Kim Sung-A, Babazono Akira, Fujita Takako, Jamal Aziz
St. Mary's Hospital, Kurume, Japan.
Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Popul Health Manag. 2022 Oct;25(5):639-650. doi: 10.1089/pop.2022.0110. Epub 2022 Aug 30.
This study aimed to determine whether there are disparities in the utilization of home-based care services according to income level among people aged 75 years or older in Japan. The research team used administrative claims data from April 2014 to March 2018 for people aged 75 years or older in Fukuoka Prefecture. Subjects were categorized according to income level using medical insurance claim data. Associations between income level and usage days of inpatient care, outpatient care, home medical care, and usage number of home-based long-term care (LTC) services were evaluated. Furthermore, medical and LTC costs were evaluated and adjusted for gender, age, and level of LTC needs. The team used generalized linear models (GLMs) to estimate medical and LTC services utilization, as well as the potential influence of gender, age, care needs level, and death as risk factors. The study analyzed 31,322 subjects, among whom 17,288 were in low-, 12,755 were in middle-, and 1399 were in high-income groups. The results of GLMs showed the number of home medical care days was 59.45, 62.24, and 69.66 days for users from low-, middle-, and high-income groups, respectively. Correspondingly, the number of home-based LTC services used was 668.84, 709.59, and 833.14 times. This study suggests that older adults with lower incomes had relatively low utilizations of home-based care services and high utilizations of nonhome-based LTC services. Policymakers should implement policies focused on people who need care to tackle socioeconomic inequalities in home-based care.
本研究旨在确定日本75岁及以上人群中，根据收入水平划分，在居家护理服务利用方面是否存在差异。研究团队使用了2014年4月至2018年3月福冈县75岁及以上人群的行政索赔数据。利用医疗保险索赔数据，根据收入水平对研究对象进行分类。评估了收入水平与住院护理、门诊护理、家庭医疗护理的使用天数以及居家长期护理（LTC）服务的使用次数之间的关联。此外，还评估了医疗和长期护理成本，并对性别、年龄和长期护理需求水平进行了调整。研究团队使用广义线性模型（GLM）来估计医疗和长期护理服务的利用率，以及性别、年龄、护理需求水平和死亡作为风险因素的潜在影响。该研究分析了31322名研究对象，其中低收入组有17288人，中等收入组有12755人，高收入组有1399人。广义线性模型的结果显示，低收入、中等收入和高收入组的家庭医疗护理天数分别为59.45天、62.24天和69.66天。相应地，居家长期护理服务的使用次数分别为668.84次、709.59次和833.14次。本研究表明，收入较低的老年人居家护理服务利用率相对较低，而非居家长期护理服务利用率较高。政策制定者应实施针对需要护理人群的政策，以解决居家护理中的社会经济不平等问题。
