Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records

PLOS ONE, Nov 2019

Background The population is aging rapidly in many developed countries. Such countries need to respond to the growing demand and expanding costs of healthcare (HC) for the elderly. Therefore, it is important to investigate the factors correlating such HC costs. In Japan, HC is composed of two sections, namely medical care (MC) and long-term care (LTC). While many studies have examined MC and LTC costs on their own, few studies have conducted comprehensive investigations of HC costs. The aim of this study is to examine the risk factors that influence HC costs for the elderly who enroll in the LTC insurance system in Japan. Methods The inclusion criteria in the present study are as follows: being 65 years of age, or older; certified eligibility for, and use of services offered by the LTC insurance system at home or in an institutional setting in December 2009; and being covered by the National Health Insurance (NHI) system. MC and LTC insurance data were obtained from claim records for the elderly in July and December of 2007, 2008, and 2009 (i.e., a total of six survey points). Panel data, per subject, were constructed using MC and LTC claim records. The sample included 810 subjects and 4029 observations. Results We estimated a regression equation with a censored dependent variable using a Tobit model. Significant associations between MC or LTC costs and interaction terms (household composition × seasonal effects) were investigated. MC costs significantly decreased and LTC costs significantly increased among subjects living alone during winter. Income level was also a positive determinant of MC costs, while eligibility level was a positive determinant of LTC costs. Conclusions We recommend that the health policy for the elderly focus more on seasonal effects, household composition, and income level, as well as on eligibility level.

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Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records

May Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records Naomi Akiyama 0 1 2 Takeru Shiroiwa 0 2 Takashi Fukuda 0 2 Sachiyo Murashima 0 2 Kenshi Hayashida 0 2 0 Data Availability Statement: To protect participant privacy, public data sharing has been restricted by the Ethics Committee of the University of Tokyo and the government administration of City A. Qualified researchers may request data access by med.ac.jp 1 Iwate Medical University, School of Nursing, Iwate, Japan, 2 Department of Health and Welfare Services, National Institute of Public Health , Wako, Saitama , Japan , 3 Nursing and Health Sciences, Oita University , Oita, Oita , Japan , 4 Department of Medical Informatics and Management, University Hospital, University of Occupational and Environmental Health , Kitakyushu, Fukuoka , Japan 2 Editor: Iratxe Puebla, Public Library of Science , UNITED KINGDOM The population is aging rapidly in many developed countries. Such countries need to respond to the growing demand and expanding costs of healthcare (HC) for the elderly. Therefore, it is important to investigate the factors correlating such HC costs. In Japan, HC is composed of two sections, namely medical care (MC) and long-term care (LTC). While many studies have examined MC and LTC costs on their own, few studies have conducted comprehensive investigations of HC costs. The aim of this study is to examine the risk factors that influence HC costs for the elderly who enroll in the LTC insurance system in Japan. Background Methods Results The inclusion criteria in the present study are as follows: being 65 years of age, or older; certified eligibility for, and use of services offered by the LTC insurance system at home or in an institutional setting in December 2009; and being covered by the National Health Insurance (NHI) system. MC and LTC insurance data were obtained from claim records for the elderly in July and December of 2007, 2008, and 2009 (i.e., a total of six survey points). Panel data, per subject, were constructed using MC and LTC claim records. The sample included 810 subjects and 4029 observations. We estimated a regression equation with a censored dependent variable using a Tobit model. Significant associations between MC or LTC costs and interaction terms (household composition × seasonal effects) were investigated. MC costs significantly decreased and LTC costs significantly increased among subjects living alone during winter. Income level was also a positive determinant of MC costs, while eligibility level was a positive determinant of LTC costs. design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: NA received funding from Pfizer Health Research Foundation. The Pfizer Health Research Foundation is a separate organization from Pfizer Pharmaceutical. This does not alter adherence to PLOS ONE policies on sharing data and materials. Conclusions We recommend that the health policy for the elderly focus more on seasonal effects, household composition, and income level, as well as on eligibility level. Introduction According to the Organization for Economic Cooperation and Development (OECD), many developed countries will experience an aging society as the baby boom generation ages. Consequently, the demand for long-term care (LTC) is expected to rise sharply over the coming three decades [ 1 ]. Such countries need to respond to the growing demand for, and cost of LTC. Japan, in particular, is at the forefront of countries experiencing an aging society. The healthcare (HC) policy in Japan includes both medical care (MC) and LTC insurance systems. MC insurance is necessary for medical treatment due to illness, injury, preparation for hospitalization, surgery, outpatient visits, and medication treatment. LTC insurance applies when a person requires nursing care. The MC insurance service covers hospitalization, rehabilitation, medication, medical treatment, surgery, and visiting nursing services. The LTC insurance service covers in-home care and community-based care, such as residential facilities and facility care. If an insured person is over the age of 65, he/she is eligible for the MC insurance service and the LTC insurance service. If the insured person needs acute medical care, he/she will be admitted to a hospital and will receive medical treatment. After being discharged, the person can use in-home care services, including housekeeping and nursing care, on a daily basis, and can receive rehabilitation services in order to maintain his/her physical activity ability, which does not fall under acute treatment rehabilitation. These are services provided by LTC insurance. However, the two insurance services are separate and provided independently. Since 1961, Japan has provided a universal National Health Insurance (NHI) system for MC to all its citizens. The LTC insurance system, a mandatory social system suppor (...truncated)


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Naomi Akiyama, Takeru Shiroiwa, Takashi Fukuda, Sachiyo Murashima, Kenshi Hayashida. Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records, PLOS ONE, 2018, Volume 13, Issue 5, DOI: 10.1371/journal.pone.0190392