Abstract
BackgroundIn Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city.MethodsData were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused 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.ResultsThe study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates.ConclusionsBeyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of the highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financial sustainability of LTCI from a public insurer perspective in Japan.
Highlights
In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and growing expenditures are threatening the sustainability of the system
The breakdown of subjects using facility services at the end of study period was as follows: 32% of the total number of subjects reside in facility services; 54.7% of these facility users belonged to the high care needs level; and 61% of subjects certified at high care needs level used facilities services at the end of study period
Beyond confirming that the disability status of elderly persons, measured as care needs level, is the main factor driving the demand of LTC services and of the LTC expenditures, we demonstrated that others factors, such as changes in utilization of LTC insurance benefits (URB) and the use of institutional care conditional on a high care needs level, were the strongest predictors of the highest LTC expenditures
Summary
In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and growing expenditures are threatening the sustainability of the system. Face to the challenge of an aging population and its impact on social security system, it is important to improve our understanding of the factors associated with LTC expenditures among the elderly. In Japan and most of developed countries, as the number of elderly people with disabilities or requiring support in their activities of daily living (ADLs) increase, the demand for long-term care (LTC) services has increased and the expenditures of the LTC system are growing steadily, threatening the financial sustainability of the system [2,3,4,5]. By the years 2025 and 2050, the elderly population is expected to reach 30.5% and 39.6% of the total Japanese population, respectively [6,7], and estimates projected by the OECD, depending on the scenarios, demographic effects, and cost-pressure or cost-containment, the projected LTC expenditures for Japan could reach 2.3%, 3.1%, and 2.4% of GDP by 2050, respectively [4]
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