Yoshida Hiroto, Fujiwara Yoshinori, Amano Hidenori, Kumagai Shu, Watanabe Naoki, Sangyoon Lee, Mori Setuko, Shinkai Shoji
Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology.
Nihon Koshu Eisei Zasshi. 2007 Mar;54(3):156-67.
This study was conducted to evaluate disability prevention programs for community-dwelling elderly in terms of the cost/benefit balance.
Out of all residents aged 65 years and over who lived in Yoita Town, Niigata Prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline survey conducted in November, 2000 (response rate, 92.2%). Based on the results, Yoita town then launched several kinds of disability prevention programs for community-dwelling elderly, e.g., preventive programs for falls, dementia and homeboundness. The subjects for the present study included only those aged 70 years and over who responded to the baseline survey and were alive as of March 2004. During 2001 to 2003, 146 persons had participated at lease once in one of disability prevention programs (denoted as the participant group), whereas 846 persons had not participated in any of the programs (denoted as the non-participant group). We compared medical and care expenses (sum of national and employment health insurance benefits, and long-term care insurance) between the two groups during 2000-2003, and determined whether participating in program affected subsequent medical and care expenses independent of key confounders [sex, age, and baseline medical and care expenses or health indicator (TMIG-Index of Competence or Generic Mobility Index)], using general linear models.
The mean medical expenses per capita and per month slightly decreased over the period of the study in the participant group (51,606 yen for 2000 to 47,539 yen for 2003), while those in non-participant group steadily increased (41,888 yen, to 51,558 yen, respectively). During the same period, the mean care cost per capita and per month increased in both groups, but the increase was much more moderate in the participating group (507 yen to 5,186 yen vs. 8,127 yen to 27,072 yen for non-participant group). Summed cost reduction through the program participation accounted for 49 million yen during the three years (2001-2003). After adjustment for sex, age and baseline medical and care expenses or health indicator, it was estimated as 12 million yen per year. Given that the expenses for the disability prevention programs summed 2.3 million yen per year, the net benefit of disability prevention programs was estimated to be approx. 10 million yen per year.
Disability preventive programs for the community-dwelling elderly are economically efficient in terms of the cost/benefit balance. Future research is needed to examine how such programs lead to cost reduction.
本研究旨在从成本效益平衡的角度评估针对社区居住老年人的残疾预防项目。
在日本新潟县余市町居住的所有65岁及以上居民（n = 1673）中，1544人参与了2000年11月进行的基线调查（回复率为92.2%）。基于该结果，余市町随后为社区居住老年人开展了多种残疾预防项目，例如预防跌倒、痴呆和居家不出的项目。本研究的对象仅包括那些在基线调查中做出回复且截至2004年3月仍在世的70岁及以上老年人。在2001年至2003年期间，146人至少参加过一次残疾预防项目（称为参与组），而846人未参加任何项目（称为非参与组）。我们比较了两组在2000 - 2003年期间的医疗和护理费用（国民健康保险和就业健康保险福利以及长期护理保险的总和），并使用一般线性模型确定参与项目是否会影响后续的医疗和护理费用，同时控制关键混杂因素[性别、年龄以及基线医疗和护理费用或健康指标（TMIG能力指数或通用活动能力指数）]。
在研究期间，参与组的人均每月医疗费用略有下降（从2000年的51,606日元降至2003年的47,539日元），而非参与组的人均每月医疗费用稳步上升（分别从41,888日元升至51,558日元）。在同一时期，两组的人均每月护理费用均有所增加，但参与组的增加幅度要小得多（从507日元增至5186日元，而非参与组从8127日元增至27,072日元）。通过参与项目在三年（2001 - 2003年）期间总计节省成本4900万日元。在对性别、年龄以及基线医疗和护理费用或健康指标进行调整后，估计每年节省1200万日元。鉴于残疾预防项目每年的费用总计为230万日元，残疾预防项目的净效益估计约为每年1000万日元。
针对社区居住老年人的残疾预防项目在成本效益平衡方面具有经济效率。未来需要开展研究以探讨此类项目如何实现成本降低。
