ObjectivesContinuity of care is a core dimension of primary care, and better continuity is associated with better patient outcomes. Therefore, care fragmentation can be an indicator to assess the quality of primary care, especially in countries without formal gatekeeping system, such as Japan. Thus, this study aimed to describe care fragmentation among older adults in an ageing city in Japan.DesignCross-sectional study.SettingThe most populated basic municipality in Japan.ParticipantsOlder adults aged 75 years and older.InterventionsThis study used a health claims database, including older adults who visited medical facilities at least four times a year in an urban city in Japan. The Fragmentation of Care Index (FCI) was used as an indicator of fragmentation. The FCI was developed from the Continuity of Care Index and is based on the total number of visits, different institutions visited and proportion of visits to each institution. We employed Tobit regression analysis to examine the association between the FCI and age, sex, type of insurance and most frequently visited facility.ResultsThe total number of participants was 413 600. The median age of the study population was 81 years, and 41.6% were men. The study population visited an average of 3.42 clinics/hospitals, and the maximum number of visited institutions was 20. The proportion of patients with FCI >0 was 85.0%, with a mean of 0.583. Multivariable analysis showed that patients receiving public assistance had a lower FCI compared with patients not receiving public assistance, with a coefficient of 0.137.ConclusionsTo our knowledge, this is the first study to demonstrate care fragmentation in Japan. Over 80% of the participants visited two or more medical facilities, and their mean FCI was 0.583. The FCI could be a basic indicator for assessing the quality of primary care.

PurposeThis study aims to provide evidence of how budget officers use non-financial and accrual-based cost information in the budgeting process and how the usage of this information is influenced by financial constraints.Design/methodology/approachA randomized survey-based field experiment investigating budget officers in 546 Japanese local governments (LGs) was conducted. This allowed us to identify the budget officers' decision-making in the public sector budgeting process by creating and analyzing primary data with regression models.FindingsWe found that budget officers suppress budget amounts based on non-financial information of good performances. Under fiscal constraints, officers further reduce budget amounts using information on high accrual-based costs and poor non-financial performance.Originality/valueOur survey-based field experiment allowed us to obtain primary data from officers making budget decisions. To the best of our knowledge, this study provides the first evidence that non-financial good and poor performance information and accrual-based cost information affect budget officers' decision-making under financial constrain.

Aim Urbanization and ageing are worldwide issues for healthcare providers. In particular, older adults aged 90 years and older have increased cognitive impairment and lower daily functioning than younger adults. However, the healthcare use of the oldest old remains unclear. This study aimed to describe the healthcare use of the oldest old compared with younger older adults in a city using the ecology of medical care model. Methods We conducted a cross‐sectional study. This study targeted all residents aged 75 years and older registered in a city in Japan for one year. We described healthcare use per 1000 inhabitants over a 1‐month period and included: outpatient visits, emergency department visits, hospitalizations, home visits, home care services, and facility services. We also compared healthcare use among older adults aged 75–89 years and 90 years and older. Results We described the healthcare use of 454 366 (male/female: 186 177/268 189) older adults. The numbers of persons per 1000 residents who used healthcare resources at least once in 1 month (75–89 years/90 years and older) were: outpatient clinic visits, 622/570; hospital outpatient visits, 300/263; advanced treatment hospital outpatient visits, 16/6; emergency department visits, 10/27; hospitalizations, 45/96; advanced treatment hospital hospitalizations, 2/1; planned home visits, 36/228; urgent home visits, 6/38; home care services, 173/533; and facility services, 32/178. Conclusions The results revealed that older adults over 90 years had more hospitalizations, emergency department visits and home visits, and used facility/home care services more compared with older adults aged 75–89 years. The results provide a useful benchmark for healthcare use estimation. Geriatr Gerontol Int 2022; 22: 483–489.

Accompanying the spread of “new public management” since the 1980s, accrual accounting and results-based management has become a global standard. However, whether accrual accounting results in successful outcomes and which drivers lead to the intended impacts of the reform have been contested. Given the mixed arguments in the literature, we set out two research questions: (1) “Have public sector organizations realized any positive impacts on management practices by adopting mandatory accrual accounting?”; and (2) “What are the primary drivers of such impacts?” To answer these questions, we examine the impact on management practices by analyzing a survey to ascertain how financial department officers in Japanese local governments perceive the benefits of adopting mandatory accrual accounting on management practices. The results indicate that they have so far not recognized the intended benefits, though they had expected higher benefits in internal control. Then, we use technical-rational, socio-political, and institutional isomorphic perspectives in a comprehensive approach to understand the impacts on management practices. The logistic analysis shows that financial managers in local governments that do not have a majority party in the assembly, but consist of several parties in power, as well as in those with greater financial dependence on the central government, perceive higher benefits. Further, we find that financial managers that imitate other local governments as a form of mimetic pressure perceive fewer benefits. The results show that some technical-rational tools, socio-political conditions, and institutional pressures change the perceived benefits for public managers of adopting mandatory accrual accounting. Points for practitioners We find that some technical-rational, socio-political, and institutional factors explain the intended internal benefits of the mandatory adoption of accrual accounting. In practice, financial managers in local government feel the merits of accrual accounting in less autonomy in not only politics, but also finance, and few mimetic conditions. It might be understood that difficult situations would drive practitioners to use mandatory information.

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