BackgroundThe population is aging rapidly in many developed countries. Such countries need to respond to the growing demand and expanding costs of healthcare (HC) for the elderly. Therefore, it is important to investigate the factors correlating such HC costs. In Japan, HC is composed of two sections, namely medical care (MC) and long-term care (LTC). While many studies have examined MC and LTC costs on their own, few studies have conducted comprehensive investigations of HC costs. The aim of this study is to examine the risk factors that influence HC costs for the elderly who enroll in the LTC insurance system in Japan.MethodsThe inclusion criteria in the present study are as follows: being 65 years of age, or older; certified eligibility for, and use of services offered by the LTC insurance system at home or in an institutional setting in December 2009; and being covered by the National Health Insurance (NHI) system. MC and LTC insurance data were obtained from claim records for the elderly in July and December of 2007, 2008, and 2009 (i.e., a total of six survey points). Panel data, per subject, were constructed using MC and LTC claim records. The sample included 810 subjects and 4029 observations.ResultsWe estimated a regression equation with a censored dependent variable using a Tobit model. Significant associations between MC or LTC costs and interaction terms (household composition × seasonal effects) were investigated. MC costs significantly decreased and LTC costs significantly increased among subjects living alone during winter. Income level was also a positive determinant of MC costs, while eligibility level was a positive determinant of LTC costs.ConclusionsWe recommend that the health policy for the elderly focus more on seasonal effects, household composition, and income level, as well as on eligibility level.
The number of regional ACHD centers offering sufficient outpatient and inpatient care is limited; transfer from pediatric departments is not standard in Japan. Role division clarification between regional ACHD centers and other facilities and cooperative network establishment including transitional care programs is necessary. (Circ J 2016; 80: 1242-1250).
Background Task shifting and task sharing in health care are rapidly becoming more common as the shortage of physicians increases. However, research has not yet examined the changing roles of hospital administrative staff. This study clarified: (1) the adverse incidents caused by hospital administrative staff, and the direct and indirect impact of these incidents on patient care; and (2) the incidents that directly involved hospital administrative staff. Methods This study used case report data from the Japan Council for Quality Health care collected from April 1, 2010 to March 31, 2019, including a total of 30,823 reports. In April 2020, only the 88 self-reported incidents by hospital administrative staff were downloaded, excluding incidents reported by those in medical and co-medical occupations. Data from three reports implicating pharmacists were rejected and the quantitative and textual data from the remaining 85 case reports were analyzed in terms of whether they impacted patient care directly or indirectly. Results Thirty-nine reports (45.9%) involved direct impact on patient care, while 46 (54.1%) involved indirect impact on patient care. Most incidents that directly impacted patient care involved administrative staff writing prescriptions on behalf of a doctor (n = 24, 61.5%); followed by errors related to system administration, information, and documentation (n = 7, 17.9%). Most reported errors that indirectly affected patient care were related to system administration, information, and documentation used by administrative staff (n = 22, 47.8%), or to reception (n = 9, 19.6%). Almost all errors occurred during weekdays. Most frequent incidents involved outpatients (n = 23, 27.1%), or occurred next to examination/operation rooms (n = 12, 14.1%). Further, a total of 14 cases (16.5%) involved patient misidentification. Conclusions Incidents involving hospital administrative staff, the most common of which are medication errors from incorrect prescriptions, can lead to severe consequences for patients. Given that administrative staff now form a part of medical treatment teams, improvements in patient care may require further submission and review of incident reports involving administrative staff.
As life expectancy among the elderly has improved, increases in health care spending and care methods have become issues in many developed countries. The present study examined health care costs for disabled elderly with a focus on care location. A total of 226 inhabitants (age, over 65 years) of a town in Hokkaido, whose Care Needs Levels were classified by Long-Term Care Insurance and who were covered by National Health Insurance, participated in this study. We considered three care locations for disabled elderly: home, LTC facilities and chronic hospitals. We performed generalized liner model (GLM) with log link for the subjects of home and LTC facilities, in order to determine which factor affected health care costs. The dependent variable was health care cost, and independent variables were age, gender, Care Needs Level, and hospital length of stay. Age and hospital length of stay were treated as continuous variables, and the other variables were treated as dummy variables. We described health care cost for the subjects in chronic hospitals by Care Needs Level and length of hospital stay, because the number of those was too small to conduct multivariate analysis. Institutional costs accounted for 74% of health care costs. Care Needs Level and hospital length of stay were factors significantly associated with health care costs, particularly with respect to home and LTC facilities. It has been suggested that preventing Care Needs Level becoming more severe and prolonging home care could be effective for reducing health care cost. But it may be said that we should consider the family status of the disabled elderly at the selection of care location.
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