Effects of the 2018 Japan Floods on long-term care insurance costs in Japan: retrospective cohort study

Abstract

Background Climate change has increased the frequency and severity of torrential rains and floods around the world. Estimating the costs of these disasters is one of the five global research priorities identified by WHO. The 2018 Japan Floods hit western Japan causing extensive destruction and many deaths, especially among vulnerable elderly. Such affected elderly would need long-term care due to the various health problems caused by the disaster. A Long-Term Care Insurance (LTCI) system provides care services in Japan. The aim of this study was to evaluate the effect of the 2018 Japan Floods on LTCI costs and service utilization. Methods The participants of this retrospective cohort study were all verified persons utilizing LTCI services in Hiroshima, Okayama and Ehime prefectures. The observation period was from 2 months before to 6 months after the disaster. We used Generalized Estimating Equations (GEEs) to examine the association between disaster status (victims or non-victims) and the monthly total costs of LTCI service (with gamma-distribution/log-link) by residential environment (home or facility). Among home residents, we also examined each service utilization (home-based service, short-stay service and facility service), using the GEEs. After the GEEs, we estimated Average Marginal Effects (AME) over all observation periods by months as the attributable disaster effect. Results The total number of participants was 279,578. There were 3024 flood victims. The disaster was associated with significantly higher total costs. The AME for home residents at 2 months after was $214 (Standard Error (SE): 12, p < 0.001), which was the highest through the observation period. Among facility residents, the AME immediately after the disaster increased by up to $850 (SE: 29, p < 0.001). The service utilization among home residents showed a different trend for each service. The AME of home-based services decreased by up to − 15.2% (SE:1.3, p < 0.001). The AME for short-stay service increased by up to 8.2% (SE: 0.9, p < 0.001) and the AME for facility service increased by up to 7.4% (SE: 0.7, p < 0.001), respectively. Conclusions The 2018 Japan Floods caused an increase in LTCI costs and the utilization of short-stay and facility services, and a decrease in utilization of home-based services.

Effects of 2018 Japan floods on healthcare costs and service utilization in Japan: a retrospective cohort study

“…The WHO has noted that the problem of healthcare costs is vital to building a healthcare system that is resilient against climate change, and there are few estimations of these costs [ 35 ]. We have already shown the change in costs of long-term care insurance for older victims of this disaster [ 17 ]. Putting these results together, we can provide a more comprehensive account of health-related cost changes for the victims.…”

“…1223-2). Using this dataset, it was found that the victims used more of several types of medicines than non-victims [14][15][16][17].…”

“…Based on this certification, we divided the participants into victims and nonvictims as the main exposure groups. The certification criteria are as follows as with previous studies: (1) a person's house was completely or partially damaged, burned down, flooding of a floor, or similar damage; or (2) the main breadwinner died, was seriously injured, became ill, or went missing [17,22,23,33]. The disaster status tagged for each subject in the NDB was extracted for this study.…”

“…These include health and long-term care insurance. We have already examined the change in long-term care services and costs [ 17 ]. This study showed that an increase in LTCI costs and utilization of facilities where older people could stay in could decrease the utilization of services that they avail when staying in private homes.…”

“…The direct health impacts of torrential rain and floods include death or injury due to drowning, electric shock, and other accidental causes [18,19]. Moreover, the loss of clean water supply, interruption of transportation networks, shutdown of electric power, and impairment of communication networks cause indirect health impacts, such as the exacerbation of mental illness and cognitive impairment [17,[20][21][22][23]. Previous studies that examined the increase in healthcare service utilization and healthcare costs after disasters have been either ecological studies or investigations of a few specific affected municipalities or facilities [24,25].…”