Tomoko Ito1, Takahiro Mori2,3,4, Hideto Takahashi5, Natsumi Shimafuji6, Katsuya Iijima7,8, Satoru Yoshie9,7,8,10, Nanako Tamiya1,9. 1. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan. 2. Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan. takahiromori@outlook.com. 3. Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. takahiromori@outlook.com. 4. Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan. takahiromori@outlook.com. 5. National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan. 6. Ridgelinez Limited, 2-6-1, Marunouchi, Chiyoda-ku, Tokyo, 100-6922, Japan. 7. Institute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. 8. Institute for Future Initiatives, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. 9. Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan. 10. Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinano-cho, Shinjuku-ku, Tokyo, 160-8582, Japan.
Abstract
BACKGROUND: 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: The 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.
BACKGROUND: 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: The 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.
Entities:
Keywords:
Community care; Long-term care insurance; Older adults; Prevention services
Authors: Sarah E Lamb; Julie Bruce; Anower Hossain; Chen Ji; Roberta Longo; Ranjit Lall; Chris Bojke; Claire Hulme; Emma Withers; Susanne Finnegan; Ray Sheridan; Keith Willett; Martin Underwood Journal: N Engl J Med Date: 2020-11-05 Impact factor: 91.245