Medical cost for disability: a longitudinal observation of national health insurance beneficiaries in Japan.
OBJECTIVE
To measure the impact of disability on the use of medical care and its costs.


METHODS
A 1-year prospective cohort study of National Health Insurance beneficiaries in a rural Japanese community. Their physical function was examined by the Medical Outcomes Study questionnaire at the end of 1994; medical care and its costs were then monitored for 1 year.


METHODS
Participants were the 49,364 subjects, aged 40 to 79 years, who were beneficiaries of National Health Insurance and lived in the catchment area of Ohsaki Public Health Center, Miyagi, Japan. The subjects were mainly farmers, self-employed persons, housewives, or pensioners.


METHODS
Medical care utilization (number of outpatient visits and days of inpatient care) and the costs for each subject were obtained from National Health Insurance Claim History files. These measurements were collected from January to December 1995, and the relationship between physical functioning levels and medical costs was analyzed.


RESULTS
The medical costs per capita increased with poorer physical function. Medical costs among those with limitations in performing self-care increased by 4 times in men and 3 times in women compared with those with no functional limitation. In this cohort, the 4.3% of the subjects who were dependent in self-care used 15% of the total inpatient days and 10% of the total medical costs.


CONCLUSIONS
Treatment of patients with disability requires a huge amount of medical resources. There is an urgent need for cost-effective intervention programs for disability prevention, which could be offset against the cost for treating the disabled.
Tsuji
I
I
Department of Public Health, Tohoku University School of Medicine, Sendai, Japan.
Kuwahara
A
A
Nishino
Y
Y
Ohkubo
T
T
Sasaki
A
A
Hisamichi
S
S
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009313:National Health Programs / Q000191:economics*; D011446:Prospective Studies; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires