Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Fukuoka, Japan.
Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
PLoS One. 2023 Mar 10;18(3):e0282965. doi: 10.1371/journal.pone.0282965. eCollection 2023.
Japan introduced a financial incentive scheme in April 2016 to improve hospital-based dementia care, but its effectiveness remains unclear. This study aimed to investigate the scheme's impact on medical and long-term care (LTC) expenditures, as well as on changes in care needs levels and daily living independence levels among older persons one year after hospital discharge.
We linked medical and LTC claims databases, and retrospectively identified patients who received LTC needs certification and daily living independence assessments in Fukuoka, Japan. Case patients (received care under the new scheme) were those admitted from April 2016 to March 2018, and control patients were those admitted from April 2014 to March 2016 (before the scheme was implemented). Through propensity score matching, we identified 260 case patients and 260 control patients, and compared using t-tests, and chi-square tests.
The analyses found no significant differences between the case and control groups in medical expenditure (US$26,685 vs US$24,823, P = 0.37), LTC expenditure (US$16,870 vs US$14,374, P = 0.08), daily living independence level changes (26.5% vs 20.4%, P = 0.12), or care needs level changes (36.9% vs 30%, P = 0.11).
The financial incentive scheme for dementia care did not demonstrate any beneficial effects on patients' healthcare expenditures or health conditions. Further studies are needed to examine the scheme's long-term effects.
2016 年 4 月，日本推出了一项财政激励计划，以改善医院内的痴呆症护理，但该计划的效果仍不清楚。本研究旨在调查该计划对医院出院后一年老年人的医疗和长期护理（LTC）支出、护理需求水平变化以及日常生活自理水平变化的影响。
我们将医疗和 LTC 索赔数据库进行了链接，并回顾性地确定了在日本福冈接受 LTC 需求认证和日常生活自理评估的患者。病例患者（接受新计划下的护理）是 2016 年 4 月至 2018 年 3 月入院的患者，对照患者是 2014 年 4 月至 2016 年 3 月（计划实施前）入院的患者。通过倾向评分匹配，我们确定了 260 名病例患者和 260 名对照患者，并通过 t 检验和卡方检验进行比较。
分析发现，病例组和对照组在医疗支出（26685 美元对 24823 美元，P = 0.37）、LTC 支出（16870 美元对 14374 美元，P = 0.08）、日常生活自理水平变化（26.5%对 20.4%，P = 0.12）或护理需求水平变化（36.9%对 30%，P = 0.11）方面无显著差异。
痴呆症护理的财政激励计划并未显示对患者的医疗保健支出或健康状况有任何有益影响。需要进一步研究该计划的长期效果。
