Medical Care Insurance Research Articles

Sense of medical care policy alienation: conceptualization, scale development, and validation

Although medical care policy affects utilization of medical care resources, most existing research focuses on the impact of effectiveness of medical care insurance coverage on people’s behavior. We argue that psychological distance from medical care policy is important in shaping people’s behavior, leading to a sense of policy alienation from the medical care policy field (SPA-M). We conceptualized SPA-M and developed, validated, and evaluated a scale to assess it. We reviewed the definition of SPA-M and created the item pool for the SPA-M scale with item generation process. Sample I and Sample II included data from 524 to 462 Chinese residents, respectively, without any overlap. We used Sample I to examine the dimensions of the SPA-M scale via exploratory factor analysis. Sample II was used to investigate whether the results of Sample I could be verified through confirmatory factor analysis. The analyses showed that a six-dimension SPA-M model could be confirmed in the two samples. The SPA-M scale has good convergent and discriminant validity, making it potentially applicable in the medical public policy field.

Regulatory and legal regulation of the healtcare sector in Ukraine and Hungary: general and special

This article conducts a comparative analysis of the current state of legal regulation in the healthcare sector in Ukraine and Hungary. The significance of healthcare issues has elevated them to the level of one of the most important state tasks and an internal function of the modern state. This necessitates not only the execution of effective state governance but also the formation and implementation of state policy in this sphere. The article is dedicated to the formation and implementation of state policy concerning the legal regulation of the healthcare sector in Ukraine and Hungary, which underscores its relevance.
 During the writing process, the author researched the system of legal relations and state bodies responsible for performing relevant functions and tasks in the formation and implementation of healthcare policy. It analyzes the legislative system regulating these areas and the practice of its application in both countries. The article identifies the roles and places of the Verkhovna Rada (Supreme Council) of Ukraine and the Hungarian National Assembly, as well as the Cabinets of Ministers and the executive branch systems in both countries in the realization of healthcare policy.
 Like most contemporary scientific developments in this field, the article covers problems of three scientific disciplines – medicine, management, and law. In preparing this article, the author reviewed a considerable amount of medical literature, particularly in social medicine and healthcare organization, thoroughly exploring their scientific issues in both Ukraine and Hungary. However, it aims to illuminate the issues and problems arising in this context, specifically from the legal standpoint, particularly administrative law. Therefore, the focus of this work is primarily on legal categories and concepts – the legal mechanisms for implementing state medical and health improvement programs, ensuring the constitutionally guaranteed right of individuals in Ukraine and the Fundamental Law of Hungary to medical care, healthcare, and medical insurance, particularly the guaranteed level of free qualified medical aid.

Implementation status of postoperative rehabilitation for older patients with hip fracture in Kyoto City, Japan: A population-based study using medical and long-term care insurance claims data.

Continuing rehabilitation after hip fractures is recommended to improve physical function and quality of life. However, the long-term implementation status of postoperative rehabilitation is unclear. This study aims to investigate the implementation status of postoperative rehabilitation for older patients with hip fractures and the factors associated with continuing rehabilitation. A retrospective cohort study evaluated medical and long-term care insurance claims data of patients aged 75 years or older in Kyoto City, Japan, who underwent hip fracture surgeries from April 2013 to October 2018. We used logistic regression analysis to examine factors associated with six-month rehabilitation continuation. Of the 8,108 participants, 8,037 (99%) underwent rehabilitation the first month after surgery, but only 1,755 (22%) continued for six months. The following variables were positively associated with continuing rehabilitation for six months: males (adjusted odds ratio: 1.41 [95% confidence interval: 1.23-1.62]), an intermediate frailty risk (1.50 [1.24-1.82]), high frailty risk (2.09 [1.69-2.58]) estimated using the hospital frailty risk scores, and preoperative care dependency levels: support level 1 (1.69 [1.28-2.23]), support level 2 (2.34 [1.88-2.90]), care-need level 1 (2.04 [1.68-2.49]), care-need level 2 (2.42 [2.04-2.89]), care-need level 3 (1.45 [1.19-1.76]), care-need level 4 (1.40 [1.12-1.75]), and care-need level 5 (1.31 [0.93-1.85]). In contrast, dementia was cited as a disincentive (0.53 [0.45-0.59]). Less than 30% of older patients continued rehabilitation for six months after surgery. Factors associated with continuing rehabilitation were male sex, higher frailty risk, care dependency before hip fracture surgeries, and non-dementia.

Atrial fibrillation and mortality after ischemic stroke: An observational study using an insurance claim database

ObjectivesIn this study, we aimed to examine the association between atrial fibrillation and mortality after ischemic stroke and evaluate the use of anticoagulation therapy for atrial fibrillation before stroke onset in patients who experienced stroke. MethodsIn this retrospective observational study, we used a combined database of medical and long-term care insurance claims data from one prefecture in Japan. The data of 25,352 patients aged ≥ 65 years who were hospitalized in acute care hospitals with a diagnosis of ischemic stroke between April 2012 and March 2015 were extracted. Cox proportional hazard modeling, with adjustment for age, sex, comorbidities, and long-term care dependency level (based on the activities of daily living), was performed to evaluate the relationship between mortality and atrial fibrillation. ResultsThe prevalence of atrial fibrillation was 21.8% in the study population. A significant association was noted between mortality and atrial fibrillation (adjusted hazard ratio: 1.28, 95% confidence interval: 1.16–1.41, p < 0.001). Anticoagulant drugs were used in 32.2% of the patients with atrial fibrillation. ConclusionsThese results indicate that atrial fibrillation is associated with mortality after stroke; however, the use of anticoagulation therapy for atrial fibrillation is unsatisfactory. Efforts to improve the use of atrial fibrillation therapy are required in Japan.

Impact of home-visit nursing service use on costs in the last 3 months of life among older adults: A retrospective cohort study.

Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home-visit nursing services at the end of life for community-dwelling older adults. We examined the use of home-visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long-term care costs (total costs) in the last 3 months of life. This was a retrospective cohort study. We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long-term care insurance claims data. Participants were classified into five groups based on their history of home-visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not-early initiation/continuous use, (4) not-early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home-visit nursing service use. Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home-visit nursing services. Multivariable linear regression analysis of the log10-transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). Early initiation use of home-visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end-of-life care for community-dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home-visit nursing services, they provide a perspective from which to assess the use of home-visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home-care settings for older adults who prefer to spend their final days at home.

Long-term care planning and the influencing factors among sexual minority older women: A qualitative study.

The aim of the study was to explore plans, considerations and factors influencing long-term care among older sexual minority (SM) women. Qualitative interview study. Semi-structured in-depth interviews were conducted with 37 older Taiwanese SM women between May and September 2019. This study analysed interview data using a socio-ecological model and constant comparative analysis. The most frequently reported long-term care plans were housing and institutions, private medical or long-term care insurance, financial planning and medical decisions. Factors associated with women's long-term care plans were categorized using the socio-ecological model level: (1) intrapersonal factors: current physical and mental health status, ageing signs and women's attitudes towards ageing; (2) interpersonal-level factors: receiving support from partners, child(ren), siblings or significant others, concerns about being a caregiver for parents and worries regarding social isolation; (3) community-level factors: receiving support from lesbian, gay, bisexual and transgender (LGBT) organizations; private lesbian online groups; or religious groups; (4) societal-level factors: concerns about negative social environments, concerns about the healthcare system and healthcare providers, inappropriate policies and insufficient resources. This study identified multi-level factors related to long-term care plans and concerns among older Taiwanese SM women. Recommendations for nurses, managers of long-term care and healthcare settings, policymakers, and governments have been provided to diminish health disparities and reduce anxiety among older SM women. This study assists nurses in understanding older SM women's long-term care concerns and worries when accessing long-term care and healthcare services and helps nurses provide SM-sensitive services and care for women. SM older women were recruited from LGBT organizations, LGBT-friendly bookstores, restaurants, coffee shops and LGBT online chatrooms using purposive and snowball sampling.

АНАЛИЗ ПОКАЗАТЕЛЕЙ РАЗВИТИЯ ДОБРОВОЛЬНОГО МЕДИЦИНСКОГО СТРАХОВАНИЯ И ПРОГРАММ СТРАХОВАНИЯ ЛЕКАРСТВЕННОГО ОБЕСПЕЧЕНИЯ

The purpose of the study is to determine the direction of development of the voluntary medical insurance market and pharmaceutical insurance for the population of Russia. The materials of the study were the data of the statistical reporting form of insurers (reporting of the Bank of Russia); statistical indicators and information about individual subjects of the insurance business; the register of licenses issued to insurance companies, Insurance Rules, data on the population of the Federal State Statistics Service. The method of content analysis, the method of analysis of time series, methods of analysis, synthesis and generalization of information were used. It is revealed that the voluntary medical insurance market in 2022 is characterized by the following trends: a decrease in the volume of insurance premiums, a stable number of insurance contracts, the growth of the corporate segment, a decrease in the amount of payments, a decrease in the number of insurers working in the field of health insurance, high monopolization of the market. A significant increase in the share of corporate voluntary medical insurance shows not only the unwillingness and/or inability of individuals to purchase insurance policy, but also the alertness of insurance companies to this insurance sector in times of turbulence. The top 10 (by the amount of insurance premiums) companies operating in the field of voluntary medical insurance have been identified. Drug insurance in the form of a separate program is offered by 6 companies from the top 10 offer a separate drug insurance program; all 6 companies apply a franchise, the level of which ranges from 10% to 100%; 2 companies include the provision of biologically active additives and medical products, 1 company offers the provision of specialized nutrition products. The basic tariff rates for drug insurance programs are significantly higher than those for medical care insurance.

The patient experience of prior authorization for cancer care: Anxiety, delays, and the erosion of trust.

6561 Background: Prior authorization (PA) requires healthcare providers to obtain pre-approval from insurance for medical care. While PA is intended to promote evidence-based standards and reduce unnecessary care, it requires clinicians and patients to navigate an often-complex approval process. Delays or denied care can be particularly problematic for patients with cancer and their experience with PA remains unexplored. Methods: Social media recruitment enrolled adult cancer patients with a self-reported personal experience with PA to an anonymous online survey of investigator-designed questions on their experience. Descriptive statistics and univariate tests characterized survey responses, and multivariable analysis, controlling for age, diagnosis, race/ethnicity, and education, assessed associations with healthcare and insurance trust and delays in care. Results: 178 patients completed the survey; they were mostly women (90%), non-Hispanic white (84%), college graduates (81%), young [18-39 (42%), 40-54 years old (34%)] with private insurance (86%). PA was most frequently required for imaging (71%), IV chemotherapy (48%), surgery (47%), radiation (34%). Most care was ultimately given as recommended (58%); however, 20% of respondents didn’t receive recommended care due to delays or denials, and 9% received recommended care but paid out-of-pocket. PA delayed 69% of care, with 51% of patients noting a delay ≥2 weeks. Delays did not vary by demographic, clinical, insurance, or treatment factors (all p &gt; .05). 67% of patients had to personally get involved in the PA process by either calling their insurance (53%) or filing an appeal (25%); 20% of patients and/or their caregivers spent ≥11 hours dealing with PA issues. Overall PA experience was rated as “bad” (40%) or “horrible” (32%) for most respondents. Self-reported PA-related anxiety was significantly higher than self-reported baseline anxiety (mean = 74 vs mean = 37, 0-100 scale, t = 16.6, p &lt; .001) and was significantly correlated with time spent on PA (ρ = .16, p = .04) and overall PA experience (ρ = .34, p &lt; .001). While 18% felt PA made them trust their cancer team less, 89% said it made them trust their insurance company less, and 83% said it made them trust the healthcare system less. Patient involvement in the PA process (vs. healthcare team handling) was associated with higher-than-expected trust in their cancer team (χ2= 19.6, p &lt; .001), and increased odds of distrusting their insurance company (β = 5.7, 95% CI: 1.8,17.6) and distrusting the healthcare system (β = 3.2, 95% CI: 1.3,7.9). Having to file appeal was associated with 2.9 increased odds (95% CI: 1.2,7.2) of experiencing a delay in care. Conclusions: PA practices may substantially delay care for patients with cancer increasing anxiety and eroding trust in healthcare. Streamlining the PA process could both allow optimal quality of care and improve the patient experience with cancer care.

Evaluation of comprehensive reform effect of public hospitals in Sanming, Fujian Province

The reform of public hospitals is a complex process, involving multiple subsystems and the interaction of related factors. This paper conducts a preliminary evaluation of the joint reform of medication, medical care, and medical insurance in Sanming using quantitative and qualitative methodologies. The method of system dynamics is applied to model the three subsystems of medication, medical care, and medical insurance in Sanming and analyze the cause-and-effect relationship between different factors in the subsystem. Based on the analysis, the evaluation index is determined to evaluate the effect of the medical reform in Sanming. The analysis results show that Sanming’s public hospitals have experienced a comprehensive reform that includes changing the way pharmaceuticals are procured, cutting prescription prices, and raising hospital worker wages. To maximize the hospital revenue structure, the medical insurance payment system was changed. The expense of patient therapy was reduced, and the development of hierarchical diagnosis and treatment was encouraged.

A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey.

This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher's exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient. Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of "referral from the same medical corporation" and "obtaining the rehabilitation plan" by Fisher's exact test (odds ratio: 3.242; P<0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6). The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.

Comparative analysis of the current state of regulatory and legal regulation of health care in Ukraine and Hungary

The article provides a comparative analysis of the current state of legal regulation of health care in Ukraine and Hungary. The importance of public health issues has led to their elevation to the level of one of the most important state tasks, an internal function of the modern state, and this requires not only effective public administration, but also the formation and implementation of state policy in this area. This article is devoted to the formation and implementation of the state policy of legal regulation of the healthcare sector in Ukraine and Hungary. In the process of writing it, the author studied the system of legal relations and state bodies that perform the relevant functions and tasks in the formation and implementation of state health policy, analyzed the system of legislation that regulates them and the practice of its application in both countries. The article defines the place and role of the Verkhovna Rada in relation to health policy in comparison with the role of the Hungarian State Assembly, the Cabinet of Ministers, and the system of executive authorities of both countries in its implementation.&#x0D; The article, like most modern scientific developments in this field, covers the problems of three scientific disciplines - medicine, management and law. In the process of preparing this article, the author has processed a significant amount of medical literature, on social medicine and health care organization, and thoroughly researched their scientific issues both in Ukraine and Hungary. However, he tried to cover the issues and problems arising in this area from the standpoint of legal and administrative law. Therefore, in this work the main attention is focused not on the categories and concepts of social medicine and health care organization, but on the actual legal categories and concepts - legal mechanisms for the implementation of state medical and health programs, ensuring the human right to medical care, health care and health insurance guaranteed by the Constitution of Ukraine and the Basic Law of Hungary guaranteed level of free qualified medical care.

COSTS OF DEMENTIA CARE AND EARLY-STAGE PREVENTIVE NURSING: A COMPARATIVE BIG DATA STUDY IN OSAKA

Abstract Data show a substantial increase in the costs of dementia care nationally and globally. We assessed the factors increasing financial pressure, and found an association between the costs and the severity of dementia. We suggest that early diagnosis and preventive nursing care can reduce the deterioration associated with dementia, and therefore the overall costs of dementia care. The purpose of this study was to determine the relationship between the costs of dementia care and early-stage preventive nursing care in a sample of people with dementia aged 65 to 85 years, using the Medical Care Insurance and Osaka Prefecture Long-Term Care Insurance Database (N = 17973). We found that early care might have a significant effect on formal care costs in the early period of dementia but did not influence the medical care costs of dementia. During the first 5 years, the long-term care costs of people with dementia with an initial care level of Support 1/2 (one type of care level of Japanese long-term care insurance system, and the participants receive preventive services) were $4,389, while people with an initial care level of Care 1/2 (the other type of care level, and the participants receive nursing services) were $12,333. About 20% of people who received preventive care recovered, suggesting that preventive nursing care can restore the ability of people with early-stage dementia. This might be the reason for the reduction in long-term care costs. This research provides a basis for supporting preventive nursing care and extending healthy lifespans.

Description de fractures avec fragments laminaires ostéochondraux inhabituels dans les fractures du radius distal

BackgroundDistal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. Patients and methodsWe reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. ResultsTwo main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI: 1.4 to 2.9). DiscussionGlobal prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. Level of evidenceIV (observational/descriptive); cross-sectional study.

An Introduction to The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, a Study on the Impact of Medicare in Nova Scotia by Murray G. Brown and Vernon A. Hicks

This research note directs the attention of policy scholars to a unique and important research study on Canadian Medicare that is not generally known. Conducted by Murray G. Brown and Vernon A. Hicks, the study examined the impact of Medicare on the demand for services in Nova Scotia before and after the introduction of universal medical care insurance. Titled The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, this research was written up into a report delivered to the US government but was, unfortunately, never disseminated—nor did it become known in Canada. By summarizing the history and context of the study, the approach and methods used by Brown and Hicks, and the study’s policy significance, this research note also acts as an introduction to the study.

Description of unusual osteochondral laminar fragment patterns in Distal Radius fractures

BackgroundDistal radius fracture (DRF) is one of the most common fractures and, frequently, surgical treatment is mandatory in the presence of an intra-articular fracture. However, there are some unusual intra-articular fracture patterns, were it remains challenging to properly recognize and anatomically reconstruct the articular surface. The objective of the present study is to describe an intra-articular fracture pattern of the distal radius characterized by the presence of osteochondral laminar fragments, which could potentially require a different treatment to standard stabilization. We aim to answer the following questions: (1) What are the radiological characteristics of intra-articular DRFs with osteochondral laminar fragments (OCLF), (2) What is the prevalence of DRFs with OCLF relative to all intra-articular surgical DRFs, (3) What are the differences in epidemiological characteristics of patients with OCLF in relation to all patients with intra-articular DRFs, (4) What is the prevalence of intra-articular DRFs with OCLF in patients belonging to a closed community. Patients and methodsWe reviewed radiological and tomographic records of all adult patients operated on distal radius fractures at our institution. We analyzed tomographic characteristics; prevalence of osteochondral laminar fragments relative to all intra-articular surgical distal radius fractures and compared clinical and demographic characteristics of patients with osteochondral laminar fragments in relation to all patients with intra-articular fractures. ResultsTwo main groups according to the fracture pattern were described: group I, volar rim impacted OCLF (vOCLF); and group II, central impacted OCLF (cOCLF). Prevalence of OCLF relative to surgical intra-articular DRFs: 42/989 (4.2%); group I: 23/989 (2.32%); group II: 19/989 (1.92%). Characteristics of patients with OCLF compared to all patients with intra-articular DRFs: Significant differences were found in the five variables evaluated (age, less than 65 years, female, high energy fracture, and associated fractures). The global prevalence of DRFs with OCLF in patients affiliated with the medical care insurance system of our institution was 2 per 10,000 individuals (95% CI 1.4 to 2.9). DiscussionGlobal prevalence of these fragments relative to surgical intra-articular fractures was very low. However, despite being epidemiologically rare, it is important to identify these specific fracture patterns because their treatment can be challenging. Level of EvidenceIV (Observational/Descriptive); Cross sectional study.

Analysis of the risk factors of mortality in elderly patients with hip fracture using a combined database of medical and long-term care insurance claims data

BackgroundThe present study evaluated the risk of mortality in elderly hip fracture, focusing on comorbidities and nursing care levels. MethodsThe present study was an observational cohort study that used a combined database of medical and long-term care insurance (LTCI) claims data from one prefecture in Japan between 2011 and 2016. In total, 6125 patients aged 65 years and older were selected from acute care hospitals with a diagnosis of “hip fracture” between March 2011 and March 2012. The impact of long-term care insurance claim evaluation levels and comorbidities at recruitment time was investigated using this dataset. These patients were followed up monthly until March 2016. Based on this person-month dataset, survival analysis was performed with death as the endpoint. Cases in which receipt data were missing during the middle of the observation period and cases in which the patient survived at the end of the observation period were censored. ResultsThe number of deaths during the observation period was 635 (10.4%). The impact of comorbidities and nursing care level on mortality were both significant as follows: high nursing care level before the fracture (hazard ratio: 1.09, P < 0.001), comorbidities of malignant diseases (HR: 1.45, P < 0.001), heart disease (hazard ratio: 1.20, P = 0.037), pneumonia (hazard ratio: 1.27, P < 0.001), chronic obstructive pulmonary disease (hazard ratio: 1.28, P = 0.026), renal failure (hazard ratio: 1.44, P < 0.001), and dementia (hazard ratio: 1.27, P = 0.013). ConclusionThe results of this study showed that a high level of nursing care and presence of comorbidities such as malignant diseases, heart diseases, pneumonia, chronic obstructive pulmonary disease, renal failure, and dementia increased mortality in elderly patients with hip fracture. Furthermore, this study showed the usefulness of a combined database of medical and LTCI claims data for clinical and health service-related research in the field of orthopedics.

Effects of Early Postdischarge Rehabilitation Services on Care Needs–Level Deterioration in Older Adults With Functional Impairment: A Propensity Score–Matched Study

ObjectiveTo examine the effects of early postdischarge rehabilitation on care needs–level deterioration in older Japanese patients. DesignPropensity score–matched retrospective cohort study. SettingA secondary data analysis was conducted using medical and long-term care insurance claims data from a suburban city in Japan. ParticipantsWe analyzed patients (N=2746) aged 65 years or older who were discharged from hospital to home between April 2012 and March 2014 and had care needs certification indicating functional impairment. InterventionsThe provision of early rehabilitation services by rehabilitation therapists within 1 month of discharge. Propensity score matching was used to control for differences in characteristics between patients with and without early rehabilitation services. Main Outcome MeasuresAny deterioration in care needs level during the 12-month period after discharge. Cox proportional hazards analyses were conducted to identify the association between the exposure and outcome variables after matching. ResultsAmong 2746 patients, 573 (20.9%) used early rehabilitation services. Care needs–level deterioration occurred in 508 patients (incidence: 18.3 per 1000 person-months), of which 76 used early rehabilitation services (12.3 per 1000 person-months) and 432 did not use early rehabilitation services (20.0 per 1000 person-months). One-to-one propensity score matching produced 566 matched pairs that adjusted for the differences in all covariables. In these matched pairs, the hazard of care needs–level deterioration was significantly lower among patients who used early rehabilitation services (hazard ratio=0.712, 95% CI, 0.529-0.958). A Kaplan-Meier survival analysis showed similar results (log-rank: P=.023). ConclusionsEarly rehabilitation services provided by rehabilitation therapists after hospital discharge appeared effective in preventing care needs–level deterioration, and involving rehabilitation therapists in transitional care may aid the optimization of health care for older Japanese adults with functional impairment.

Effects of the Medicaid expansion under the Affordable Care Act on health insurance coverage, health care access, and use for people with disabilities.

People with disabilities have higher health care needs, service utilization, and expenditures. They are also more likely to lack insurance and experience unmet need for medical care. There has been limited research on the effects of the Affordable Care Act Medicaid expansion on people with disabilities. To examine the effects of the Medicaid expansion on health insurance coverage, access, and service use for working-age adults with disabilities. A retrospective study using 11 years (2007-2017) of data from the Medical Expenditure Panel Survey - Household Components, linked to Area Health Resource Files and Local Area Unemployment Statistics (N=40,995). Difference-in-differences multinomial logistic and linear probability models with state and year fixed-effects were used to estimate the effects. We found strong evidence of increased Medicaid coverage in expansion states (3.2 to 5.0 percentage points), reasonably strong evidence of reduced private insurance coverage (-2.2 to-2.5 percentage points), and some evidence of reduced uninsured rate (from no effect to-3.7 percentage points). Results suggest that the increase in Medicaid coverage was due at least in part to the "crowd-out" of private insurance in expansion states. No statistically significant effects were detected for access and use outcomes. Findings suggest that state Medicaid expansions led to an increase in Medicaid coverage and a decrease in private insurance coverage as well as the uninsured. However, no evidence was found for health care access and use outcomes. Further research into access and use is needed when more data become available for the post-expansion period.

Factors Associated with Outpatient Cardiac Rehabilitation Participation in Older Patients: A Population-Based Study Using Claims Data from Two Cities in Japan.

Although outpatient cardiac rehabilitation has been shown to be effective, the participation status of older cardiac patients is unclear in real-world settings. We investigated the proportion and associated factors of outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention. We analyzed data from medical and long-term care insurance claims data from two municipalities in Japan. The data coverage period was between April 2014 and March 2019 in City A and between April 2012 and November 2016 in City B. We identified patients aged ≥65 years with post-operative acute myocardial infarction, angina pectoris, or heart valve disease. We estimated the proportion of cardiac rehabilitation participation and conducted logistic regression to identify factors (age, sex, type of cardiac disease, open-heart surgery, Charlson comorbidity index, long-term care need level, catecholamine use, inpatient cardiac rehabilitation, and hospital volume for cardiac rehabilitation) associated with outpatient cardiac rehabilitation participation. A total of 690 patients were included in this study. The proportion of patients receiving outpatient cardiac rehabilitation was 9.0% overall. Multivariable logistic regression analysis suggested that men (adjusted OR 3.98; 95% CI 1.69-9.37), acute myocardial infarction (adjusted OR 2.76; 95% CI 1.20-6.36; reference angina pectoris), inpatient cardiac rehabilitation (adjusted OR 17.01; 95% CI 5.33-54.24), and "hospital volume" for cardiac rehabilitation (adjusted OR 4.35; 95% CI 1.14-16.57 for high-volume hospitals; reference low-volume hospital) were independently associated with outpatient cardiac rehabilitation. The participation rate of outpatient cardiac rehabilitation among older post-operative cardiac patients was suboptimal. Further studies are warranted to examine its generalizability and whether a targeted approach to a group of patients who are less likely to receive outpatient cardiac rehabilitation could improve the participation rate.

Predicting demand for long-term care using Japanese healthcare insurance claims data.

Driven by the rapid aging of the population, Japan introduced public long-term care insurance to reinforce healthcare services for the elderly in 2000. Precisely predicting future demand for long-term care services helps authorities to plan and manage their healthcare resources and citizens to prevent their health status deterioration. This paper presents our novel study for developing an effective model to predict individual-level future long-term care demand using previous healthcare insurance claims data. We designed two discriminative models and subsequently trained and validated the models using three learning algorithms with medical and long-term care insurance claims and enrollment records, which were provided by 170 regional public insurers in Gifu, Japan. The prediction model based on multiclass classification and gradient-boosting decision tree achieved practically high accuracy (weighted average of Precision, 0.872; Recall, 0.878; and F-measure, 0.873) for up to 12 months after the previous claims. The top important feature variables were indicators of current health status (e.g., current eligibility levels and age), risk factors to worsen future healthcare status (e.g., dementia), and preventive care services for improving future healthcare status (e.g., training and rehabilitation). The intensive validation tests have indicated that the developed prediction method holds high robustness, even though it yields relatively lower accuracy for specific patient groups with health conditions that are hard to distinguish.