Introduction of long-term care insurance: Changes in service usage

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  • MATSUDA Tomoyuki
    Department of Health Services Research, Doctoral Program in Human Care Science Graduate School of Comprehensive Human Sciences, University of Tsukuba Department of Physical Therapy School of Medical Health, Ibaraki Prefectural University of Health Sciences
  • TAMIYA Nanako
    Faculty of Medicine, University of Tsukuba
  • KASHIWAGI Masayo
    Faculty of Medicine, University of Tsukuba College of Nursing, School of Medicine, Yokohama City University
  • MORIYAMA Yoko
    Faculty of Medicine, University of Tsukuba

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  • 介護保険制度導入前後における在宅サービス利用の変化
  • カイゴ ホケン セイド ドウニュウ ゼンゴ ニ オケル ザイタク サービス リヨウ ノ ヘンカ

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Abstract

Objectives With the aging of the population, Japan's long-term care system has shifted from a welfare-placement system to a social-insurance system, which is a precedent of policies for the elderly. We examined how individuals who used care services before the implementation of long-term care insurance (LTCI) (previous service users) currently use the LTCI services, with a focus on the processes of service use.<br/>Methods Panel data were obtained from the Nihon University Japanese Longitudinal Study of Aging database. These data were collected by interviews conducted before (November 1999 and March 2000) and after (November 2001 and December 2001) the establishment of LTCI. Among the 3992 individuals who participated in these interviews, 416 of the previous service users, aged ≥65 years, were sampled. The outcome measures were the processes of using LTCI services (application for LTCI, certification of long-term care need, and contract with LTCI service providers). Logistic regression analysis was performed to identify individual factors associated with the process of application for LTCI.<br/>Results There were 133 LTCI users among the 416 previous service users (32.0%). Of the service processes used, 45.5% of previous service users were applicants, 85.7% of the applicants were certified individuals, and 88.7% of those certified used services with service contracts. The application process was significantly easier for individuals with disease (odds ratio[OR], 8.34 : 95% confidence interval [CI], 1.86–37.46), those dependent for their instrumental activities of daily living (IADL) (OR, 11.21 : 95% CI, 5.22–24.07), those with an equivalent income of <1.25 million yen (OR, 2.72 : 95% CI, 1.30–5.69), and those who had used respite care (OR, 3.29 : 95% CI, 1.16–9.35) previously. In contrast, the application process was significantly difficult for community rehabilitation users (OR, 0.38 : 95% CI, 0.17–0.82).<br/>Conclusion Only half of the previous service users were applicants, and they had severe diseases or were more dependent for their IADL. Our findings suggest that many individuals who were functionally independent were covered under the welfare-placement system. Additionally, low-income individuals did not refrain from applying.

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