Technical Efficiency of Prevention Services for Functional Dependency in Japan's Public Long-term Care Insurance System: An Ecological Study.
Int J Health Policy Manag
; 13: 8226, 2024.
Article
em En
| MEDLINE
| ID: mdl-39099485
ABSTRACT
BACKGROUND:
Public long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan's public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive.METHODS:
We estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates.RESULTS:
Prevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range 0.89-0.99).CONCLUSION:
These findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Seguro de Assistência de Longo Prazo
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Região como assunto:
Asia
Idioma:
En
Revista:
Int J Health Policy Manag
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Japão
País de publicação:
IR
/
IRAN
/
IRÃ