Abstract
Background: In patients with Parkinson's disease (PD), long-term care insurance (LTCI), which can provide physical activity, might affect medical costs and utilization. We investigated the impact of LTCI on medical costs and utilization among patients with PD aged ≥60 years. Methods: Data were derived from the 12-year Korean National Health Insurance Service‒Senior cohort. Among patients with newly developed PD, the intervention group receiving LTCI was matched with the control group using propensity score risk-set matching. As medical costs and utilization may increase markedly immediately before LTCI allocation, the baseline period was set from 5 years to 1 year prior to receiving LTCI. Medical costs and utilization were recorded in six 1-year intervals thereafter. We compared medical costs and utilization between groups using a comparative interrupted time-series analysis. Results: 5011 LTCI beneficiaries and 5011 propensity score- and risk-set-matched controls were included. The overall mean (standard deviation) age was 77.73 (5.7) years, and 66.2% were women, in both groups. LTCI benefit was associated with reduced overall direct medical costs for 5 years (post-intervention year 5: -270$, p = 0.033), and overall hospital length-of-stay (LOS) for 2 years post-LTCI (post-intervention year 2: -2.43 days, p = 0.002), although medical costs and LOS increased immediately pre-LTCI implementation. The long-term care hospital LOS of LTCI beneficiaries increased relatively by 3-years post-LTCI implementation, particularly in those with a high Charlson Comorbidity Index score (post-intervention year 3: +2.65 days, p = 0.04). Conclusions: LTCI benefit stably decreased medical costs for patients with PD for 5 years, despite the steep increase immediately pre-LTCI benefit, but was limited in reducing medical utilization, particularly as reflected by LOS in long-term care hospitals and patients with comorbidities. LTCI could be a useful health policy to reduce PD disease burden. However, further development is required to provide services that can reduce LOS to PD patients with comorbidities.
| Original language | English |
|---|---|
| Article number | 115563 |
| Journal | Social Science and Medicine |
| Volume | 317 |
| DOIs | |
| Publication status | Published - 2023 Jan |
Bibliographical note
Funding Information:However, to become a LTCI beneficiary, individuals aged 65 years or older or those under the age of 65 suffering from geriatric diseases, such as dementia, stroke, or PD, must achieve a certain score in the care-needs certification (CNC) system that uses a standardized 52-item functional assessment tool and assessment procedure across the nation (Ju et al., 2019). These items represent mental and physical states derived from five domains (physical function, cognitive function, behavior change, nursing treatment, and rehabilitation), including position change (physical function), short-term memory impairment (cognitive function), delusions, hallucinations or hallucinations (behavior change), bronchostomy care, pressure sores nursing (nursing treatment), and movement disorders (rehabilitation). In general, the effective period of approval for long-term care granted by the CNC system is two years.It was expected that benefits for home care service could reduce medical utilization and expenditure by satisfying long-term care recipients' desire for medical use through visiting nursing services, in addition to welfare services supporting physical and housekeeping activities. Furthermore, it was expected that the use of medical care could be reduced by protecting the recipients in a long-term care institution for certain hours a day, supporting physical activity, and maintaining or improving mental and physical functions (Lee and Kwak, 2016). Additionally, institutional care benefits can contribute to the reduction of medical use by providing beneficiaries with appropriate nutrition, hygiene management, position change, physical therapy, and cognitive function programs at the facility (Jeon and Kwon, 2017).
Publisher Copyright:
© 2022 The Author(s)
All Science Journal Classification (ASJC) codes
- Health(social science)
- History and Philosophy of Science
