- 著者
- Olivares-Tirado Pedro Tamiya Nanako Kashiwagi Masayo Kashiwagi Kimikazu
- 出版者
- BioMed Central
- 雑誌
- BMC health services research
- 巻号頁・発行日
- vol.11, pp.103, 2011-05
- 被引用文献数
- 32 7
Background: In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system hasincreased, demand for long-term care services has increased substantially and consequently growing expendituresare threatening the sustainability of the system. Understanding the predictive factors associated with long-termcare expenditures among the elderly would be useful in developing future strategies to ensure the sustainability ofthe system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly personswho received consecutive long-term care services during a year in a Japanese city.Methods: Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression wasused to examine the predictors of the highest long-term care expenditures. We used a simplified model thatfocused on the effects of disability status and type of services used, while controlling for several relevant factors.Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model.Results: The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender andincome, age, increased utilization rate of benefits, decline in functional status, higher care needs level andinstitutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate ofbenefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significantinteraction between institutional care and high care need level was found, providing evidence of the combinedeffect of the two covariates.Conclusions: Beyond to confirm that disability status of elderly persons is the main factor driving the demand ofLTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specificinsurance factor- and the use of institutional care conditional on the high care level, were strongest predictors ofthe highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financialsustainability of LTCI from a public insurer perspective in Japan.