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

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

SAKAMAKI, Hiroyuki, MBAInstitute for Health Economics and policy (IHEP)

Tokyo,Japan

10th Oct, 2002, OECD Paris

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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

20

40

60

80

100

120

140

0

19201931

19421953

19641975

19861997

20082019

20302041

20522063

20742085

2096

65yo-

15-64yo

0-14yo

Current

（Mio）

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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)

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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.

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Expenditure for long-term care in Japan for 1999

Items of Health DataEstimate

(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%

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Financing of long-term care in Japan for 1999

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%)

(Million Yen)

Expenditures for long-term care by function of care and provider industry in Japan of 1999(SHA table 2)

HP.1.1General Hosp.

HP.2.1Nursing care

facilitiesTotal

HC.3Services of long-term nursing care

2,057,493 942,083 2,999,576

HC.3.1In-patient long-term nursing care

1,966,093 942,083 2,908,176

HC.3.2Day cases of long-term nursing care

0 0 0

HC.3.3Long-term nursing care: home care

91,400 0 91,400

(Million Yen)

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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.

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

0

50,000

100,000

150,000

200,000

250,000

300,000

350,00019

5419

56

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

Year

100Mio Yen

introduced LTCI

Trend of National Medical Expenditure

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Before and after enforcement of LTCI

Before After

National medical expenditure

National medical expenditure

Official statistics about LTCI

No available data

Total expenditure for long-term care, defined by SHA

Data

source

s

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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 as;presenile dementia or cerebrovascular disorders, etc

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Integration of Health and Welfare

• Special Nursing home for the aged • Home help services • Day services

• Health care services for the Aged • Medical treatment beds • General Hospital • out-patient • rehabilitation

Welfare for the Aged Medical services for the Aged

Under Health InsuranceLong LoSNot equiped for LTC

From gov. budget The municipalities drivenMeans tested

Long term care insuranceSocial insurance

April 2000 ～

Financing of LTCI

● 　 2001 budget4,770 billion yen

co-pays 560 billion yenProvision 4,210 billion yen

Apart from co-payment of the users. The users pay 10% of the benefit amount.

Prefecture(HF1.1.2)

13%Municipalitie

s(HF1.1.3)

13%

State(HF1.1.1)

25%

Premium(HF1.2)49%

Public Expenditure

(HF.1.1)

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Estimating Strategy for LTCI

• Discrimination b/w LTC and Healthcare services

– by Providers

– by Function of Services

– by Degree of Need of LTC

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

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

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Benefits　 of LTCI

Persons requiring long term care or support will receive benefits in the following services.

- In-home services

- Facility services

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

In-home services

Home-visit/ commuting care service

Home-visit care (Home help service) HC 3.3 ?

HP 3.6?

Home-visit bathing services HC 3.3 ?

HP 3.6?

Home-visit nursing HC 3.3 HP 3.6?

Home-visit rehabilitation HC 3.3 ?

HP 3.6?

Commuting for care (Day services, at day care centres) HC 3.2

Commuting rehabilitation (Day care) HC 3.2

Welfare equipment rental service X

Short-term stay service

Short-term stay at a care facility HC 3.2?

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?

Daily life care for residents in a special facility HC 3.2?

Management guidance for in-home care X

Allowance for purchasing welfare equipment X

Allowance for modifying house X

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Degree of Need of LTCCondition 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

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

SHA application of LTC

LTCM

TBDTBDTBDTBDLTCH

LTCW

Home care

Need 5Need 4Need 3Need2Need1Assi.

Increase of m

edical provision →

Intensity of medical need → = Include in HHA

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Conclusion

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

Institute for Health Economics and Policy, Tokyo, JapanIHEP10th Oct, 2002, OECD Paris

Japan SHA Team

• Koki 　 HAYAMIZU

• Tastuo 　 IHARA

• Yoshiyuki 　 OZAWA

• Hiroyuki 　 SAKAMAKI

• Manabu 　 YAMAZAKI