Impact of long-term care insurance on institutional dementia care in Japan
Impact of long-term care insurance on institutional dementia care in Japan
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DOI：
10.1016/s0168-8510(02)00181-1
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发表时间：
2003-06-01
期刊：
影响因子：
3.3
通讯作者：
Miyamoto, Y
中科院分区：
文献类型：
--
作者：
Ito, H;Miyamoto, Y
日本于2000年4月开始为护理和家务助理服务提供长期护理保险，以科普65岁以上人口日益增长的医疗支出。为了研究新保险对痴呆症护理利用率的影响，我们比较了长期护理或医疗保险覆盖的痴呆症患者在推出之前和之后的人口统计学和临床特征，包括诊断，残疾程度和行为障碍。研究的对象是随机选择的病人/住院医生的专门痴呆症护理单位在精神病医院和老年护理设施之前（1145名病人/住院医生在2000年初）和之后（262名医疗保险和2001年的长期护理保险），新的系统启动。虽然2000年和2001年的病人/居民总体上相似，但2001年的样本显示，每种保险制度的病人之间存在差异。Logistic回归分析显示，长期护理保险覆盖的患者/居民更有可能是女性，需要更高水平的护理。长期护理保险覆盖的患者不太可能从精神科转移，也没有表现出行为障碍或无法扑灭或处理火灾。这些结果表明，医疗机构已经转向新的保险制度，为病人需要更高水平的照顾，但没有行为障碍，因为它是打算。另一方面，有政策关注到，有中度日常生活活动障碍及行为障碍的失智症患者有可能被排除在长期护理计划之外。(C)2002爱思唯尔科学爱尔兰有限公司保留所有权利。
Japan started long-term care insurance for nursing and home help services in April 2000 to cope with growing medical expenditures for the population aged over 65. To study the impact of the new insurance on utilization of dementia care, we compared demographic and clinical characteristics including diagnosis, degree of disability and behavioral disturbance before and after the launch among people with dementia covered by either long-term care or medical insurance. The subjects of the study were randomly selected patients/residents of specialized dementia care units in both psychiatric hospitals and geriatric care facilities before (1145 patients/residents in early 2000) and after (262 for medical insurance and 205 for long-term care insurance in 2001) the new system was launched. Although patients/residents in 2000 and 2001 were similar as a whole, the 2001 sample showed differences between patients in each of the types of insurance systems. Logistic regression analysis revealed that patients/residents covered by long-term care insurance were significantly more likely to be females and require higher levels of care. Patients covered by long-term care insurance were significantly less likely to be transferred from a psychiatric department nor did they display behavioral disturbance or an inability to put out or deal with fire. These results suggest that health care facilities have shifted to the new insurance system for patients requiring higher levels of care but without behavioral disturbances as it was intended. On the other hand, there were policy concerns of that demented persons with moderate activities of daily living impairments and behavioral disturbances would be at risk being excluded from the long-term care scheme. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.