Impact of Increased Copayments for Long-Term Care Insurance Services on Medical and Long-Term Care Costs for Late-Stage Older Adults in Japan

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  • Ishihara Reiko
    Department of Human Sciences, Osaka University of Economics, Osaka, Japan
  • Babazono Akira
    Department of Healthcare Administration and Management, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Liu Ning
    Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
  • Yamao Reiko
    School of Nursing, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
  • Yoshida Shinichiro
    Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

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Aim<br> 　  To determine the impact of increased copayment on long-term care (LTC) and medical service utilization among older adults in Japan.<br> Methods<br> 　  LTC and medical claims data were obtained for individuals aged ≥ 75 years as of August 1, 2014, and those utilizing LTC services in Fukuoka Prefecture, Japan, between August 2014 and March 2019. Participants were categorized into three groups: the 10% group (no copayment change), the 20% group (copayment increased from 10% to 20% in August 2015), and the 30% group (copayment increased from 20% to 30% in August 2018). Monthly panel data was constructed , and controlled interrupted time series analysis was used to estimate changes in LTC and medical expenditures before and after the copayment increases.<br> Results<br> 　  Of 32,295 participants, 2991, 1459, and 925 were in the 10%, 20%, and 30% groups, respectively. LTC expenditure increased significantly by an average of 502.5 yen per month during the 12 months before the first intervention, with a further significant increase of 560.0 yen between the two intervention periods. The 30% group had a significant decrease (569.9 yen/month) in facility service expenditures and a significant increase (996.5 yen/month) in hospitalization expenditures after the second intervention. Conclusions<br> 　  No clear reduction in LTC expenditure was observed, suggesting a possible shift from LTC to medical care. Further research is needed to examine measures, including copayments, for the appropriate medical care and LTC service use.<br>

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