Sugisawa Hidehiro, Fukaya Taro, Sugihara Yoko, Ishikawa Hisanori, Nakatani Yomei, Kim Hye-Kyung
Gerontology Program, Obirin University Graduate School.
Nihon Koshu Eisei Zasshi. 2002 May;49(5):425-36.
This study was conducted to examine factors associated with under-utilization of in-home services covered by the long-term care insurance. Under-utilization was measured in terms of the discrepancy rate between benefits limits and service costs for individuals. Based on the behavioral model, possible predictors were chosen; the level of nursing care as the need factor, living arrangements and income as enabling factors, and family caregiving consciousness as a predisposing factor. Both direct and interaction effects of those factors were examined.
1,500 people were randomly selected from all people certified as needing long-term care in one ward, Tokyo to be interviewed. People categorized as "requires assistance" or "requires nursing care level 1" were interviewed directly. With people categorized as "level 2" to "level 5", their primary caregivers were interviewed. Information about in-home service utilization was collected from the insurer.
People who were categorized as requiring a lower level of nursing care, lived with others, had a low income, or had high family caregiving consciousness demonstrated significantly greater under-utilization rate as compared with others. An interaction between living arrangements and the level of nursing was observed in this regard. While people who lived alone exhibited low a level of under-utilization rate without regard of the level of nursing care, the rate changed by those who lived with other.
Under the new system, informal support might have a significant impact on under-utilization of in-home services. The responsibility for paying 10% of total care costs might be related to under-utilization by people with low income, though reduction of individual co-payments has been introduced for individuals in difficult financial conditions.
本研究旨在探讨与长期护理保险所涵盖的居家服务利用不足相关的因素。利用不足是根据个人福利限额与服务成本之间的差异率来衡量的。基于行为模型，选择了可能的预测因素；护理级别作为需求因素，生活安排和收入作为促成因素，家庭护理意识作为 predisposing 因素。研究了这些因素的直接和交互作用。
从东京一个病房所有被认证为需要长期护理的人中随机抽取1500人进行访谈。被归类为“需要协助”或“需要一级护理”的人直接接受访谈。对于被归类为“二级”至“五级”的人，对其主要照顾者进行访谈。从保险公司收集有关居家服务利用情况的信息。
与其他人相比，被归类为需要较低护理级别、与他人同住、收入较低或家庭护理意识较高的人，其利用不足率明显更高。在这方面观察到生活安排与护理级别之间存在交互作用。虽然独居的人无论护理级别如何，利用不足率都较低，但与他人同住的人的利用率会发生变化。
在新制度下，非正式支持可能对居家服务的利用不足产生重大影响。支付总护理费用10%的责任可能与低收入人群的利用不足有关，尽管已为经济困难的个人引入了个人自付费用的减免。
