title: Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan.
abstract: Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan.
  
  
  
  A cross-sectional study was performed to compare the total medical costs during patients' final days of life (30 days or less) between Zaitaku care and hospital care from September 2012 to August 2013 in Fukuoka Prefecture, Japan.
  
  
  
  Thirty four patients died at home under Zaitaku care, and 72 patients died in the hospital during this period. The average daily cost of care during the last 30 days did not differ significantly between the two groups. Although Zaitaku care costs were higher than hospital care costs in the short-term (≦10 days, Zaitaku care $371.2 vs. Hospital care $202.0, p = 0.492), medical costs for Zaitaku care in the long-term care (≧30 days) were less than that of hospital care ($155.8 vs. $187.4, p = 0.055).
  
  
  
  Medical costs of Zaitaku care were less compared with hospital care if incorporated early for long term care, but it was high if incorporated late for short term care. For long term care, medical costs for Zaitaku care was 16.7% less than for hospitalization at the end of life. This physician-led home visit care model should be an available option for patients who wish to die at home, and may be beneficial financially over time.
authors.affiliation: Department of General Medicine, Morinosato Hospital/Kameda Hospital, Tokai University, Keio University, 3-1-1 Morinosato, Atsugi, Kanagawa, 243-0122, Japan. kentaro.kinjo@gmail.com.
authors.forename: Kentaro
authors.identifier: 0000-0002-6072-1710
authors.initials: K
authors.lastname: Kinjo
authors.affiliation: Department of Family Medicine, University of Washington, E304 Health Sciences 1959 NE Pacific Street, Seattle, WA, 98195-6390, USA.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sairenji
authors.affiliation: Department of Medical Information Analysis, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of General Medicine, Fujita Health University, 1-98 Kutzukake Dengakugakubo, Toyoake, 470-1192, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Osugi
authors.affiliation: Department of General Medicine, Aso Iizuka Hospital, Iizuka Kaita Family Medicine Residency Program, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of General Medicine, Aso Iizuka Hospital, Iizuka Kaita Family Medicine Residency Program, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Ichinose
authors.affiliation: You-no-mori clinic, 444-1 Bepucho, Matsuyama, Ehime, 791-8056, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nagai
authors.affiliation: Department of General Medicine, Aso Iizuka Hospital, Iizuka Kaita Family Medicine Residency Program, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imura
authors.affiliation: Department of Family Medicine, University of Pittsburgh, 4420 Bayard Street, Suite 520, Pittsburgh, PA, 15260, USA.
authors.forename: Jeannette E
authors.initials: JE
authors.lastname: South-Paul
authors.affiliation: Department of Family Medicine, University of Pittsburgh, 4420 Bayard Street, Suite 520, Pittsburgh, PA, 15260, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Meyer
authors.affiliation: Kaita Hospital, 1061 Haranokuchi, Iizuka, Fukuoka, 820-1114, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Honda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services / Q000191:economics*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006792:House Calls / Q000191:economics*; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D010820:Physicians; D011181:Postnatal Care; D012111:Residence Characteristics; D013727:Terminal Care
keywords: End of life care; Home visit; Japan; Medical costs; Physician-led team home visit; Zaitaku care