Department of Planning, Information and Management, The University of Tokyo Hospital, Japan.
Health Policy. 2013 Apr;110(1):94-100. doi: 10.1016/j.healthpol.2012.12.011. Epub 2013 Jan 9.
The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications.
We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level.
After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p < 0.001).
Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system.
本研究旨在探讨居家长期护理保险服务对护理需求水平增加的影响，并讨论其政策意义。
我们分析了 2009 年 10 月和 2010 年在东京一个区的 3006 名非机构化老年人的护理需求认证和长期护理服务使用数据。从两次护理需求评估的数据中计算出个人护理需求评估间隔及其对应的护理需求水平变化。那些已经获得认证但未使用任何长期护理保险服务的人被定义为对照组。使用 Cox 比例风险模型确定使用长期护理保险服务是否与护理需求水平的增加相关。
在调整性别、年龄和护理需求水平后，服务使用者护理需求水平增加的概率的风险比计算为 0.75（95%置信区间，0.64-0.88；p < 0.001）。
居家长期护理服务的使用可能有助于预防护理需求水平的增加。护理需求认证和服务使用的行政数据可能是评估长期护理保险制度的有效工具。
