Several areas were indicated when inequity may affect
access to nurse visiting services for those elderly who need it
most [21]. Elderly who live alone or utilize non-government
services may be more vulnerable than those who have
caregivers who are family members or home help. Home
visit nursing services’ use fell where the individual either
lived alone, used a corporate type of care management
agency or relied on the services of a non-medical care
management agency to create a service plan [21]. Access to
home visit nursing services was also found to be better
facilitated when the elderly have family caregivers or home
help, compared to those who depend on care management
agencies alone. In addition, the findings also suggest that
Japan’s long-term care insurance system may be limiting the
use of visiting nursing services by low-income earners with
higher care needs. Nurses have a key role to play in
addressing health inequities. This can involve targeting
screening for vulnerable patients, working in partnership
with other members of health and social care organisations,
engaging local people and groups, in public health awareness
and action and utilising public health evidence in everyday
practice, not just evidence for treating illness [33]. However,
the provision of universal health care must be considered
within a health system approach [34] where financing and
governance issues are considered alongside workforce ones.
To encourage equity in the delivery of health services, Japanese
policy makers will need to reconsider the present
provision of home-visit nursing services.