Abstract
Background: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system. Methods: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization. Results: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level.Conclusion: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.
Highlights
Japan is struggling with a growing aged population
This study aimed to provide a comprehensive analysis of the impact of the cost-sharing policy on healthcare utilization among older people by calculating hospitalization rate, length of stay (LOS), cost per patient per day, and total hospitalization cost as categorized by income levels
In comparing the bed types, the highest hospitalization rate was for Diagnosis Procedure Combination (DPC) beds with a low-income level of 18.72%, middleincome level of 19.21%, and high-income level of 19.60%, while the lowest hospitalization rate was for psychiatric beds
Summary
Japan is struggling with a growing aged population. In 2016, the number of people aged 75 years or more was 16.91 million, which was 13.3% of Japan’s total population.[1] With this increase in the number of older people in Japan, a dramatic increase in healthcare demand due to age- and lifestyle-related diseases is expected. Healthcare costs and utilization are varied according to the hospitalization bed types.[2,3,4] A case–mix system called Diagnosis Procedure Combination (DPC) was developed to increase the efficiency and provide a comprehensive care service for inpatients.[5] Using the DPC system, hospitalization bed types can be categorized further into DPC beds, general beds other than DPC (named as general beds), medical chronic care beds, psychiatric beds, and others. Based on a survey conducted by the Japanese Ministry of Health, Labor and Welfare in 2016, the hospitalization cases according to general, medical chronic care, psychiatric, and other hospital beds, were 891 398 (57.1%), 328 161 (21%), 334 258 (21.4%), 7188 (0.5%), respectively.[6]
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