title: Institutional care versus home care for the elderly in a rural area: cost comparison in rural Japan.
abstract: BACKGROUND
  The rise in institutional care costs, such as that associated with care in chronic hospitals or nursing homes, is a serious social concern in Japan, and this is particularly so in rural areas which are more rapidly aging than others. This has led to a proposal to reduce costs by deinstitutionalizing the disabled elderly. However, the actual financial benefit of deinstitutionalizing the disabled elderly is unclear.
  
  
  OBJECTIVE
  To examine the effectiveness of deinstitutionalizing the disabled elderly with the aim of cost reduction.
  
  
  METHODS
  This study utilized a cross-sectional design and complete census survey. The participants were 139 residents of a rural town in Hokkaido who were institutionalized as of 1 July 2007, and whose Care Needs Levels were classified according to Long-Term Care Insurance (LTCI) in Japan. Of these, 87 participants were considered candidates for deinstitutionalization. Participants who were considered unable to stay alone at home, such as those with behavioral problems, at risk of falling, or in need of hospital medical care, were excluded. Data were collected on institutional care costs, and an original questionnaire was distributed asking institutional staff about participant characteristics and physical function levels. Existing costs were collected and costs were calculated if participants were discharged from institutions to their homes.
  
  
  RESULTS
  Approximately 20% of participants lived alone, and 80% had a severe disability. The estimated costs of discharging patients to their homes were higher than existing institutional care costs for 98% of participants. The gap in cost tended to be greater in patients with higher care needs.
  
  
  CONCLUSIONS
  The deinstitutionalization of disabled elderly is not an effective measure to help reduce healthcare costs in rural areas of Japan.
authors.affiliation: The Japan Baptist Hospital, Kyoto, Japan. n-akiyama@bukkyo-u.ac.jp
authors.forename: Akiyama
authors.initials: A
authors.lastname: Naomi
authors.forename: Takeru
authors.initials: T
authors.lastname: Shiroiwa
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Murashima
mesh_terms: D000203:Activities of Daily Living; D000288:Administrative Personnel / Q000523:psychology; D000369:Aged, 80 and over; D019352:Censuses; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003688:Deinstitutionalization / Q000191:economics / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000191:economics* / Q000458:organization & administration; D006305:Health Status Indicators; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000191:economics* / Q000706:statistics & numerical data; D007353:Insurance, Long-Term Care; D007564:Japan; D008297:Male; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012144:Respite Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012946:Social Welfare; D011795:Surveys and Questionnaires; D013997:Time Factors