The effects of raising the long‐term care insurance co‐payment rate on the utilization of long‐term care services

Abstract

AimThe effect of raising insurance co‐payment rates on healthcare service utilization in Japan remains unclear. In this study, we utilized patient‐level long‐term care (LTC) insurance claims data to analyze these effects.MethodsClaims data were obtained on individuals certified as requiring LTC in City A and City B, Fukuoka Prefecture, Japan during August 2014–July 2016. Individuals whose LTC insurance co‐payment rate increased from 10% to 20% in August 2015 were regarded as high‐income individuals; individuals whose co‐payment rate remained at 10% were regarded as non–high‐income individuals. We examined the changes in LTC service utilization between high‐income individuals and non–high‐income individuals during the study period. Monthly LTC insurance charges were analyzed to evaluate service utilization. We created monthly panel data for the study participants, and quantified the differences in LTC service utilization before and after August 2015 between the high‐income and non–high‐income groups. Care needs levels and age were included as covariates in a fixed‐effects model.ResultsThe sample comprised 7711 individuals (1000 high‐income individuals and 6711 non–high‐income individuals) in City A and 647 individuals (84 high‐income individuals and 563 non–high‐income individuals) in City B. After adjusting for care needs levels and age, the co‐payment rate increase was associated with reductions in monthly LTC insurance charges of $34.3 (P < 0.001) in City A and $91.0 (P = 0.022) in City B.ConclusionThe increase in co‐payment rate for high‐income individuals in August 2015 negatively affected their utilization of LTC services. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2020; ••: ••–••.

The impact of using community home-based elderly care services on older adults’ self-reported health: fresh evidence from China

“…The self-reported health of older adults may be affected by unobserved factors, such as the price and quality of CHECS ( 23 ), which may relate to the use of CHECS by older adults ( 24 ). In addition, a possible reverse causation between CHECS utilization and self-reported health: older people with poorer health are more likely to use CHECS ( 25 ).…”

A comparative perspective on long‐term care systems

“…The systems are mainly financed by payroll contributions (Germany and Israel) or by a mix of payroll contributions and taxes (Japan, the Republic of Korea and the Netherlands). Co‐payments help care systems control costs by lowering incentives for service use (Soga et al, 2020) and redistribute economic burdens among income groups through means‐testing (Wouterse, Hussem and Wong, 2022). Access is regulated by assessment tests, which in some form consider living circumstances and impairments in mobility, cognitive ability, behaviour, ADL, and IADL.…”

A Comparative Perspective on Long-Term Care Systems

“…The systems are mainly financed by payroll contributions (Germany and Israel) or by a mix of payroll contributions and taxes (Netherlands, Japan, and South Korea). Copayments help care systems control costs by lowering incentives for service use (Soga et al, 2020) and redistribute economic burdens among income groups through means-testing (Wouterse et al, 2021). 2 Access is regulated by assessment tests, which in some form consider living circumstances and impairments in mobility, cognitive ability, behavior, ADL, and IADL.…”