Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;11(4):489-497.
doi: 10.34172/ijhpm.2020.190.

Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan

Yunfei Li  1 , Akira Babazono  1 , Aziz Jamal  1   2 , Peng Jiang  1 , Takako Fujita  3   1
Affiliations

Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan

Yunfei Li et al. Int J Health Policy Manag. .

Abstract

Background: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system.

Methods: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization.

Results: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level.

Conclusion: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.

Keywords: Cost-Sharing; Hospitalization Cost; Japan; Length of Stay; Older People.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization (WHO). World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva: WHO; 2017.
    1. Murata K, Hinotsu S, Sadamasa N. et al. Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan. Int J Qual Health Care. 2017;29(1):26–31. doi: 10.1093/intqhc/mzw127. - DOI - PubMed
    1. Imai H, Fushimi K. Factors associated with the use of institutional long-term care in Japan. Geriatr Gerontol Int. 2012;12(1):72–79. doi: 10.1111/j.1447-0594.2011.00732.x. - DOI - PubMed
    1. Chung W, Oh SM, Suh T, Lee YM, Oh BH, Yoon CW. Determinants of length of stay for psychiatric inpatients: analysis of a national database covering the entire Korean elderly population. Health Policy. 2010;94(2):120–128. doi: 10.1016/j.healthpol.2009.09.004. - DOI - PubMed
    1. Matsuda S, Fujimori K, Fushimi K. Development of casemix based evaluation system in Japan. Asian Pacific Journal of Disease Management. 2010;4(3):55–66. doi: 10.7223/apjdm.4.55. - DOI