Xueying Jin1,2, Nanako Tamiya1,2, Kazuaki Uda3, Hideo Yasunaga3. 1. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba city, Ibaraki Prefecture, Japan. 2. Health Services Research & Development Center, University of Tsukuba, Tsukuba city, Ibaraki Prefecture, Japan. 3. Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo City, Japan.
Abstract
BACKGROUND: Additional payment approach has been one of the most important incentives in long-term care (LTC) systems for the past 20 years in Japan. OBJECTIVE: To estimate the effect of additional payments on functional decline in long-term care health facility (LTCHF) residents of Japan. DESIGN: A 24-month retrospective cohort study. SETTING AND SUBJECTS: Residents aged ≥65 years who were newly admitted to LTCHFs in the 2014 fiscal year. METHODS: National LTC claims data were linked to the survey of institutions and establishments for LTC. Competing risk regression was performed with functional decline as the primary outcome, and additional payments as exposure, controlling for individual and facility characteristics. The level of LTC needs certified in the LTC insurance system was applied as a proxy of functional ability. Death, hospitalisation, discharge to home and transfer to other LTC facilities were treated as competing events. Individual- and facility-level additional payments were presented as binary variables: being reimbursed or not during the follow-up period. RESULTS: At baseline, 146,311 residents from 3,724 LTCHFs were included. The vast majority of additional payments were associated with a lower risk of functional decline at follow-up. At the individual level, additional payment for pre/post admission instructions had the strongest association with a lower risk of functional decline. Despite this, only 8% of residents were reimbursed for this additional payment. At the facility level, residents in LTCHFs with additional payments for support for home-life resumption and nutritional management were associated with a decreased risk of functional decline. CONCLUSIONS: The results of our study may be of particular interest to policymakers in monitoring and evaluating additional payment approaches and provide insight into improving quality of care.
BACKGROUND: Additional payment approach has been one of the most important incentives in long-term care (LTC) systems for the past 20 years in Japan. OBJECTIVE: To estimate the effect of additional payments on functional decline in long-term care health facility (LTCHF) residents of Japan. DESIGN: A 24-month retrospective cohort study. SETTING AND SUBJECTS: Residents aged ≥65 years who were newly admitted to LTCHFs in the 2014 fiscal year. METHODS: National LTC claims data were linked to the survey of institutions and establishments for LTC. Competing risk regression was performed with functional decline as the primary outcome, and additional payments as exposure, controlling for individual and facility characteristics. The level of LTC needs certified in the LTC insurance system was applied as a proxy of functional ability. Death, hospitalisation, discharge to home and transfer to other LTC facilities were treated as competing events. Individual- and facility-level additional payments were presented as binary variables: being reimbursed or not during the follow-up period. RESULTS: At baseline, 146,311 residents from 3,724 LTCHFs were included. The vast majority of additional payments were associated with a lower risk of functional decline at follow-up. At the individual level, additional payment for pre/post admission instructions had the strongest association with a lower risk of functional decline. Despite this, only 8% of residents were reimbursed for this additional payment. At the facility level, residents in LTCHFs with additional payments for support for home-life resumption and nutritional management were associated with a decreased risk of functional decline. CONCLUSIONS: The results of our study may be of particular interest to policymakers in monitoring and evaluating additional payment approaches and provide insight into improving quality of care.