higher quality under severe budget constraints.

This study is a comprehensive empirical assessment on the quality of child care in Japan. Especially we focus on the comparison of quality of services between public and private centers to investigate higher wage costs in public centers could be justified by higher quality of care. Since no single index is entitled to stand for the quality of child care, we adopt three different approaches to measure quality. We take advantage of some unique survey data, which contains the largest sample size and the highest quality currently available in Japan. The "test score" approach uses several indexes to evaluate the quality and to compare the total scores by different management. We observe that public centers have higher scores in the structural index to stand for labor or capital inputs. However, this is not the case for developmental psychological index, parents' convenience index and other index. The "quality of workers" approach adjusts for the non-random allocation of workers to measure the quality of child care closely related with the quality of employees. The results based on the treatment effect model demonstrate that the share of regular or qualified workers and the number of children per worker is better in private-licensed centers than it is in public centers, and thus provide higher quality of services than do the public centers. In other words, the superiority measured by the structural index in public centers disappears after controlling selection bias. The "users' request" approach utilizes the survey on child care users for evaluating the services currently being offered and demanded in future. Private-licensed centers provide higher quality regarding parents' convenience and additional care such as extra hours of care and holiday care. Thus, the findings are consistent with the "quality of workers" approach in that the quality is better in private-licensed centers. These results demonstrate that private licensed centers are more likely to provide higher quality of services than public centers and higher wage rates in public facilities cannot be justified.

This is the first study that uses facility-level data to evaluate the cost efficiency of the child care market in Japan after controlling for quality of services. Japanese households in urban areas suffer from a severe undersupply of child care, and inefficient operation in public centers is allegedly responsible for the bottleneck. We take advantage of our unique and unusually rich data set on Japan's child care centers collected in summer 2002. We estimate quality-adjusted cost functions to compare the efficiency between public and private licensed facilities. Our findings demonstrate that public centers are more inefficient than private facilities by 10 to 20 percent. Moreover, government subsidies contribute to the inefficiency in public centers. These findings suggest that efficiency improvements in public-owned centers and reduction of subsidies are indispensable for the breakthrough of the bottleneck of the child care supply in Japan.

This paper investigates nonprofit wage premiums in Japan's child care labor market, an area that has not yet been studied. We take advantage of a unique, large, and high-quality data set on child care workers collected in the summer 2002 to evaluate nonprofit wage premiums after controlling for selection bias and various characteristics of employers and employees. Our findings demonstrate that wage premiums in the nonprofit sector relative to subsidized for-profit centers were clearly observed in Japan's child care industry; the estimated hourly wage differential is 28.3 percentage points (398 yen in real value), even after controlling for differences in subsidies for each area and facility. Second, nonprofit firms are more likely to value workers with respect to age, market experience, education, qualifications, and the size of firms than are subsidized for-profit firms. Third, more experienced workers with higher levels of education and qualifications, who therefore may provide higher quality of care, tend to choose working in nonprofit centers because they are more likely to be valued in the not-for-profit sector compared to the proprietary sector. Fourth, significant amounts of nonprofit wage premiums in the child care market are most likely to be caused by the high value on not-for-profit workers rather than on the presence of a larger number of workers who have unmeasurable comparative advantage in the nonprofit sector. To improve the efficiency of child care management and break through the bottleneck of child care supply, therefore, the policy should shed light on the lavish and inefficient rate of return to workers in the not-for-profit sector.

This study is the first comprehensive empirical assessment on wage determinants of child care workers in Japan. In particular, this paper focuses on the sectoral wage differentials among publicly owned and licensed private facilities and the wage-age profile among different types of management. To address these topics, we take advantage of a unique, large, and high-quality employer-employee matched survey data set on child care workers collected in the summer 2002. We present four major empirical findings. First, we found adjusted hourly waged are higher at public centers by 19.3 percentage points (355 yen in real value) compared to the private centers. Second, regular workers who are male, older, more experienced, and who have higher degrees of education and qualifications tend to have higher wages, while a similar profile is not significantly correlated with non-regular workers' wage rates. Thus, we can conclude that the age and experience wage profile for regular workers in the child care market strongly reflects the seniority system in Japan. At the same time, differences in the wage-age profile could not be attributed wholly to differences in types of management. Third, the rates of increases in return for workers' human capitals are diminishing much faster in private centers than the ones in public facilities. The magnitudes of diminishing rates in the public sector are negligible, while the diminishing rates in private facilities are not insignificant. Finally, employment status also has a large effect on the wage profile. Both regular and non-regular employees with long hours of work enjoy enormously higher wages than non-regular workers with shorter work hours. The result might be partially accounted for by the implications of human capital such that they are valued for regular workers, but not appreciated for non-regular workers in the labor market. We conclude that much higher wage levels and steeper age-wage profile in public centers cannot be justified unless such high costs are closely related with higher quality of care in the public sector. That might not be the case, however, since we observe smaller differences in the age profile for non-regular workers in both sectors.

This paper uses a unique census data on Japanese nursing homes to evaluate the determinants of nursing home exit and the price elasticity of the institutional care. We take two approaches to address these by making use of micro-level data from Kaigo Service Shisetsu Zigyousho Chousa (Survey on Care Service Providers) conducted by the Ministry of Health, Labor and Welfare in September 2000. First, we use probit estimates to examine the choice decision to exit a nursing facility to home by making use of clients who left their facilities in September 2000. Our results show that one percentage point increase in self-burden to use institutional care will lead to an increase in probability to return to home by 0.04 percentage points for long-term care welfare facilities, 3.7 percentage points for long-term care health facilities, respectively. On the contrary, the price elasticity with respect to exit to re-hospitalization is minus 3.3 percentage points (health care facility) and minus 1.9 percentage points (medical care facility). These results suggest that at-home care is a substitute for institutional care but care services in medical institution are complement for services at nursing homes. Especially, the elderly with relatively lower care levels and thus higher self-burden to use long-term care tends to be re-hospitalized if they do not have any family members to live together. Therefore, policies to address deduction of the "socially hospitalized" elderly should focus on these types of the elderly. Then, we apply a duration model to the sample that consists of all clients who stayed in or left from a nursing home in September 2000 in order to evaluate the price effect on how long a client stays in a nursing home. Our results report that price elasticity with respect to duration staying in nursing homes is 1.7 percentage points (95% confidence interval: 0.4-3.0 percentage points) for long-term care welfare facilities; and 1.8 percentage points (95% confidence interval: 0.0-3.8 percentage points) for health facilities. Our findings demonstrate that price policy might be useful for allocating clients from institutional care to at-home care, though the effect is relatively small for long-term care welfare facilities compared to health facilities.

PART I : Are Nonprofit Earnings Differentials Observed in Japan? Evidence from Micro-level Data in Japanese Nursing Homes This research is the first empirical assessment on the wage differentials between the nonprofit sector and profit sector in Japanese nursing homes, and makes use of the Jigyosho Ni Okeru Kaigo Rodo Jittai Chosa (Statistical Survey on Nursing Home Employees) conducted by the Care Worker Support Center Foundation (Kaigo Roudou Antei Center) in September 2000. Theoretically, those who support nonprofit wage premium emphasize the asymmetry of information frequently observed in services sectors and "non-distributional constraint" in the nonprofit enterprises while those who argue that nonprofit wage is lower than for-profit counterparts believe in the voluntary and altruistic characteristics of employees in the nonprofit sectors. Previous studies on the nonprofit premium in the U.S. are inconclusive. We present three major empirical findings. First, our empirical results support to confirm that there is nonprofit wage premium in the long-term care labor market in Japan before and after controlling for nonrandom unobserved self-selection bias. Second, nonprofit firms are more likely to value workers with respect to age as a proxy of market experience and the qualifications as proxies of education than for-profit firms. Third, the long-term care market is segregated between for-profit and not-for-profit facilities in Japan as a consequence of the presence of comparative advantage on workers' self-allocation procedure. More experienced workers with higher level of education, therefore who may provide the higher quality of care, tend to choose working in nonprofit homes because they are more likely to be valued in the not-for-profit sector than the proprietary sector. PART II : Quality Differentials in For-Profit versus Nonprofit Long-Term Care: Evidence from Japanese Micro-level Data This paper aims to evaluate the quality differentials between nonprofit sectors and profit sectors in Japan's long-term care industry by making use of the Jigyosho Ni Okeru Kaigo Rodo Jittai Chosa (Statistical Survey on Nursing Home Employees) conducted by the Care Worker Support Center Foundation (Kaigo Roudou Antei Center) in September 2000. We investigate the difference in the quality of services represented by workers' skills (share of qualified workers and provision of professional training), worker's status (share of regular workers) and stable service supply (job stability and future labor demand) by type of management (for-profit versus nonprofit), which are associated with quality of services. We use the treatment effect model to assess the quality differentials after controlling for various characteristics of each affiliate as well as adjusting for "treatment" effects such as wage rates and non-wage benefits to address the possible selection bias. Our estimates report that nonprofit enterprises are obviously advantageous in stable service supply and the quality of employees associated with the quality of products are not in favor of for-profit facilities. Therefore, our findings demonstrate that for-profit nursing homes, which were allowed to enter the long-term care market after 2000, have not yet been able to catch up with their nonprofit counterparts, which are still dominant in the long-term care industry.