Abstract
BackgroundTo examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures.MethodsA 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.ResultsAmong 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.ConclusionHousehold 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.
Highlights
To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures
In order to contribute to the improvement of access to long-term care (LTC) services in Japan regardless of income, this study aimed to examine if household income was associated with the utilization and expenditures of home-based rehabilitation and home help services
37.6% of subjects were categorized into the low-income group
Summary
To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures. The proportion of older Japanese adults receiving LTC services has steadily risen with advancing age [3] With this rapid increase in the number of LTC insurance beneficiaries, there is a growing pressure to ensure that services are distributed equitably and sustainably according to each individual’s need. Care managers must consider each beneficiary’s needs, and their financial constraints Due to these limitations, the level of household income is likely to affect LTC service utilization. It has been previously reported that unadjusted expenditures for LTC services were higher for low-income beneficiaries than those with higher income [4], another study found that LTC service expenditures for low-income beneficiaries were lower than those with higher income after adjusting for health status–related factors [5] This difference of expenditures between income level may be due to the regressivity of the out-ofpocket burden, in which out-of-pocket payments account for a higher proportion of household income in lower-income beneficiaries than higher-income beneficiaries [6]. Low-income beneficiaries may shy away from using services that are expensive or involve relatively higher minimum payments
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