A panel vector autoregression analysis for the dynamics of medical and long-term care expenditures.

Although medical and long-term care expenditures for older adults are closely related, providing rigorous statistical analysis for their dynamic relationship is challenging. In this research, we propose a novel approach using the panel vector autoregression model to reveal the realized patterns of the interdependence. As an empirical application, we analyze monthly panel data on individuals in a city of Japan, where social insurance covers many formal services for long-term care. Our estimation results indicate the existence of intertemporal transition from expensive acute medical care to reasonable at-home medical care, then to at-home long-term care. Under this context, the enhancement of formal long-term care sector in Japan might have played an important role in the suppression of the total care cost in spite for its rapid aging over the past 2 decades. Additionally, we find that daycare plays multiple roles in Japanese long-term care, such as respite and rehabilitation, but there is no considerable transition from outpatient rehabilitation to daycare in the long-term care sector.

Regional disparities in Dementia-free Life Expectancy in Japan: An ecological study, using the Japanese long-term care insurance claims database.

BACKGROUND: The number of people with dementia increases in an aging society; therefore, promoting policies for dementia throughout the community is crucial to creating a dementia-friendly society. Understanding the status of older adults with dementia in each region of Japan will be a helpful indicator. We calculated Dementia-free Life Expectancy and aimed to examine regional disparities and their associated factors. METHODS: We calculated Dementia-free Life Expectancy and Life Expectancy with Dementia for each secondary medical area in Japan based on the Degree of Independence in Daily Living for the Demented Elderly, using data extracted from the Japanese long-term care insurance claims database. We then conducted a partial least squares regression analysis, the objective variables being Dementia-free Life Expectancy and Life Expectancy with Dementia for both sexes at age 65, and explanatory regional-level variables included demographic, socioeconomic, and healthcare resources variables. RESULTS: The mean estimated regional-level Dementia-free Life Expectancy at age 65 was 17.33 years (95% confidence interval [CI] 17.27-17.38) for males and 20.05 years (95% CI 19.99-20.11) for females. Three latent components identified by partial least squares regression analysis represented urbanicity, socioeconomic conditions, and health services-related factors of the secondary medical areas. The second component explained the most variation in Dementia-free Life Expectancy of the three, indicating that higher socioeconomic status was associated with longer Dementia-free Life Expectancy. CONCLUSIONS: There were regional disparities in secondary medical area level Dementia-free Life Expectancy. Our results suggest that socioeconomic conditions are more related to Dementia-free Life Expectancy than urbanicity and health services-related factors.

Regional variations in in-hospital mortality, care processes, and spending in acute ischemic stroke patients in Japan.

BACKGROUND: Little is known about the regional variations in ischemic stroke care in Japan. This study investigates the regional variations and associations among outcomes, care processes, spending, and physician workforce availability in acute ischemic stroke care. METHODS: Using administrative claims data from National Claims Database, we identified National Health Insurance beneficiaries aged 65 years and older and Long Life Medical Care System beneficiaries from 9 prefectures who had been hospitalized for acute ischemic stroke between April 2010 and March 2012. Patients were grouped according to their subprefectural regions of residence known as secondary medical areas (SMAs). Performances in 8 outcome and process of care measures were analyzed in each SMA. Multilevel regression models with 2 levels (patient and regional) were used to analyze age- and sex-adjusted in-hospital mortality, hospitalization spending, and tissue plasminogen activator (tPA) utilization rate. The associations between regional supply of physicians for stroke care and the various quality measures were investigated. RESULTS: We analyzed 49,440 acute ischemic stroke patients. The regional variations among SMAs in in-hospital mortality, spending, and tPA utilization were 3.2-, 1.7-, and 5.9-fold, respectively. Higher physician supply was significantly associated with lower in-hospital mortality and higher spending. Additionally, spending had a significantly negative correlation with regional continuity of care planning rate but a significantly positive correlation with rehabilitation rate. CONCLUSIONS: The study revealed substantial regional variations in Japanese ischemic stroke care. Improving the allocative efficiency of physicians and establishing continuity of care networks may be useful in mitigating regional disparities and reconstructing the stroke care system.

Patient perceived priorities between technical skills and interpersonal skills: their influence on correlates of patient satisfaction.

OBJECTIVES: The study objective was to elucidate the differences in factors related to overall patient satisfaction levels among subgroups based on whether patients placed higher priorities on technical or interpersonal skills of health care personnel. METHODS: This questionnaire survey targeted 2341 patients discharged from five Japanese hospitals in 2007. Patients were grouped based on whether they prioritized technical or interpersonal skills by chi-squared automatic interaction detection (CHAID) analysis. Multiple regression analysis was used to compare and evaluate differences in various factors related to patient satisfaction among the subgroups. RESULTS: Survey respondent rate was 55.7% (1305 patients). CHAID analysis showed that patients, in particular those warded in surgery departments, tended to place a higher value on technical skills, although paediatric and rehabilitation patients also placed a high value on interpersonal skills. While it has been shown that non-surgical patients tended to prioritize interpersonal skills, our results revealed that patients warded in the surgery department who did not undergo operations still prioritized technical skills. These variation patterns among patient subgroups were further supported by regression analysis of overall patient satisfaction. In surgical patients, the 40- to 79-year-old subgroup regarded technical skills to be more important and the role of the doctor was found to be more associated with overall satisfaction. However, even among surgical patients, older patients placed higher values on interpersonal skills, and overall satisfaction was found to be more associated with health care professionals (besides doctors) and living arrangements. CONCLUSIONS: We conclude that differences in patient satisfaction levels could be influenced by different perspectives on prioritized skills.