NursingWave: entry, exit, and market concentration of home-visit nursing providers across Japan's secondary medical zones, 2020–2026

Kunihisa Ohno
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Kunihisa Ohno: NPO Intensive Care Collaboration Network (ICON)

No r5y7m_v1, SocArXiv from Center for Open Science

Abstract: Background: Japan's home-visit nursing workforce faces the most acute shortage of any nursing field, and national policy deliberations moved in July 2026 from prefecture-level to secondary-medical-zone-level data. Existing evidence, however, consists of static cross-sections; the dynamics of the provider market have never been measured at zone level. Methods: We constructed a semiannual panel of all home-visit nursing providers listed in the national long-term care information disclosure registry across 12 waves (December 2020 to June 2026), linked providers by insurance provider number, and assigned them to 330 secondary medical zones using a bitemporal municipality-to-zone crosswalk. We computed supply density per population aged 75+, cumulative entry/exit rates, turnover, corporate-group market concentration (HHI), and physician-issued home-visit nursing instructions (NDB item C007) per zone, with Theil decomposition of inequality. All sources are open data; the dataset, code, and an interactive viewer are released under CC BY 4.0. Results: Providers grew 41.5% nationally (13,032 to 18,436), with designated stations up 48.4% and deemed medical institutions down 16.7%. Yet 43 of 330 zones (13.0%) experienced net decline, concentrated in small zones (24.3% of zones with <25,000 residents aged 75+ vs. 1.7% of large zones), which also showed 12-fold higher market concentration (median HHI 0.125 vs. 0.010). Within-prefecture disparities accounted for 38.4% of total inequality. Same-name re-registrations explained only 2.1% of 5,729 observed exits. Conclusions: Behind aggregate growth, small zones face a triple disadvantage — lower density, net provider retreat, and single-provider dependence — invisible in prefecture statistics. Zone-level dynamic monitoring is feasible with open data alone.

Date: 2026-08-20
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Persistent link: https://EconPapers.repec.org/RePEc:osf:socarx:r5y7m_v1

DOI: 10.31235/osf.io/r5y7m_v1

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