Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan.
Cost-Sharing
Hospitalization Cost
Japan
Length of Stay
Older People
Journal
International journal of health policy and management
ISSN: 2322-5939
Titre abrégé: Int J Health Policy Manag
Pays: Iran
ID NLM: 101619905
Informations de publication
Date de publication:
01 Apr 2022
01 Apr 2022
Historique:
received:
22
11
2019
accepted:
28
09
2020
pubmed:
17
10
2020
medline:
26
3
2022
entrez:
16
10
2020
Statut:
epublish
Résumé
The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system. The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization. For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level. The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.
Sections du résumé
BACKGROUND
BACKGROUND
The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system.
METHODS
METHODS
The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization.
RESULTS
RESULTS
For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level.
CONCLUSION
CONCLUSIONS
The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.
Identifiants
pubmed: 33059428
doi: 10.34172/ijhpm.2020.190
pmc: PMC9309955
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
489-497Informations de copyright
© 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Références
BMC Health Serv Res. 2014 Dec 21;14:630
pubmed: 25528468
Health Aff (Millwood). 2015 Jun;34(6):907-15
pubmed: 26056194
Int J Health Policy Manag. 2019 May 29;8(8):462-466
pubmed: 31441285
J Orthop Traumatol. 2015 Sep;16(3):209-13
pubmed: 25697846
JAMA Intern Med. 2018 Mar 1;178(3):347-355
pubmed: 29356828
Health Policy. 2012 Oct;107(2-3):194-201
pubmed: 22277879
JAMA. 2015 Jan 20;313(3):243-4
pubmed: 25602990
Medicine (Baltimore). 2020 May;99(18):e19871
pubmed: 32358355
N Engl J Med. 2015 Nov 5;373(19):1793-7
pubmed: 26535509
Int J Technol Assess Health Care. 2003 Summer;19(3):465-75
pubmed: 12962333
Annu Rev Public Health. 2009;30:293-311
pubmed: 18976141
Health Econ Rev. 2017 Aug 15;7(1):28
pubmed: 28808952
Geriatr Gerontol Int. 2012 Jan;12(1):72-9
pubmed: 21843199
Int J Health Econ Manag. 2019 Mar;19(1):53-77
pubmed: 29728908
J Am Med Dir Assoc. 2012 Jul;13(6):507-11
pubmed: 22572554
Health Aff (Millwood). 2010 Nov;29(11):1988-94
pubmed: 21041737
Health Aff (Millwood). 2010 Mar-Apr;29(3):530-6
pubmed: 20093294
World Dev. 2018 Jan;101:334-350
pubmed: 29422705
Int J Qual Health Care. 2017 Feb 01;29(1):26-31
pubmed: 27979962
J Health Econ. 2016 Jan;45:115-30
pubmed: 26603160
Health Aff (Millwood). 2007 Mar-Apr;26(2):w195-203
pubmed: 17264100
J Health Econ. 2013 Sep;32(5):850-62
pubmed: 23872676
Benefits Q. 2006;22(1):7-18
pubmed: 16792387
Int J Equity Health. 2018 Jan 27;17(1):11
pubmed: 29374481
J Am Med Dir Assoc. 2012 Mar;13(3):202-6
pubmed: 22056922
Eur J Intern Med. 2013 Apr;24(3):260-5
pubmed: 23269392
Milbank Q. 2015 Jun;93(2):359-91
pubmed: 26044633
N Engl J Med. 2010 Jan 28;362(4):320-8
pubmed: 20107218
Front Pharmacol. 2016 Mar 30;7:73
pubmed: 27065864
Lancet. 2011 Sep 17;378(9796):1106-15
pubmed: 21885107
Med Care. 2013 Jan;51(1):4-10
pubmed: 22874500
Health Policy. 2010 Feb;94(2):120-8
pubmed: 19783062
Int J Equity Health. 2019 Jan 28;18(1):22
pubmed: 30691462
J Am Med Dir Assoc. 2020 May;21(5):640-646.e5
pubmed: 31623988
Int J Equity Health. 2017 Jul 14;16(1):127
pubmed: 28709422
J Econ Perspect. 2011 Spring;25(2):47-68
pubmed: 21595325
Popul Health Manag. 2013 Feb;16(1):58-63
pubmed: 22823294
J Am Geriatr Soc. 2010 Mar;58(3):510-7
pubmed: 20398120
BMC Health Serv Res. 2017 Feb 21;17(1):156
pubmed: 28222774