ArticleInternational journal of health policy and management2024
Technical Efficiency of Prevention Services for Functional Dependency in Japan's Public Long-term Care Insurance System: An Ecological Study.
Article in International journal of health policy and management, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Health Care-Related Determinants of First-Time Long-Term Care Need in Older Adults in Germany: Retrospective Cohort Study Using Claims Data.Interactive journal of medical research · 2026Article
- Mechanisms influencing adult children's willingness to use medical visit accompaniment services for older adults in Nanjing: a structural equation modeling study.Frontiers in public health · 2026Article
- Older adults' adoption of shared service platforms outside long-term care insurance in Japan based on technology acceptance model.Frontiers in public health · 2026Article
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3 authors.
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Abstract
backgroundPublic long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan's public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive.
methodsWe estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates.
resultsPrevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range: 0.89-0.99).
conclusionThese findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.
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