Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan

Kinjo, Kozen; Sairenji, Tomoko; Koga, Hidenobu; Osugi, Yasuhiro; Yoshida, Shin Ichi; Ichinose, Hidefumi; Nagai, Yasunori; Imura, H; South-Paul, Jeannette E.; Meyer, Mark J.; Honda, Yoshihisa

doi:10.1186/s12913-016-1961-x

Cited by 22 publications

(39 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our estimate on direct costs of home healthcare (USD 2,547 per person per month) was lower than that estimated by Kinjo et al (USD 4,680 per person per month), although the latter was based on patients during their end of life (Kinjo et al, ). Also, our finding that direct home healthcare costs of > 75years old patients was lower than that of other age groups is consistent with that observed by a recent national survey conducted by Ministry of Health (Minisry of Health, L. a. W ).…”

Section: Discussioncontrasting

confidence: 72%

Direct and indirect costs of home healthcare in Japan: A cross‐sectional study

Tomita

Hoshino

Kamiya³

et al. 2020

Health Soc Care Community

View full text Add to dashboard Cite

To tackle the rising healthcare expenditure in an ageing society in Japan, home healthcare has been promoted over the past several years. However, there is a dearth of literature on total costs incurring for home healthcare. In this study, we conducted a cross‐sectional study among patients, who received home healthcare in the month of May, 2018. Direct healthcare costs and patients’ clinical characteristics were collected from medical records and long‐term care databases (n = 166). Indirect costs were estimated using a questionnaire survey which obtained information on job absenteeism and care time from the caregiver. A total of 112 patients responded to the survey. The median age was 82 years (interquartile range: 74–88). Total per‐person per month home‐care costs averaged USD 6,163 with direct costs (USD 2,547) and indirect costs (USD 3,596) accounted for 41.3% and 58.3% of the total costs, respectively. The largest components of direct costs were long‐term care costs (48%) and medical costs (47%). Multivariable adjusted model showed that those with heavy healthcare were more likely to incur higher total as well as direct and indirect home healthcare cost (p<.05 for each). Patients aged >75 years (p = .041) were less likely and those who used oxygen at home were more likely to incur direct home healthcare cost (p = .001) than their counterpart. Our study findings show that indirect cost is a major contributor to total home healthcare costs in Japan. Also for patients who need heavy healthcare, both direct and indirect costs are large burden.

show abstract

Section: Discussioncontrasting

confidence: 72%

Direct and indirect costs of home healthcare in Japan: A cross‐sectional study

Tomita

Hoshino

Kamiya³

et al. 2020

Health Soc Care Community

View full text Add to dashboard Cite

show abstract

“…People living in more deprived areas were more likely to die at a hospital, which might be caused by the inability to bear the costs of caring at home [ 40 ]. In Japan, the average cost of home-based medical care across 30 days was 1.32 times higher than the cost of hospitalization for EOL care (p = 0.3625, $266.8 vs. $202.0) [ 41 ]. In this context, the Japanese health care system, together with universal health insurance coverage, generally favors hospital care rather than home care.…”

Section: Discussionmentioning

confidence: 99%

Association between local-level resources for home care and home deaths: A nationwide spatial analysis in Japan

et al. 2018

View full text Add to dashboard Cite

AimLittle is known about whether and how local-level resources regarding home care are associated with the prevalence of home deaths. We aimed to investigate whether geographic patterns of the resources for home care were associated with the prevalence of home deaths, taking spatial variation into consideration.MethodsWe conducted an ecological cross-sectional study in Japan using nationwide data in 2014. The areal unit was the municipality, the smallest administrative unit in Japan. We investigated the association between the percentage of home deaths and the resources of home care support clinics with available 24-hour-a-day functions, considering the geographic effect of neighboring municipalities by applying a geographically weighted regression model.ResultsThe mean and standard deviation of the percentages of home deaths were 11.4% (5.0%), and those of the number of home care support clinics per 10,000 elderly population were 3.4 (3.7). The percentages of home deaths in neighboring municipalities tended to be significantly correlated (Moran’s I 0.34, p<0.001). Adjusting for the number of hospital beds, total population, and the socio-economic status of municipality, the results of an ordinary least squares regression model showed a positive correlation between the percentage of home deaths and the local resources for home care support clinics per 10,000 elderly population (regression coefficient 0.15, 95% confidence interval 0.07, 0.22), while the existence of spatial autocorrelation of the residual was suggested (Moran’s I of the residual 0.227, p<0.001). The geographically weighted regression model showed local regression coefficients varying across municipalities with a better model fit over the analogous ordinary least squares model (adjusted R2 0.414 vs. 0.131).ConclusionHome deaths were more prevalent in municipalities with greater home care resources. This association was geographically varied and further strengthened in some areas.

show abstract

“…Huber et al 128 described capitated (as opposed to activity-based) payments to providers as a favourable context. Kinjo et al 107 found that replacing hospital with PHC end-of-life care reduced costs only if community care began > 30 days before the patient's death, although that finding reflected the Japanese structure of GP payments.…”

Section: Causal Link 11:13 -Contextsmentioning

confidence: 96%

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

View full text Add to dashboard Cite

Background The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience. Study registration This study is registered as PROSPERO CRD42016038900. Funding The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

show abstract

Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan

Cited by 22 publications

References 33 publications

Direct and indirect costs of home healthcare in Japan: A cross‐sectional study

Direct and indirect costs of home healthcare in Japan: A cross‐sectional study

Association between local-level resources for home care and home deaths: A nationwide spatial analysis in Japan

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Contact Info

Product

Resources

About