A gap in formal long-term care use related to characteristics of caregivers and households, under the public universal system in Japan: 2001-2010

•Formal long-term care (LTC) use has increased under Japan's new public insurance system.•Differences in service use by caregiver's gender remain despite demographic changes.•Differences in use are also linked to household income since the economic crisis.•To improve equality of utilization, the universal LTC system needs to further overcome barriers related to gender norms and economic disparity.

We investigated whether the universal provision of long-term care (LTC) under Japan's public system has equalized its use across households with different socio-economic characteristics, with a special focus on the gender and marital status of primary caregivers, and income. We used repeated cross-sectional data from national household surveys (2001, 2004, 2007, and 2010) and conducted multiple logistic regression analyses to obtain odds ratios of caregiver and household characteristics for service use, adjusting for recipients' characteristics. The results showed that the patterns of service use have been consistently determined by caregivers' gender and marital status over the period despite demographic changes among caregivers. The gap in service use first narrowed, then widened again across income levels after the global economic recession. The results indicate that the traditional gender-bound norms and capacity constraints on households' informal care provision remained influential on decisions over service use, even after the universal provision of formal care. To improve equality of service utilization, the universal LTC system needs to meet diversifying needs of caregivers/recipients and their households, by overcoming barriers related to gender norms and economic disparity.