背景:公共长期护理保险(LTCI)系统可以促进平等和更广泛地获得优质的长期护理。然而,由于与人口老龄化相关的护理需求不断增长,确保财务可持续性具有挑战性。为了控制不断增长的需求,日本的公共LTCI系统为老年人的功能依赖提供了独特的基于家庭和社区的预防服务(即,成人日托,护理,家庭护理,功能筛选,功能训练,健康教育,和对社会活动的支持),遵循2006年至2015年分散交付的全国协议。然而,对这些服务效果的评估尚无定论。
方法:我们使用2009-2014年日本474家本地公共保险公司的面板数据估算了本地预防服务的边际收益和技术效率,基于随机前沿分析。结果是观察到的年龄≥65岁的被证明接受中度护理的个体与预期数量的性别和年龄调整后的比率。较高的结果值表明每年每个地区中度功能依赖的人群风险较低。估计了作为解释变量的预防服务数量的边际收益,调整区域医疗和福利准入,护理需求和供应,和其他区域因素作为协变量。
结果:预防服务(功能筛查除外)显着降低了中度功能依赖的人群风险。具体来说,成人日托每增加1%的平均结果变化,其他护理,家庭护理占0.13%,0.07%,和0.04%,分别。本地公共保险公司的技术效率中位数为0.94(四分位数范围:0.89-0.99)。
结论:这些研究结果表明,以人口为基础的服务,按照标准化方案进行分散的本地操作,可以实现跨区域的有效预防。通过提出提供预防性福利的有用选择,这项研究可以为当前有关公共LTCI系统中福利覆盖范围的讨论提供信息。
BACKGROUND: Public long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan\'s public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive.
METHODS: We estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates.
RESULTS: Prevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range: 0.89-0.99).
CONCLUSIONS: These findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.