Resumen
Managing the cost of the long term care service is critically important to provide the better service to the aged people in the hyper-aged society. In such management, we need to be sensitive in keeping the necessary services in cutting the cost. Therefore, identifying what determines the aged people's service user is necessary. Mobility would be one of the keys to the decision making in choosing the service, because most of the nursing care service is related to the transportation: Nursing service offers not only facility care services but home nursing care including shopping assistance. In this study, we investigated the relationship between the transportation environment and the use of the service. We focused on those who do not use nursing service, despite the certification of the long-term care, in order to find why they do not use. We analyzed what led one to use or not use the nursing care service by using multilevel logistic regression analysis, because it allowed us to consider the difference of the error structure. We applied the model to the data of a local city in Japan. The result shows that some variables indicating accessibility significantly affected one's decision whether one uses the service or not. The accessibilities of car to clinic, hospital and neighborhood shops significantly affected the decision, while only the accessibility to the hospital was significant when one uses public transport. More than 50 percent of the aged people use motorcars to travel in this city, and this might be why more number of the accessibility by using the car significantly affected the nursing service use. We might be able to manage the cost of service use more effectively and efficiently through the accessibility improvement.