title: Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.
abstract: OBJECTIVE
  The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency.
  
  
  METHODS
  Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders.
  
  
  RESULTS
  Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively).
  
  
  CONCLUSIONS
  Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231.
authors.affiliation: Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China.|School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Mei
authors.initials: M
authors.lastname: Feng
authors.affiliation: School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Noguchi-Watanabe
authors.affiliation: Center for Home Care Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Yoshie
authors.affiliation: Institute of Gerontology, The University of Tokyo, Tokyo, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Iijima
authors.affiliation: School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Yamamoto-Mitani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003631:Day Care, Medical / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008297:Male; D010346:Patient Care Management / Q000458:organization & administration*
keywords: Japan; case management; day care service; home help service; long-term care insurance