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

Abstract

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.

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

“…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.…”

“…Second, morbidity status is not adjusted due to a lack of medical information in the LTCI claims data, even though morbidity status is known to be an important factor in LTC demand. 34 Third, only those who have LTC certifications are included in our study, even though the large variation in LTC certification among regions is an issue. 40 Future study is needed to systematically investigate whether access to LTCI services is equitable.…”

Multimorbidity Analysis of 13 Systemic Diseases in Northeast China

“…A person with numerous long-term health conditions has an increased risk of depression, hospitalizations, polypharmacy, loss of physical functioning, and even premature death [5,6]. In addition, multimorbidity places a substantial economic burden on the healthcare system [7][8][9][10], especially in the world's most populous country, China [11,12], because patients with multimorbidity often require additional intensive treatment and monitoring by nurses, physicians and other healthcare staff [13,14]. Therefore, the identification of the key determinants of multimorbidity is an important public health aim that should be addressed urgently.…”

Geographical distribution of family physicians in Japan: a nationwide cross-sectional study

“…Family physicians are pivotal in providing care in Japan where the population is rapidly ageing and more patients than ever are presenting with numerous chronic conditions. The prevalence of multimorbidity, the co-occurrence of two or more disorders, was 29.9% among adults and 80.2% among elderly aged 75 or older in Japan [24, 25]. The government and professional bodies need to counteract the limited popularity of family medicine.…”