Household Income Relationship With Health Services Utilization and Healthcare Expenditures in People Aged 75 Years or Older in Japan: A Population-Based Study Using Medical and Long-term Care Insurance Claims Data

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Author(s)

    • Hamada Shota
    • Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare|Department of Health Services Research, Faculty of Medicine, University of Tsukuba
    • Sakata Nobuo
    • Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare|Department of Health Services Research, Faculty of Medicine, University of Tsukuba
    • Jeon Boyoung
    • Department of Health Services Research, Faculty of Medicine, University of Tsukuba|Division of Health Service for the Disabled, National Rehabilitation Center
    • Mori Takahiro
    • Department of Health Services Research, Faculty of Medicine, University of Tsukuba
    • Yoshie Satoru
    • Department of Health Services Research, Faculty of Medicine, University of Tsukuba|Institute of Gerontology, The University of Tokyo|Department of Health Policy and Management, School of Medicine, Keio University
    • Tamiya Nanako
    • Department of Health Services Research, Faculty of Medicine, University of Tsukuba

Abstract

<p><b>Background:</b> This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan.</p><p><b>Methods:</b> We used data on medical and long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for 5-year age groups and LTC needs level.</p><p><b>Results:</b> The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI], 0.87–0.92 for men and IRR 0.97; 95% CI, 0.95–0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54–2.56 and IRR 1.42; 95% CI, 1.20–1.67, respectively), and higher total expenditures (exp(β) 1.09; 95% CI, 1.01–1.18 and exp(β) 1.09; 95% CI, 1.05–1.14, respectively).</p><p><b>Conclusions:</b> This study suggests that older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status.</p>

Journal

  • Journal of Epidemiology

    Journal of Epidemiology 29(10), 377-383, 2019

    Japan Epidemiological Association

Codes

  • NII Article ID (NAID)
    130007724005
  • Text Lang
    ENG
  • ISSN
    0917-5040
  • Data Source
    J-STAGE 
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