Estimating Expenditure on Long-Term Care (LTC) in Japan

1
Estimating Expenditure on Long-Term Care (LTC)
in Japan

• SAKAMAKI, Hiroyuki, MBA
• Institute for Health Economics and policy (IHEP)
• Tokyo,Japan

10th Oct, 2002, OECD Paris
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Presentation Outlines

• Estimates on Expenditure for LTC
• Estimation Processes and Issues until 1999
• Public Long Term Care Insurance (LTCI) in 2000
• Estimation Strategy after 2000

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Graying population in Japan

• Population (?65yo)
• 4.16 M ( 4.9) in 1950
• 21.19M (16.7) in 1999
• 33.12M (27.4) in 2025

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Expenditures including for long-term care in
Japan until 1999
Expenditure on long-term in-patient nursing care

(HC.3.1)
-Expenditure for health service facilities for
the elderly (HP.2.1) -Estimated
expenditure for meal service for inpatients in
hospitals for the elderly (HP.1.1) -Estimated
expenditure for inpatient care in hospitals for
the elderly (HP.1.1) Expenditure on long-term
home health care (HC.3.3) -Expenditure for
home-visit nursing care for the elderly
(HP.1.1)
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Facility services providing LTC

• Long term care welfare facilities for the aged
  LTCW special nursing home for the aged
• Long term care health facilities for the aged
  LTCH facilities of health care services for
  the aged
• Long term care medical treatment facilities
  LTCM medical treatment beds, beds for
  treatment of senile dementia, LTC strength
  building hospital.

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Expenditure for long-term care in Japan for 1999
Items of Health Data Estimate (Million Yen) of THE
Total expenditure on health (THE) 38,011,356 -
Total expenditure on long-term nursing in-patient care 2,908,176 7.7
Total expenditure on long-term home health care 91,400 0.2
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Financing of long-term care in Japan for 1999
(Million Yen)
Total Public Private
Expenditure on health 38,011,356 29,669,720 (78.1) 8,341,636 (21.9)
Expenditure on long-term in-patient nursing care 2,908,176 2,549,317 (87.7) 358,859 (12.3)
Expenditure on long-term home health care 91,400 89,100 (97.5) 2,300 (2.5)
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Expenditures for long-term care by function of
care and provider industry in Japan of 1999 (SHA
table 2)
(Million Yen)
HP.1.1 General Hosp. HP.2.1 Nursing care facilities Total
HC.3 Services of long-term nursing care 2,057,493 942,083 2,999,576
HC.3.1 In-patient long-term nursing care 1,966,093 942,083 2,908,176
HC.3.2 Day cases of long-term nursing care 0 0 0
HC.3.3 Long-term nursing care home care 91,400 0 91,400
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Estimation process (1)

• Total expenditure on long-term nursing care
  (HC.3.1)
• sum of following 3 items
• ?Expenditure for health service facilities for
  the elderly(HP.2.1)
• National health expenditure for health
  facilities for the elderly (Public)
• Fee for health facilities for the elderly
  (private)
• ?Estimated expenditure for meal service for
  inpatients in hospitals for the elderly (HP.1.1)
• National health expenditure for meal services
  during hospitalisation related to hospitals
• Proportion of the number of working beds for
  the elderly to the total number of working beds
• ?Estimated expenditure for inpatient care in
  hospitals for the elderly (HP.1.1)
• National health expenditure for inpatient care
  in hospitals for the elderly
• Estimated proportion of amount of inpatient
  care in hospitals for the elderly, on the basis
  of official statistics

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Estimation process (2)

• Total expenditure on long-term home health care
  (HC.3.3)
• Expenditure for home-visit nursing care for the
  elderly (HP.1.1)
• Private expenditure on long-term home health care
  
• total expenditure on long-term health care
• patients payment about home-visit nursing care
  for the elderly.
• Public expenditure on long-term home health care
• total expenditure on long-term health care
• -private expenditure on long-term health care

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Issues of estimation

• ?Date source necessary for estimates of
  expenditure items that conceptually exist are not
  available. This may cause underestimate.For
  example, expenditure for day cases of long-term
  nursing care (HC.3.2)
• ? Boundary of LTCPersons who need long-term care
  (NOT health services) were covered by the Medical
  Insurance due to insufficiency of the Long-term
  Insurance system before 2000.
• ?Introducing Long Term Care Insurance System
  (LTCI) in 2000Consistency should be needed
  before/after introducing LTCI.

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Trend of National Medical Expenditure
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Before and after enforcement of LTCI
After
Before
Official statistics about LTCI
No available data
Total expenditure for long-term care, defined by
SHA
Data sources
National medical expenditure
National medical expenditure
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Public Long Term Care Insurance System (LTCI)

• ? Established in April 2000.
• ? Insurer the municipalities
• ? Insured people aged 40 and above
• ? Eligible
• - People aged 65 or older in need of care or
  support
• - People aged from 40 to 64 who are participants
  of medical insurance, in need of care or support
  due to a disease caused by aging such
  aspresenile dementia or cerebrovascular
  disorders, etc

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Integration of Health and Welfare
Welfare for the Aged
Medical services for the Aged
Under Health Insurance Long LoS Not equiped for
LTC
From gov. budget The municipalities driven Means
tested
April 2000
Long term care insurance
Social insurance
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Financing of LTCI
Public Expenditure (HF.1.1)
? 2001 budget 4,770 billion yen co-pays 560
billion yen Provision 4,210 billion yen
Apart from co-payment of the users.
The users pay 10 of the benefit amount.
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Estimating Strategy for LTCI

• Discrimination b/w LTC and Healthcare services
• by Providers
• by Function of Services
• by Degree of Need of LTC

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Facility services
Long term care welfare facilities for the Aged LTCW (Special Nursing home for the Aged) NA NA
Long term care health facilities for the Aged LTCH (Facilities of health care services for the aged) HP2.1 HC3.1
Long term care medical treatment facilities LTCM Medical treatment beds Beds for treatment of senile dementia LTC strength building Hospital HP1.1 HC1.1
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Benefits of LTCI
Persons requiring long term care or support will
receive benefits in the following services. -
In-home services - Facility services
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In-home services
Home-visit/ commuting care service Home-visit care (Home help service) HC 3.3 ? HP 3.6?
Home-visit/ commuting care service Home-visit bathing services HC 3.3 ? HP 3.6?
Home-visit/ commuting care service Home-visit nursing HC 3.3 HP 3.6?
Home-visit/ commuting care service Home-visit rehabilitation HC 3.3 ? HP 3.6?
Home-visit/ commuting care service Commuting for care (Day services, at day care centres) HC 3.2
Home-visit/ commuting care service Commuting rehabilitation (Day care) HC 3.2
Home-visit/ commuting care service Welfare equipment rental service X
Short-term stay service Short-term stay at a care facility HC 3.2?
Short-term stay service Medical care service through a short-term stay HC 3.2?
Others Daily life care in communal living for the elderly with dimentia HC 3.2?
Others Daily life care for residents in a special facility HC 3.2?
Others Management guidance for in-home care X
Others Allowance for purchasing welfare equipment X
Others Allowance for modifying house X
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Degree of Need of LTC
Condition Yen /Month
Needing Assistance Not deemed LTC but needing assistance in everyday life 61,500
Needing LTC 1 Needing some LTC 165,800
Needing LTC 2 Needing small degree of LTC 194,800
Needing LTC 3 Needing medium degree of LTC 267,500
Needing LTC 4 Needing large degree of LTC 306,000
Needing LTC 5 Needing highest degree of LTC 358,000
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SHA application of LTC
Include in HHA
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Conclusion

• Pilot Study to estimate LTC will start beginning
  of 2003, when all relevant data will be published.

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Japan SHA Team

• Koki HAYAMIZU
• Tastuo IHARA
• Yoshiyuki OZAWA
• Hiroyuki SAKAMAKI
• Manabu YAMAZAKI