Intermunicipal Collaboration and Multilevel Governance of Community-based Integrated Care Systems in a Rural Area: A Case Study of the Uwajima Area, Ehime Prefecture

A community-based integrated care system established through broad cooperation among municipalities in a rural setting, focusing specifically on Uwajima area, Ehime Prefecture, is investigated. The study adopts the perspective of multilevel governance and finds that the organization of community care conferences and consultative bodies is tailored according to each municipality's distinct features. Uwajima City, having a larger population, implements a three- tiered structure, whereas smaller towns in Uwajima area adopt a simpler, single-tiered model. Long-term care insurance services and rights protection facilities are initiated through extensive intermunicipal collaboration. Thus, the community-based integrated care system in the Uwajima area is established using a multilevel governance approach, involving both horizontal and vertical networks. Within each municipality's vertical network, the overarching governance of the local comprehensive community support center facilitates the scaling of local issues into policy. In contrast, in horizontal networks among municipalities, Uwajima City stands at the core, wielding significant influence. At present, no vertical network between community care conferences and consultative bodies facilitates broad cooperation. However, when vertical networks arise, a new multilevel governance framework is needed. The multilevel governance facet, as described above, is commonly observed in rural areas, where limited local resources available for community-based integrated care systems necessitate intermunicipal cooperation.