Prevention services via public long-term care insurance can be effective among a specific group of older adults in Japan

BMC Health Services Research

Tomoko Ito¹  Nanako Tamiya²  Takahiro Mori³  Satoru Yoshie⁴  Katsuya Iijima⁵  Hideto Takahashi⁶  Natsumi Shimafuji⁷ 

[1] Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, 305-8575, Ibaraki, Japan;Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, 305-8575, Ibaraki, Japan;Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, 305-8575, Ibaraki, Japan;Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, 305-8575, Ibaraki, Japan;Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan;Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan;Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, 305-8575, Ibaraki, Japan;Institute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan;Institute for Future Initiatives, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan;Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinano-cho, Shinjuku-ku, 160-8582, Tokyo, Japan;Institute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan;Institute for Future Initiatives, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan;National Institute of Public Health, 2-3-6 Minami, Wako, 351-0197, Saitama, Japan;Ridgelinez Limited, 2-6-1, Marunouchi, Chiyoda-ku, 100-6922, Tokyo, Japan;

关键词: Prevention services;    Community care;    Older adults;    Long-term care insurance;   

DOI  :  10.1186/s12913-021-06495-0

来源: Springer

【 摘 要 】

BackgroundTo evaluate the effects of prevention services provided by long-term care insurance (LTCI) for older adults who require support from LTCI in Kashiwa City, Japan.MethodsWe conducted an analysis using the following population-based longitudinal data in Kashiwa City between April 2012 and March 2015: Data of National Health Insurance and LTCI claims, the survey for certification of LTCI, the register, and premium tier classification. All data was linked using the pre-assigned anonymous identifying numbers. We analyzed the Cox regression model using the time for the deteriorations of levels of certified care need in LTCI as an outcome and the use of preventive care services as the primary exposure among participants aged 75 years or older, who had either support levels 1 or 2 at the beginning of this analysis. The study was further stratified by both age and initial support level.ResultsThe final analysis included 1289 participants. The primary result showed, among all participants, that preventive service was not effective (hazard ratio 0.96, 95% confidence interval 0.78–1.19). In our sub-analysis, the preventive service was effective in avoiding deteriorations only among those aged 85 and older with support level 1 (HR 0.65, 95% CI 0.43–0.97) out of four groups.ConclusionsThe preventive services of LTCI in Kashiwa City showed a significant effect on the deterioration among subjects aged 85 or older, whose disability level were low (support level 1). Our results suggest that the prevention services provided by LTCI may not be effective for all older individuals; to provide these services efficiently, local governments, as insurers of LTCI, will need to identify the specified groups that may benefit from the preventive services. Additionally, it is necessary to re-examine what preventive interventions may be effective, or redesign the health system if necessary, for those who were not affected by the intervention.

【 授权许可】

CC BY