Long-term Care Expenditures Research Articles

EE404 Associations of Comprehensive Stroke Center Scores with Medical and Long-Term Care Expenditures in Ischemic Stroke Patients after Hospital Discharge: J-Aspect & Life Study

Comprehensive stroke centers (CSCs) are facilities that can diagnose and treat stroke patients with intensive and advanced care. CSC capabilities can be assessed using CSC scores that are calculated based on a hospital’s fulfillment of 25 recommended items. This study aimed to investigate the relationships between CSC scores and medical and long-term care (LTC) expenditures in ischemic stroke patients after hospital discharge.

‘Investing’ in care for old age? An examination of long-term care expenditure dynamics and its spillovers

We study the dynamic drivers of expenditure on long-term care (LTC) programmes, and more specifically, the effects of labour market participation of traditional unpaid caregivers (women aged 40 and older) on LTC spending, alongside the spillover effects of a rise in LTC expenditure on health care expenditures (HCE) and the economy (per capita GDP). Our estimates draw from a panel of more than a decade worth of expenditure data from a sample of OECD countries. We use a panel vector auto-regressive (panel-VAR) system that considers the dynamics between the dependent variables. We find that LTC expenditure increases with the rise of the labour market participation of the traditional unpaid caregiver (women over 40 years of age), and that such expenditures rise exerts large spillover effects on health spending and the economy. We find that a 1% increase in female labour participation gives rise to a 1.48% increase in LTC expenditure and a 0.88% reduction in HCE. The effect of LTC spending over HCE is mainly driven by a reduction in inpatient and medicine expenditures, exhibiting large country heterogeneity. Finally, we document significant spillover effects of LTC expenditures on per capita GDP.

Saving preferences after retirement

We investigate the importance of alternative motives for saving and spending patterns after retirement in the Netherlands and Australia. Using an online experimental survey, we elicit the impact on advised spending patterns and underlying saving motives of alternative retirement drawdown designs, ranging from complete flexibility in Australia to full annuitization in the Netherlands, and of major life events such as becoming frail or losing a spouse. We find that important motives for spending and saving after retirement in both countries are the desire to remain financially independent and to ensure that it is possible to enjoy life now as well as later. However, consistent with differences in real world pension settings, life span risk is more important and liquidity less important in Australia than in the Netherlands. With the exception of inter vivos transfers to a surviving spouse, the bequest motive is not important in either country. Our results suggest that an important reason for the widespread behaviour of retirees to hold on to their wealth might be the desire to hold precautionary savings for health and long-term care expenditures. We also find that individuals revise their saving motives in anticipation of major life events but are less responsive to variation in ‘experimental’ retirement drawdown arrangements, remaining aligned to the prevailing institutional arrangements in their country.

Total care expenditures and their drivers among older adults: A study on health and long-term care expenditures in South Korea

BackgroundSouth Korea operates two different national insurance systems: health care insurance covers medical services and long-term care (LTC) insurance covers residential care and home care services. Total care expenditures include benefits from both these insurance schemes and personal payments made for receiving these services. This study aims to identify total care expenditures per older person along with related factors and their effects on care expenditures.MethodsWe analyzed claims data of 2017 for LTC and health care insurance in Korea using multiple regression analysis. Participants were recipients of LTC insurance, aged 60 years or above (n = 650,059). The variables of interest included socioeconomic characteristics, disabilities, chronic diseases, and care needs levels.ResultsThe total expenditures were approximately USD 9,808,922,016 for 650,059 older people (USD 15,089.28 ± 8,006.57 per person) in 2017. The benefits of national health insurance accounted for 86.03% of the total, while personal payments accounted for 13.97%. Comparing the expenditure across services, the total amount was found to be much higher for LTC services. The personal payments were similar for the two insurance schemes, and the proportion of expenses by service type (to total expenses) was greater for LTC (LTC versus health care expenditures: 63.25% versus 36.15% of the total expenditures). The total care expenditures differed significantly according to recipient characteristics. Older adults who were women, between 75–84 years old, with higher care needs levels, and who suffered from diseases and lived in the residential facilities were associated with an increase in total expenditures. Moreover, factors such as any type of disability and living alone were related to a decrease in total care expenditures.ConclusionsThe increase in care expenditures should be monitored from an integrated perspective on overall health care and LTC, and to reduce care needs. In addition, we should focus on the factors involved in using (receiving) services for older individuals and complementing the lack of or inadequate services to enhance and sustain the LTC and health care service systems. Older adults receiving full basic livelihood security and living alone should receive greater attention from the perspective of social equity.

Medical expenditures for fragility hip fracture in Japan: a study using the nationwide health insurance claims database

SummaryUsing the nationwide health insurance claims database in Japan, we estimated total annual medical expenditures for fragility hip fracture across the population at 329.2 billion yen (2.99 billion US dollars). Long-term care expenditures were not included. Fragility hip fracture imposes a considerable health economic burden on society in Japan.PurposeFragility hip fracture imposes a substantial health economic burden on society globally. We aimed to estimate medical expenditures for fragility hip fracture using the nationwide health insurance claims database in Japan.MethodsWe included adults aged 60 and over without prior hip fracture who were admitted for fragility hip fracture (i.e., femoral neck or extracapsular) between October 2014 and October 2015 (13 months). Fragility hip fracture was identified through newly assigned disease codes for fracture and procedure codes associated with the fracture. As a proxy for medical expenditures per patient, incremental payments were calculated (i.e., the difference between the total payments 6 months before and after fragility hip fracture). The total payments included health insurance reimbursements and copayments for inpatient and outpatient services. Long-term care expenditures were not included in this study.ResultsWe identified 142,361 individuals (28,868 male and 113,493 female) with fragility hip fracture. Mean medical expenditures for fragility hip fracture per patient were 2,550,000 yen (¥) (23,180 US dollars [$]; ¥110 = $1) in male and ¥2,494,000 ($22,670) in female patients, respectively. Total annual medical expenditures for fragility hip fracture across the population were 329.2 billion yen (2.99 billion US dollars): 67.96 billion yen (620 million US dollars) in male and 261.24 billion yen (2.37 billion US dollars) in female patients, respectively.ConclusionThis is the first study to estimate medical expenditures for hip fracture using the nationwide health insurance claims database, which represents almost all health insurance claims in Japan. Fragility hip fracture inflicts a considerable health economic burden on society in Japan.

Association of Body Mass Index in Midlife With Morbidity Burden in Older Adulthood and Longevity

Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures. To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older. Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 and January 1973 linked with Medicare follow-up between January 1985 and December 2015. Participants included 29 621 adults who were at least age 65 years in follow-up and enrolled in Medicare. Data were analyzed from January 2020 to December 2021. Standard BMI categories. (1) Morbidity burden at 65 years and older assessed with the Gagne combined comorbidity score (ranging from -2 to 26, with higher score associated with higher mortality), which is a well-validated index based on International Classification of Diseases, Ninth Revision codes for use in administrative data sets; (2) longevity (age at death); and (3) health care costs based on Medicare linkage in older adulthood (aged ≥65 years). Among 29 621 participants, mean (SD) age was 40 (12) years, 57.1% were men, and 9.1% were Black; 46.0% had normal BMI, 39.6% were overweight, and 11.9% had classes I and II obesity at baseline. Higher cumulative morbidity burden in older adulthood was observed among those who were overweight (7.22 morbidity-years) and those with classes I and II obesity (9.80) compared with those with a normal BMI (6.10) in midlife (P < .001). Mean age at death was similar between those who were overweight (82.1 years [95% CI, 81.9-82.2 years]) and those who had normal BMI (82.3 years [95% CI, 82.1-82.5 years]) but shorter in those who with classes I and II obesity (80.8 years [95% CI, 80.5-81.1 years]). The proportion (SE) of life-years lived in older adulthood with Gagne score of at least 1 was 0.38% (0.00%) in those with a normal BMI, 0.41% (0.00%) in those with overweight, and 0.43% (0.01%) in those with classes I and II obesity. Cumulative median per-person health care costs in older adulthood were significantly higher among overweight participants ($12 390 [95% CI, $10 427 to $14 354]) and those with classes I and II obesity ($23 396 [95% CI, $18 474 to $28 319]) participants compared with those with a normal BMI (P < .001). In this cohort study, overweight in midlife, compared with normal BMI, was associated with higher cumulative burden of morbidity and greater proportion of life lived with morbidity in the context of similar longevity. These findings translated to higher total health care expenditures in older adulthood for those who were overweight in midlife.

Educational Gradients in Disability among Asia’s Future Elderly: Projections for the Republic of Korea and Singapore

Asia is home to the most rapidly aging populations in the world. This study focuses on two countries in Asia that are advanced in terms of their demographic transition: the Republic of Korea and Singapore. We developed a demographic and economic state-transition microsimulation model based on the Korean Longitudinal Study of Aging and the Singapore Chinese Health Study. The model was employed to compare projections of functional status and disability among future cohorts of older adults, including disparities in disability prevalence by educational attainment. The model also projects increasing disparities in the prevalence of activities-of-daily-living disability and other chronic diseases between those with low and high educational attainment. Despite overall increases in educational attainment, all elderly, including those with a college degree, experience an increased burden of functional disability and chronic diseases because of survival to older ages. These increases have significant economic and social implications, including increased medical and long-term care expenditures, and an increased caregiver burden.

Autologous platelet-rich plasma vs conventional dressing in the management of chronic diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are a major complication of diabetes. Recently, considerable progress has been achieved in techniques that promote wound healing. Autologous platelet-rich plasma (PRP) is one such technique that is gaining popularity. Platelet-rich plasma is thought to stimulate wound healing by releasing growth factors essential for healing. This research aimed to study the efficacy of PRP in managing chronic DFUs. Seventy-two patients with chronic DFUs were equally divided into 2 groups. The first group was treated with activated PRP injection and gel on the surface of the ulcer, and the second group was treated with conventional dressing using normal saline to irrigate the wound, followed by coverage with petrolatum gauze and sterile dressing. Both methods of treatment improved healing, but there was a significant increase in healing rate among the PRP group compared with the conventional dressing group (31/36 patients [86.11%] vs 23/36 patients [63.89%]; P =.029). Additionally, the healing duration was shorter in the PRP group than in the conventional dressing group (10.90 weeks ± 3.40 standard deviation vs 13.48 weeks ± 3.37, respectively; P =.01). The use of autologous PRP results in a higher rate of wound healing in less time compared with conventional wound care in managing DFUs. Platelet-rich plasma is an effective and promising treatment for chronic DFUs; PRP enables healing in less time. This is expected to positively affect the individual's performance and minimize long-term health care expenditure on foot ulcers.

Investing in Aged Care? Long-Term Care Expenditure Dynamics and Health Care Spillovers

Investing in Aged Care? Long-Term Care Expenditure Dynamics and Health Care Spillovers

Identification of Long-term Care Challenges in Europe

Background: Changes in demographic structures and especially the dynamic ageing of the population lead to an increased demand for care services. Finding ways to provide them efficiently has become one of the challenges for developed countries. The choice of the research issue is a consequence of recognising the fact that in recent years it has increasingly emerged as an area of practical and theoretical reflection in many scientific disciplines, including management and health sciences.&#x0D; Research objectives: The aim of the study is to characterize characterising selected aspects of the organisations and functioning of long-term care in EU countries, describing the related initiatives taken by the European Commission and identifying the challenges faced by decision-makers and managers in the said service sector.&#x0D; Research design and methods: The paper is based on the analysis of European documents, Eurostat database and literature review. It provides numerical analysis of current and prospective variables such as: average population age in EU 28, projected population age structure, population aged 65+, long-term care expenditure.&#x0D; Results: Analysis of the available statistical data unambiguously confirms that increasing life expectancy, combined with low birth rates, leads to a significant quantitative increase in the proportion of older people in the overall population structure of EU countries. There is also no internationally accepted and standardised definition of what constitutes long-term care and thus no possibility of reliably identifying needs in this area. In many Member States, long-term care systems are characterised by horizontal interdependencies with health care and social care systems. Consequently, they may and do apply different criteria for long-term care eligibility, needs assessment, social protection scope and the catalogue of services and benefits offered.&#x0D; Conclusions: The evolving social structures, the increasing introduction of artificial intelligence solutions and the situation after COVID-19 are changing the conditions of long-term care functioning, hence the reflection on the directions of these transformations is essential to properly formulate public policy practices.

The Effects of Severe Acute Respiratory Syndrome Coronavirus 2 on the Reported Mental Health Symptoms of Nonprofessional Carers: An Analysis Across Europe

ObjectivesThis study tries to analyze how the crisis generated by severe acute respiratory syndrome coronavirus 2 has affected the reported mental health symptoms of informal caregivers in different European countries. MethodsThe Survey of Health, Ageing and Retirement in Europe-COVID-19 was used, collecting information from the beginning of June 2020 to August 2020 about individuals’ state of health and the care they received. Several probit regression models were used to analyze the differences in the probability of (1) being sad or depressed, (2) being anxious or nervous, (3) having difficulty sleeping, and (4) feeling lonely, between individuals who provided informal care and individuals who did not. Several subanalyses by geographic area, mortality rates due to coronavirus disease 2019 (COVID-19), and long-term care expenditure were also performed. ResultsSince the outbreak of COVID-19, informal caregivers have had a higher probability of being sad or depressed of 8 percentage points (p.p.), a 7.1 p.p. higher probability of being anxious or nervous, and a 5.9 p.p. higher probability of having difficulty sleeping than non-caregivers. Informal caregivers in Southern Europe have had an 8 p.p. higher probability of being sad or depressed than non-caregivers. In Eastern Europe, this difference in probability reaches 9.7 p.p. Finally, in countries with higher mortality rates due to COVID-19, there have been greater differences in terms of being sad or depressed between caregivers and non-caregivers, regardless of expenditure on long-term care. ConclusionsSince the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers.

Medical Care and Long-Term Care Expenditures Attributable to Alzheimer's Disease Onset: Results from the LIFE Study.

Background:Alzheimer’s disease (AD) can increase both medical care and long-term care (LTC) costs, but the latter are frequently neglected in estimates of AD’s economic burden.Objective:To elucidate the economic burden of new AD cases in Japan by estimating patient-level medical care and LTC expenditures over 3 years using a longitudinal database.Methods:The study was performed using monthly claims data from residents of 6 municipalities in Japan. We identified patients with new AD diagnoses between April 2015 and March 2016 with 3 years of follow-up data. Medical care and LTC expenditures were estimated from 1 year before onset until 3 years after onset. To quantify the additional AD-attributable expenditures, AD patients were matched with non-AD controls using propensity scores, and their differences in expenditures were calculated.Results:After propensity score matching, the AD group and non-AD group each comprised 1748 individuals for analysis (AD group: mean age±standard deviation, 81.9±7.6 years; women, 66.0%). The total additional expenditures peaked at $1398 in the first month, followed by $1192 and $1031 in the second and third months, respectively. The additional LTC expenditures increased substantially 3 months after AD onset ($227), and gradually increased thereafter. These additional LTC expenditures eventually exceeded the additional medical care expenditures in the second year after AD onset.Conclusion:Although total AD-attributable expenditures peaked just after disease onset, the impact of LTC on these expenditures rose over time. Failure to include LTC expenditures would severely underestimate the economic burden of AD.

LONG-TERM CARE AND SOCIAL SECURITY IN INDIA

Long-term care (LTC) spending has highest growth in various functions through health expenditures and types of services available and is expected to grow with coming years. A significant share is given by government or compulsory insurance schemes for LTC. LTC spending is the first policy issue for OECD countries. The paper upholds the analysis made by OECD countries for extending country coverage and improving methodology for the future developments in LTC and health. In addition, the paper will also project the expenditure and scope for LTC in BRIICS (Brazil, Russia, India, Indonesia, China and South Africa) countries. The paper will differentiate between health and LTC expenditure and demographic and non-demographic drivers for each study.

Comparison of 4-Year Health Care Expenditures Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Data on the long-term health care expenditures associated with bariatric surgery consisting of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are lacking. To compare 4-year health care expenditures after RYGB vs sleeve gastrectomy, identify factors independently associated with 4-year health care expenditures, and compare the procedures in terms of subsequent hospitalizations, bariatric procedures, and all-cause mortality. In this propensity score-matched cohort study, all residents of Ontario, Canada, who underwent publicly funded surgery with RYGB (n = 6301) or sleeve gastrectomy (n = 926) from March 1, 2010, to March 31, 2015, and consented to participate in the Ontario Bariatric Registry were eligible for the study. Follow-up was completed on March 31, 2019, and data were analyzed from May 5, 2020, to May 20, 2021. RYGB and sleeve gastrectomy. Publicly funded health care expenditures, subsequent hospitalizations, bariatric procedures, and mortality during the 4 years after RYGB or sleeve gastrectomy. The 1:1 matched study cohorts consisted of 1624 patients (812 per cohort) with a mean (SD) age of 48.0 (10.6) years, and 1242 women (76.5%). The mean body mass index (calculated as weight in kilograms divided by height in square meters) was 51.9 (8.3) for the RYGB cohort and 51.9 (8.9) for the sleeve gastrectomy cohort. The 4-year cumulative costs were not statistically significantly different between RYGB and sleeve gastrectomy (mean [SD], $33 682 [$31 169] vs $33 948 [$32 633], respectively; P = .86). Having a history of coronary artery disease was associated with a 35% increase in overall health care expenditures; chronic kidney disease, a 54% increase; and mental health admissions, a 67% increase. There were no statistically significant differences in all-cause mortality between RYGB and sleeve gastrectomy (1.5% vs 2.2%, respectively; P = .26) or the total number of hospitalizations (754 vs 669, respectively; P = .11) during the 4-year follow-up period. However, nonelective hospitalizations occurred more frequently with RYGB vs sleeve gastrectomy (472 vs 339, respectively; P = .002). Roux-en-Y gastric bypass was associated with relatively fewer subsequent bariatric procedures during the 4-year follow-up period (9 vs 40, respectively; P < .001). In this Canadian population-based study, key results indicated that 4-year health care expenditures, all-cause mortality, and number of hospital admissions associated with RYGB did not significantly differ from those for sleeve gastrectomy. The rate of subsequent bariatric surgery was lower with RYGB. This study identified important patient-level drivers of health care expenditures that need to be further investigated.

Does public long‐term care expenditure improve care‐related quality of life of service users in England?

Public long-term care (LTC) systems provide services to support people experiencing difficulties with their activities of daily living. This study investigates the marginal effect of changes in public LTC expenditure on care-related quality of life (CRQoL) of existing service users in England. The public LTC program for people aged 18 or older in England is called Adult Social Care (ASC) and it is provided and managed by local authorities. We collect data on the outcomes and characteristics of public ASC users, on public ASC expenditure, and on the characteristics of local authorities across England in 2017/18. We employ an instrumental variable approach using conditionally exogenous elements of the public funding system to estimate the effect of public ASC expenditure on user CRQoL. Our findings show that by increasing public ASC expenditure by £1000 per user, on average, local authorities increase user CRQoL by 0.0030. These results suggest that public ASC is effective in increasing users' quality of life but only to a relatively small extent. When combined with the other potential effects of LTC expenditure (e.g., on informal carers, mortality), this study can inform policy makers in the United Kingdom and internationally about whether social care provides good value for money.

Trajectories of end-of-life medical and long-term care expenditures for older adults in Japan: retrospective longitudinal study using a large-scale linked database of medical and long-term care claims

BackgroundAn accurate understanding of the current state of end-of-life care is important for healthcare planning. The objectives of this study were to examine the trajectories of end-of-life medical and long-term care expenditures and associated factors.MethodsThis was a retrospective longitudinal study using a large-scale linked database of medical and long-term care claims—National Health Insurance, Advanced Elderly Medical Insurance, and long-term care insurance—covering Prefecture A in Japan. Patients aged ≥70 years who died between April 1, 2016, and March 31, 2017, were included (N = 16,084 patients; mean age = 85.1 ± 7.5 years; 7804 men (48.5%) and 8280 women (51.5%)). The outcome measures were medical expenditures (inpatient, outpatient, and prescription), long-term care expenditures, and total healthcare expenditures (the sum of medical and long-term care expenditures) during the 60 months before the date of death. We calculated each patient’s monthly medical and long-term care expenditures for 60 months before the date of death and applied group-based trajectory modeling to identify distinct trajectories. Factors associated with spending trajectories were examined via multinomial logistic regression analyses. Explanatory variables included age, sex, diseases, and the medical services used.ResultsWe identified six distinct spending trajectories for the total healthcare expenditures: high persistent (45.6%), medium-to-high persistent (26.1%), early rise then high persistent (9.8%), late rise (6.4%), low persistent then very late rise (i.e., when spending starts increasing later than “late rise”; 6.4%), and progressive increase (5.7%). Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. The trajectory pattern of medical expenditures was similar to that of total healthcare expenditures; however, a different pattern was seen for long-term care expenditures.ConclusionsRegarding combined medical and long-term care spending of the last 5 years, most patients belonged to a pattern in which the healthcare expenditures remained high, and a combination of multiple factors contributed to these patterns. This finding can offer healthcare providers a longer-term perspective on end-of-life care.

Trajectories of Long-Term Care Expenditure During the Last 5 Years of Life in Japan: A Nationwide Retrospective Cohort Study

ObjectivesDespite the significant utilization of long-term care (LTC) services at the end of life, evidence on the trajectory of LTC expenditure in later life is scarce. This study aims to identify distinct trajectories of LTC expenditure in the last 5 years of life and to examine whether these trajectories differ according to cause of death. DesignA nationwide retrospective longitudinal cohort study based on linked data of National LTC Claims and the Japan's National Vital Statistic. Setting and ParticipantsParticipants comprised decedents aged 70 years or older and who died in 2017. MethodsWe assessed 5 years of monthly LTC expenditure among participants and applied group-based trajectory model to identify distinct trajectories of LTC expenditure. Subsequently multinominal logistic regression analysis was performed to investigate how these trajectories vary according to cause of death. ResultsAmong 1,124,335 decedents, 4 distinct trajectories of LTC expenditure were identified: persistently low (58.5%), late increase (9.8%), progressive increase then late decrease (8.8%), and persistently high (22.9%). Approximately 80.7% of total LTC expenditure was spent by the persistently high group. After adjustment for age and sex; deaths due to age-related physical debility and dementia were associated with persistently high LTC expenditure. Conclusions and ImplicationsOngoing discussions of LTC policy and reducing LTC expenditure may be more effective when emphasizing persistently high spenders. In addition, budget allocation for LTC at the end of life should be combined with data for health conditions.

Economic Consequences of Manipulation of Social Insurance Benefits

This paper examines the economic consequences of manipulation of social insurance benefits. Using administrative data of the public long-term care insurance (LTCI) in Japan, we document novel discontinuity and bunching in the distribution of health scores that determine benefit levels for LTCI. The observed distribution suggests that LTCI recipients tend to receive more generous benefits than they should because medical examiners manipulate recipients' health score. To quantify the impact of manipulation on long-term care (LTC) expenditures, we develop partial identification and nonparametric estimation methods that allow for flexible restrictions on counterfactual distribution. Our baseline estimation indicates that the manipulation increases monthly LTC expenditures per recipient by 60.2-227.9 USD (3.7-15.5%). We also find that the lower bound on manipulation effects is robust to various restrictions.

Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

Simulating the Impact of Long-Term Care Prevention Among Older Japanese People on Healthcare Costs From 2020 to 2040 Using System Dynamics Modeling.

Objectives: This study examined how healthcare costs might change by reducing long-term care needs among older Japanese people.Methods: A simulation model was constructed comprising two aging chains for independent and dependent people aged ≥65 years by sex. Changes in the base run from 2020 to 2040 were compared with those in two hypothetical scenarios: a 2% annual reduction in death rates (S1), and S1 plus a 2% annual reduction in the proportion of dependent people aged 65 years and in transition rates from the independent to dependent state for people aged ≥65 years (S2).Results: In the base run, the population increased by 13.0% for men and 11.3% for women, and the proportion of dependent people increased by 4.6% for men but decreased by 13.4% for women. The sum of medical and long-term care expenditure increased in the base run, S1, and S2 by 8.2, 27.4, and 16.4%, respectively, for men and women combined.Conclusions: Healthcare costs will increase as death rates fall, but the increase will be attenuated if the proportion of dependent people decreases.