Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto University, Kyoto, Japan
Department of Government, Harvard University, Cambridge, Massachusetts, USA.
BMJ Open. 2022 Jul 29;12(7):e056996. doi: 10.1136/bmjopen-2021-056996.
Increases in obesity and cardiovascular diseases contribute to rapidly growing healthcare expenditures in many countries. However, little is known about whether the population-level health guidance intervention for obesity and cardiovascular risk factors is associated with reduced healthcare utilisation and spending. The aim of this study was to investigate the effect of population-level health guidance intervention introduced nationally in Japan on healthcare utilisation and spending.
Retrospective cohort study, using a quasiexperimental regression discontinuity design.
Japan's nationwide employment-based health insurers.
Participants in the national health screening programme (from January 2014 to December 2014) aged 40-74 years.
Assignment to health guidance intervention (counselling on healthy lifestyles, and referral to physicians as needed) determined primarily on whether the individual's waist circumference was above or below the cut-off value in addition to having at least one cardiovascular risk factor.
Healthcare utilisation (the number of outpatient visits days, any medication use and any hospitalisation use) and spending (total medical expenditure, outpatient medical expenditure and inpatient medical expenditure) within 3 years of the intervention.
A total of 51 213 individuals within the bandwidth (±6 cm of waist circumference from the cut-off) out of 113 302 screening participants (median age 50.0 years, 11.9% woman) were analysed. We found that the assignment to the national health guidance intervention was associated with fewer outpatient visit days (-1.3 days; 95% CI, -11.4 to -0.5 days; p=0.03). We found no evidence that the assignment to the health guidance intervention was associated with changes in medication or hospitalisation use, or healthcare spending.
Among working-age, male-focused Japanese from a health insurer of companies of civil engineering and construction, the national health guidance intervention might be associated with a decline in outpatient visits, with no change in medication/hospitalisation use or healthcare spending.
肥胖和心血管疾病的增加导致许多国家的医疗保健支出迅速增长。然而，对于人群层面的肥胖和心血管风险因素健康指导干预是否与降低医疗保健利用和支出有关，知之甚少。本研究旨在调查日本全国范围内引入的人群层面健康指导干预对医疗保健利用和支出的影响。
回顾性队列研究，使用拟实验回归不连续性设计。
日本全国性就业为基础的健康保险公司。
参加全国健康筛查计划（2014 年 1 月至 2014 年 12 月）的年龄在 40-74 岁的人群。
健康指导干预的分配（主要根据个体的腰围是否高于或低于截止值，以及是否有至少一个心血管风险因素，确定对健康生活方式的咨询和根据需要转介给医生）。
干预后 3 年内的医疗保健利用（门诊就诊天数、任何药物使用和任何住院使用）和支出（总医疗支出、门诊医疗支出和住院医疗支出）。
在 113302 名筛查参与者（中位数年龄 50.0 岁，11.9%为女性）的带宽内（腰围截止值上下 6 厘米），共有 51213 人进行了分析。我们发现，分配到国家健康指导干预与门诊就诊天数减少有关（减少 1.3 天；95%置信区间，-11.4 至-0.5 天；p=0.03）。我们没有发现分配到健康指导干预与药物或住院使用或医疗保健支出变化有关的证据。
在来自土木工程和建筑公司的企业健康保险公司的、以男性为主的、工作年龄段的日本人群中，国家健康指导干预可能与门诊就诊减少有关，而药物/住院使用或医疗保健支出没有变化。
