Relationship Between Preventive Health Services and Use of Inpatient and Outpatient Care by Residents Aged 40 or Older in 44 Municipalities in Osaka Prefecture, Japan

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We examined the relationships between preventive health services provided under the Law for Health and Medical Services for the Elderly and the use of inpatient and outpatient care by insured residents aged 40 or older covered by the National Health Insurance in 44 municipalities in Osaka Prefecture. Factor analyses showed that hospital admission rate and inpatient days per 100 insured persons, bed days per insured person, inpatient days per case, mean bed days, the proportion of long-stay (180 days or more), and the rate of long-stay per 1, 000 insured persons accounted for the first factors of inpatient care with factor loadings of more than 0.82. Outpatient utilization rate and outpatient days per 100 insured persons comprised the first factors of outpatient care with factor loadings of more than 0.80. Patient cost per case and the proportion of high patient cost (600, 000 Yen or more for inpatient care and 60, 000 Yen or more for outpatient care) made up the second factors of either type of patient care with factor loadings of more than 0.87. The frequency of use of health check-ups and the numbers of instruction classes and participants in health education and health counseling per 100 residents showed negative correlations with indices of inpatient and outpatient care, except for patient cost per day. The scores for the first and second factors of inpatient care and for the first factor of outpatient care correlated negatively with all indices of the use of preventive health services. More active provision of preventive health services may therefore contribute to reducing the subsequent use of inpatient and outpatient care among residents aged 40 or older. J Epidemiol, 1998 ; 8 : 264-271.

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