Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Administration


Douglas A. Wolf


Germany, Japan, Korea, long term care, policy effect, subjective wellbeing

Subject Categories

Social and Behavioral Sciences


Industrialized societies face unprecedented growth of their aging populations, and therefore a drastically increasing need for long-term care (LTC). Unlike acute care LTC continues for a long time-usually at least six months-and recipients of LTC do not know how long or how intensively they will need physical help with activities of daily living such as eating, dressing, and bathing and instrumental activities of daily living such as shopping, housekeeping and preparing food.

Germany, Japan, and Korea, after recognizing the limitations of existing social assistance programs and national health insurance systems, each took a social insurance approach and created a dedicated fund for financing LTC. The long-term care insurance (LTCI) of the three countries aims to help people who need LTC and their families, while prioritizing home and community care over institutional care. Still, there are differences in the approaches taken by the three countries. German LTCI uses various incentives to maximize family care. For example, German LTCI pays a pension premium to the family caregiver of a home-care beneficiary's choice and the cost of employing a substitute formal caregiver when the family caregiver leaves on vacation. The Japanese and Korean LTCI lack this kind of direct support for family caregivers, providing benefits in the form of services instead of cash.

This study focuses on two research questions: (a) Did the introduction of the social LTCI improve the subjective well-being (SWB) of the LTC needy and their families in Germany, Japan, and Korea? (b) How did those effects on SWB change over time? This research is motivated by academic curiosity about whether the policies in question affected the well-being of the target groups in a positive way as intended. To pursue these research questions I took a regression-based approach employing secondary data from each country. Though one could argue whether SWB should be used as an official evaluative measure, I have chosen to look at SWB because the policies of the three countries are intended to improve it. I have used various satisfaction measures, including life satisfaction, to operationalize the SWB concept in the research.

Generally, social LTCI affected the SWB of the LTC needy positively-or at least non-negatively-immediately after program implementation in all three countries. The positive response of the LTC needy only lasted three or four years after LTCI implementation in Germany and Korea. Neither positive nor negative effects of LTCI on the LTC needy were observed in Japan. The effect on families of people needing LTC was quite different. German families of the LTC needy reported improved well-being in the post-LTCI period, especially in terms of income. Meanwhile, the well-being of Korean families did not show any differences after LTCI implementation. Due to the data limitation, the effect of LTCI on the Japanese families of the LTC needy was not investigated in this research. Different responses of families of the LTC needy seem to be related to the different designs of LTCI policies in each country, especially whether they incentivized family care. This research could help inform decisions about when and how these policies need to be revised in order to maintain a positive influence on the well-being of the target groups.

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