A new type of agency presented in this study is the
psychiatric-centered agency. The characteristics of this
type include ownership by a hospital, majority of psychiatric
patients, a high ratio of patients with medical insurance,
and a low ratio of emergency and 24-hour services.
Although the reimbursement structure of home-visit
nursing agencies for psychiatric patients was reviewed in
the revision of medical treatment fees in 2012 [14], there
is still insufficient information about the service delivery
system by these psychiatric-centered agencies and more
precise investigation will be needed.
Lastly, we identified the rural-centered type, making
up the largest group of home-visit nursing agencies
relative to population. To date, payment for home-visit
nursing services has been uniform nationwide, with a
base cost that is determined on a per-hour basis for
long-term care insurance and a per-number-of-times
basis for medical insurance. Comparing differences in
regional characteristics, medical fees for home-visit
nursing in certain regions, such as intermountain regions
and isolated islands, are considered additional services
(“additions”) [3]. However, rural-centered agencies
although accounting for approximately 45% of all agencies
in this study, were not localized in underpopulated
areas, such as the aforementioned isolated islands and
intermountain regions; their average population density
is 808 persons/km2 (e.g., Tsukuba City in Ibaraki Prefecture,
Choshi City in Chiba Prefecture, Hachinohe City
in Aomori Prefecture, and Munakata City in Fukuoka
Prefecture, population density: approximately 800 persons/
km2). The home-visit nursing agencies in these regions
that provided services with disregards to their
financial performance tended to be unprofitable. In the future, an appropriate payment system to support the
agencies of this type should be considered.