Abstract
BackgroundTo evaluate the effects of prevention services provided by long-term care insurance (LTCI) for older adults who require support from LTCI in Kashiwa City, Japan.MethodsWe conducted an analysis using the following population-based longitudinal data in Kashiwa City between April 2012 and March 2015: Data of National Health Insurance and LTCI claims, the survey for certification of LTCI, the register, and premium tier classification. All data was linked using the pre-assigned anonymous identifying numbers. We analyzed the Cox regression model using the time for the deteriorations of levels of certified care need in LTCI as an outcome and the use of preventive care services as the primary exposure among participants aged 75 years or older, who had either support levels 1 or 2 at the beginning of this analysis. The study was further stratified by both age and initial support level.ResultsThe final analysis included 1289 participants. The primary result showed, among all participants, that preventive service was not effective (hazard ratio 0.96, 95% confidence interval 0.78–1.19). In our sub-analysis, the preventive service was effective in avoiding deteriorations only among those aged 85 and older with support level 1 (HR 0.65, 95% CI 0.43–0.97) out of four groups.ConclusionsThe preventive services of LTCI in Kashiwa City showed a significant effect on the deterioration among subjects aged 85 or older, whose disability level were low (support level 1). Our results suggest that the prevention services provided by LTCI may not be effective for all older individuals; to provide these services efficiently, local governments, as insurers of LTCI, will need to identify the specified groups that may benefit from the preventive services. Additionally, it is necessary to re-examine what preventive interventions may be effective, or redesign the health system if necessary, for those who were not affected by the intervention.
Highlights
To evaluate the effects of prevention services provided by long-term care insurance (LTCI) for older adults who require support from LTCI in Kashiwa City, Japan
In 2000, long-term care insurance (LTCI) was introduced in Japan to be used as a public insurance system to provide care for disabled older adults, both at home and in facilities [2, 3]
Kashiwa City is located in the Kanto region and has a population of 400,000 and its proportion of people aged 65 and older is 24.4%, which is lower than the national average of 26.6% in 2015
Summary
To evaluate the effects of prevention services provided by long-term care insurance (LTCI) for older adults who require support from LTCI in Kashiwa City, Japan. Increases in the numbers of people who were certified as having mild disabilities, meaning they needed low levels of care was noticeable. Many of those who needed a low level of care were considered to have “disuse syndrome (inactive lifestyle),” where daily function gradually declines due to conditions such as falls, bone fractures, and joint diseases. Prevention services include day care (rehabilitation), day services (support for daily living), and visiting services These services are arranged for each person based on an assessment of their disabilities. Discussion is necessary to plan and implement future prevention services and determine how resources will be concentrated
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