Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users

BMC Geriatrics

Nanako Tamiya¹  Seigo Mitsutake²  Rumiko Tsuchiya-Ito²  Tatsuro Ishizaki²  Katsuya Iijima³  Satoru Yoshie⁴  Shota Hamada⁴ 

[1] Health Services Research & Development Center, University of Tsukuba;Human Care Research Team, Tokyo Metropolitan Institute of Gerontology;Institute of Gerontology, University of Tokyo;Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare;

关键词: Aging;    Economic status;    Long-term care services;    Claims data;    Two-part model;   

DOI  :  10.1186/s12877-020-01704-7

来源: DOAJ

【 摘 要 】

Abstract Background To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures. Methods A secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function. Results Among 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670–0.987) and spend on (RR: 0.910; 95%CI: 0.829–0.999) home-based rehabilitation services than middle/high-income subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232–1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799–0.986) home help services than middle/high-income subjects. Conclusion Household income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of low-income beneficiaries and encourage service utilization.

【 授权许可】

Unknown