Longitudinal Evaluation Research for Public Long-term Care Insurance in Japan -Effect of Premium increase

为了评估日本公共长期护理保险（LTCI）保费费用的增加如何影响他们对家庭护理服务的利用，我们分析了日本一个地方城市2000年4月至2003年2月之间的电子索赔账单数据和市政记录。在此期间使用LTCI服务至少一个月的受益人从索赔账单数据库中选择（N=1869）。我们计算了这35个月的月平均服务使用量和用户数量。根据受益人的基本特征（护理水平、年龄和性别）、使用的服务种类进行分层。在保费方面，我们将这些条款分为三个条款（无保费、半保费和全保费），并分析了保费增加的影响。虽然收费的增加对服务的使用产生了初步的负面影响，但在这些条款中，用户数量有所增加。支付保费可能会鼓励使用LTCI作为付款人的权利。然而，在这些任期内，机构护理的数量也有所增加。由于高额的经济负担，他们可能很难继续进行家庭护理。我们的研究结果表明，保费的支付负担一般不太大，鼓励相对独立的老年人使用服务。然而，对于严重依赖的老年人来说，经济负担的增加可能会导致机构化。

To assess how an increase the premium fee for Japanese public long term care insurance (LTCI) affected their utilization of homecare services, we analyzed Electronic claim bill data and municipal records between April 2000 and February 2003 in one local city in Japan.Beneficiaries who used LTCI services at least one month during this term were selected from the claim bill database (N=1869). We calculated monthly average of service use amount and number of users for these 35 months. Stratifications by basic characteristics of beneficiaries (Care-Level, age, and sex), kind of services used were performed. On the insurance premium, we divided these terms into three terms (no premium, half-premium, and full-premium) and analyzed the effect of increase of premium.Though increase of premium had tentative negative effect for service use, number of users increased during these terms. Payment of premium may effect to encourage using LTCI as right of payers. However, the number of institutional care also incased during these terms. They may have been difficult to continue home care with bigger economic burden due to premium.Our results suggested that payment of premium was not so big burden generally and encourage the service use for relatively independent elderly. However, for the elderly who are seriously dependent the increase of economic burden may cause institutionalization.