Abstract
BackgroundTreatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation.MethodsA retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects.ResultsOf the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 % vs. 52.0 %, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 % confidence interval [CI]: 1.86–8.78) in boys and 1.72 (95 % CI: 0.80–3.70) in girls, after adjusting for demographic characteristics and clinical factors.ConclusionsFinancial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.
Highlights
Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits
growth hormone deficiency (GHD) patients reach the cap, the combination is expected to result in total coverage of up to about 85 % of total medical expenses among GHD children, as represented by the oblique line of coverage levels. bThe national aid for severe GHD was established in October 2009. cLocal subsidies include a local subsidy for mild GHD and the generic Child Health Insurance Subsidy program and local subsidies provide financial support for patients’ out-of-pocket payments
Our findings revealed that 76.7 % of children with GHD who were financially supported continued treatment even after they exceeded the government-defined height criteria, whereas only 54.7 % of those who were not supported continued GH
Summary
Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). Several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. Most of the costs are covered by public health insurance or reimbursed by governments in many. Japan provides universal health insurance coverage to its citizens up to 70 % of the medical charges, with the remainder paid by patients [5]. CLocal subsidies include a local subsidy for mild GHD and the generic Child Health Insurance Subsidy program and local subsidies provide financial support for patients’ out-of-pocket payments.
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