Abstract
Objective
This study aimed to clarify the difference in (1) long-term care (LTC) usage and expenditure
and (2) medical care service usage and expenditure before and after the change in
the copayment limit for qualifying individuals from 10% to 20%.
Setting and Participants
This quasi-experimental longitudinal design used the database from 1 prefecture of
Japan that included 570,434 person-month records of 23,879 insured individuals (in
August 2014) who used LTC services between August 2014 and July 2015 and were aged
65 years and older on August 1, 2014.
Methods
We conducted difference-in-difference estimations to compare “before” and “after”
outcome differences between insured individuals whose LTC copayment increased to 20%
and those whose copayment remained at 10%. Sex, age, Care Needs Level, subsidy, and
public assistance were adjusted in the models, along with robustness checks.
Results
Differences in both insurer's payment and insured's copayment indicated statistical
significance between those whose copayment increased and those whose copayment did
not increase. We found no significant difference in the number of minutes of home
care service use, days of facility care service use, and LTC expenditures among those
with copayment increases as well as those with no increase in copayment following
the insured's copayment increase policy implementation. In contrast, the policy implementation
caused significant differences in the number of days of hospitalization, medical care
expenditures, and total expenditures.
Conclusions and Implications
The increase in insured individuals' copayment decreased LTC insurer's payment. However,
total LTC expenditure increased over time although the increase trend slowed down
in the treatment group after the copayment increase policy implemented. Besides, medical
care expenditure increased consistently among insured individuals whose copayment
increased. As there appears to be a “balloon effect” between LTC and medical care
services, it is important to discuss the medical care system while considering the
LTC insurance system comprehensively.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Japan. Health system review.Health Syst Transit. 2018; 8: 248
- Financing long-term care: Ex ante, ex post or both?.Health Econ. 2015; 24: 45-57
- An outline of the Japanese Medical System.(Available at:)https://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken01/dl/01_eng.pdfDate: 2019Date accessed: May 18, 2019
- Investigation on the impact of copayment increase to 20 percent of long-term care insurance.(Available at:)
- The Revision of the Healthcare Payment System for 2016 Fiscal Year.Ministry of Health, Labour and Welfare, Tokyo2016
- Care-needs certification in the long-term care insurance system of Japan.J Am Geriatr Soc. 2005; 53: 522-527
- The comprehensive project for long-term care prevention and daily life support.(Available at:)https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000192992.htmlDate: 2018Date accessed: July 2, 2018
- The effect of copayments on the utilization of the GP service in Norway.Soc Sci Med. 2018; 205: 99-106
- Introducing a GP copayment in Australia: Who would carry the cost burden?.Health Policy. 2017; 121: 543-552
- Considering long-term care insurance for middle-income countries: Comparing South Korea with Japan and Germany.Health Policy. 2015; 119: 1319-1329
- How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011.Eur J Health Econ. 2014; 15: 813-828
- Co-payments in long-term Home Care: Do They Affect the Use of Care?.CPB Discussion Paper 363, CPB Netherlands Bureau for Economic Policy Analysis, 2017 (Available at: https://ideas.repec.org/p/cpb/discus/363.html, Accessed September 30, 2019)
- Social insurance for long-term care: An evaluation of the German model.Soc Policy Admin. 2010; 44: 436-460
- National long-term care insurance policy in Japan a decade after implementation: Some lessons for aging countries.Ageing Int. 2012; 37: 271-284
- Health and long-term care utilization among the elderly in the last year of life.Q Soc Secur Res. 2011; 47: 304-319
- Long-term care and hospital utilisation by older people: An analysis of substitution rates.Health Econ. 2009; 18: 1322-1338
- Implementation of long-term care and hospital utilization: Results of segmented regression analysis of interrupted time series study.Arch Gerontol Geriatr. 2018; 78: 221-226
- Cost trajectories at the end of life: The Canadian experience.J Pain Symptom Manage. 2009; 38: 75-80
- Public assistance system. 2010.(Available at:)https://www.mhlw.go.jp/english/topics/social_welfare/index.htmlDate accessed: December 11, 2018
- The Survey of the Effectiveness of Long-Term Care Insurance System Revision in 2015.Health and Welfare Bureau for the Elderly, Tokyo2018
- Methods for evaluating changes in health care policy: The difference-in-differences approach.JAMA. 2014; 312: 2401-2402
- XTOVERID: Stata Module to Calculate Tests of Overidentifying Restrictions After Xtreg, Xtivreg, Xtivreg2, Xthtaylor.2016 (Available at: https://EconPapers.repec.org/RePEc:boc:bocode:s456779. Accessed September 30, 2019)
- Introductory Econometrics: A Modern Approach.6th, student ed. Cengage Learning, Boston, MA2016
- The determinants of long-term care expenditure and their interactions.Int J Healthc Manage. 2016; 9: 269-279
- DIFF: Stata Module to Perform Differences in Differences Estimation.StataCorp, College Station, TX2017
- Estimates of national medical care expenditure in FY 2015.(Available at:)https://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/15/index.htmlDate: 2017Date accessed: July 27, 2018
- Fact-finding survey on Project of Long-term Care FY2015.(Available at:)https://www.mhlw.go.jp/topics/kaigo/osirase/jigyo/15/index.htmlDate: 2015Date accessed: July 27, 2018
- Are community-living and institutionalized dementia patients cared for differently? Evidence on service utilization and costs of care from German insurance claims data.BMC Health Serv Res. 2013; 13: 2
- Long-term care services expenditure projection in South Korea from 2015 to 2050.Int J Health Plann Manage. 2015; 30: 45-56
- The effect of a subsidy policy on the utilization of community care services under a public long-term care insurance program in rural Japan.Health Policy. 2006; 77: 43-50
- Utilization of long-term care services under the public long-term care insurance program in Korea: Implications of a subsidy policy.Health Policy. 2013; 111: 166-174
- Burden among family caregivers of older people who need care in Japan.in: Washio M. Kiyohara C. Health Issues and Care System for the Elderly. Springer Singapore, Singapore2019: 17-32
- Abridged life tables for Japan 2017.(Available at:)https://www.mhlw.go.jp/english/database/db-hw/lifetb17/index.htmlDate: 2017Date accessed: May 18, 2019
- Survey of Institutions and Establishments for Long-term Care. 2016.(Available at:)https://www.mhlw.go.jp/english/database/db-hss/dl/siel-2016-02.pdfDate accessed: May 19, 2019
- Pay less, consume more? The price elasticity of home care for the disabled elderly in France.Health Econ. 2017; 26: 1162-1174
- Determinants of long-term care services among the elderly: A population-based study in Taiwan.PLOS One. 2014; 9: e89213
- A prospective study of long-term care institutionalization among the aged.Am J Public Health. 1982; 72: 1373-1379
- Implications of long-term care capacity response policies for an aging population: A simulation analysis.Health Policy. 2014; 116: 105-113
- A comparative analysis of costs to government for home care and long-term residential care services, standardized for client care needs.Can J Aging. 2007; 26: 149-161
- Moral hazard under zero price policy: Evidence from Japanese long-term care claims data.Eur J Health Econ. 2019; 20: 785-799
- The role of home ownership in Japan’s aged society.J Hous Built Environ. 2010; 25: 175-191
- Act on Promotion of Comprehensive Securing of Medical Care and Long-Term Care in Areas.Ministry of Health, Labour and Welfare, Tokyo2014
- Visions for integration of community-based health care and long-term care.J Natl Inst Public Health. 2016; 65: 103-104
- Co-operation between medical and social care and health services research.Jpn J Geriatr (Nippon Ronen Igakkai Zasshi). 2017; 54: 22-27
Article info
Publication history
Published online: October 14, 2019
Footnotes
Funding sources: This study was supported by a Health and Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare, Japan (H29-ICT-007), and a Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research (A) (16H02634).
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
