Estimated expenditures for hip fractures using merged healthcare insurance data for individuals aged ≥ 75 years and long-term care insurance claims data in Japan

Mori, Takahiro; Tamiya, Nanako; Jin, Xueying; Jeon, Boyoung; Yoshie, Satoru; Iijima, Katsuya; Ishizaki, Tatsuro

doi:10.1007/s11657-018-0448-2

Cited by 22 publications

(24 citation statements)

References 21 publications

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“…Indeed, the previous studies based on claims data from one city in Japan suggested that there is a trade-off between medical and LTC expenditures; hence, it is important to include both medical and LTC expenditures when the societal financial burden from multiple diseases is evaluated. 22 , 34 At the time of this analysis, however, national medical insurance claims data could not be merged with national LTCI claims data in Japan. If such a procedure is available in the future, further study, including both medical insurance and LTCI claims data, would be warranted.…”

Section: Discussionmentioning

confidence: 99%

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Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Jin

Mori

Watanabe

et al. 2020

European Journal of Public Health

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Background Japan, with the oldest population in the world, faces a financial challenge caused by rising long-term care (LTC) expenditure. For policymakers to address this, it is important that we have a better understanding of how individual and regional characteristics affect LTC expenditure. Methods We linked national LTC insurance (LTCI) claim data, covering the entire population who used LTCI services in Japan, with municipality data on an individual level. Individuals 65 years and older (n=3 876 068) who had used LTCI benefits at least once in the fiscal year (FY) 2016 were included. We examined the associations of individual and municipality characteristics regarding supply and demand of healthcare with the LTC expenditures on facility care, home and community care, and total care (the sum of both types of care), after adjusting for regional differences in LTC extra charges. Results The following variables were associated with higher total expenditure; at the individual level: female, a higher care-need level, a lower income (0% co-payments) or a facility service user; at the municipality level: municipalities locating in metropolitan areas, with a higher proportion of single elderly households, more doctors per 1000 citizens, more nursing homes per 100 000 LTC benefit users or more outpatient medical spending per citizen ≥75 years old. Conclusions As we are able to identify several individual and municipality characteristics associated with higher LTC expenditure in Japan, the study offers insights into dealing with the rapidly growing LTC expenditure.

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Section: Discussionmentioning

confidence: 99%

“…Finally, the variables capturing medical spending 22 were included. These were medical expenditure per capita, inpatient medical spending per citizen ≥75 years old and outpatient medical spending per citizen ≥75 years old.…”

Section: Methodsmentioning

confidence: 99%

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Jin

Mori

Watanabe

et al. 2020

European Journal of Public Health

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“…We obtained medical insurance claims data of the Late-Stage Medical Care System for the Elderly (i.e., adults ≥75 years) and LTC insurance claims data from the municipal government of Kashiwa City: a suburb in the Tokyo metropolitan area. Kashiwa City had a population of approximately 405,000 in 2012 with 8.7% of the population being at least 75 years old in October 2012 [20]. Insurance claims data for the period between April 2012 and September 2013 were available for analysis at the time of this study.…”

Section: Methodsmentioning

confidence: 99%

“…We included medical insurance claims data from both Diagnosis Procedure Combination/Per-Diem Payment Systems (DPC/PDPS) and non-DPC/PDPS. DPC/PDPS was introduced in Japan in 2003, and it offers a case-mix payment system for acute inpatient care according to diagnoses and procedures [20].…”

Section: Methodsmentioning

confidence: 99%

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

et al. 2019

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Background The occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan. Methods Medical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level. Results The mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34% of the sum, respectively. Every increase in one unit of the CCI scores was associated with a ¥257,000 (US$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures ( p < 0.001; n = 29,915). Conclusions Using a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone. Electronic supplementary material The online version of this article (10.1186/s12877-019-1057-7) contains supplementary material, which is available to authorized users.

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“…This study identified all diseases recorded in the claims for hospital admissions. The diseases with a “suspicious” flag in the claims datasets were excluded from the comorbidities because they were used to justify diagnostic procedures at non-DPC/PDPS hospitals with a fee-for-service payment system [ 28 ]. The comorbidities were categorized by ICD-10 codes for the Charlson Comorbidity Index (CCI) [ 29 , 30 ], as well as underlying diseases [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Long‐term prognosis of enteral feeding and parenteral nutrition in a population aged 75 years and older: a population‐based cohort study

et al. 2021

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Background Enteral feeding and parenteral nutrition (PN) using gastrostomy (GS) and a nasogastric tube feeding (NGT) and PN should be initiated for older patients based on their prognoses. This study aimed to investigate the long-term prognosis of patients aged ≥75 years who underwent enteral feeding via GS and NGT as well as PN. Methods A population-based cohort study was conducted using Japan’s universal health insurance claims in the Nara Prefecture. This study enrolled 3,548 patients aged ≥75 years who received GS (N=770), NGT (N=2,370), and PN (N=408) during hospital admissions between April 2014 and March 2016. The GS group was further categorized into secondary GS (N=400) with preceding NGT or PN within 365 days and primary GS (N=370) without preceding NGT or PN groups. In the secondary GS group, 356 (96%) patients received NGT (versus PN). The outcome was mortality within 730 days after receiving GS, NGT, and PN. Cox regression analyses in cases with or without malignant diseases, adjusted for sex, age, comorbidity, and hospital type, were performed to compare mortality in the groups. Results Of the 3,548 participants, 2,384 (67%) died within 730 days after the initiation of GS and NGT and PN. The 2-year mortality rates in the secondary GS, primary GS, NGT, and PN groups were 58%, 66%, 68%, and 83% in patients without malignancies and 67%, 71%, 74%, and 87% in those with malignancies, respectively. In the non-malignant group, Cox regression analysis revealed that secondary GS (hazard ratio (HR) = 0.43, 95% CI: 0.34–0.54), primary GS (HR = 0.51, 95% CI: 0.40–0.64), and NGT (HR = 0.71, 95% CI: 0.58-0.87) were statistically significantly associated with lower mortality compared with PN. Conclusions Approximately 58% to 87% patients aged ≥75 years died within 730 days after initiation of nutrition through GS, NGT, or PN. Patients with non-malignant diseases who received secondary GS exhibited better 2-year prognosis than those who received NGT or PN. Healthcare professionals should be aware of the effectiveness and limitations of enteral feeding and PN when considering their initiation.

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Estimated expenditures for hip fractures using merged healthcare insurance data for individuals aged ≥ 75 years and long-term care insurance claims data in Japan

Cited by 22 publications

References 21 publications

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims

The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan

Long‐term prognosis of enteral feeding and parenteral nutrition in a population aged 75 years and older: a population‐based cohort study

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