title: Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan.
abstract: BACKGROUND
  This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits.
  
  
  METHODS
  Health insurance data and LTCI data were combined into a database of 1,020 individuals in two farming communities in Hokkaido who were enrolled in Citizen's Health Insurance. They had not received long-term care services prior to April 1, 2000 and were newly certified as eligible for Long-Term Care Insurance benefits between April 1, 2000 and February 29, 2008. The analysis covered 565 subjects who had not been hospitalised or institutionalised at the time of first certification of LTCI benefits. The adjusted hazard ratios (HRs) of hospitalisation or institutionalisation or death after the initial certification were calculated using the Cox proportional hazard model. The predictors were age, sex, eligibility level, area of residence, income, year of initial certification and average monthly outpatient medical expenditures, in addition to average monthly total home and community-based services expenditures (analysis 1), the use or no use of each type of service (analysis 2), and average monthly expenditures for home-visit and day-care types of services, the use or no use of respite care, and the use or no use of rental services for assistive devices (analysis 3).
  
  
  RESULTS
  Users of home and community-based services were less likely than non-users to be hospitalised or institutionalised. Among the types of services, users of respite care (HR: 0.71, 95% confidence interval [CI]: 0.55-0.93) and rental services for assistive devices (HR: 0.70, 95% CI: 0.54-0.92) were less likely to be hospitalised or institutionalised than non-users. For those with relatively light needs, users of day care were also less likely to be hospitalised or institutionalized than non-users (HR: 0.77, 95% CI: 0.61-0.98).
  
  
  CONCLUSIONS
  Respite care, rental services for assistive devices and day care are effective in preventing hospitalisation and institutionalisation. Our results suggest that home and community-based services contribute to the goal of the LTCI system of encouraging individuals certified as needing long-term care to live independently at home for as long as possible.
authors.affiliation: Department of Health Policy & Management, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tomita
authors.forename: Kimio
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Ikegami
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003153:Community Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D004608:Eligibility Determination / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006301:Health Services Needs and Demand / Q000191:economics; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006699:Home Care Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000191:economics / Q000706:statistics & numerical data; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data*; D007564:Japan; D008134:Long-Term Care / Q000191:economics; D008297:Male; D037141:Mandatory Programs; D011159:Population Surveillance; D017064:Process Assessment, Health Care / Q000592:standards; D016016:Proportional Hazards Models; D012189:Retrospective Studies