Association of household income with home-based rehabilitation and home help service utilization among long-term home ca
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RESEARCH ARTICLE
Open Access
Association of household income with home-based rehabilitation and home help service utilization among long-term home care service users Rumiko Tsuchiya-Ito1,2* , Tatsuro Ishizaki1, Seigo Mitsutake1, Shota Hamada3,4, Satoru Yoshie3,4,5,6,7, Katsuya Iijima5,7 and Nanako Tamiya4,8
Abstract Background: To examine the association of household income with home-based rehabilitation and home help services in terms of service utilization and expenditures. Methods: A secondary data analysis of cross-sectional design was conducted using long-term care (LTC) insurance claims data, medical claims data, and three types of administrative data. The subjects comprised LTC insurance beneficiaries in Kashiwa city, Japan, who used long-term home care services in the month following care needs certification. Household income was the independent variable of interest, and beneficiaries were categorized into low-income or middle/high-income groups based on their insurance premiums. Using a two-part model, the odds ratios (ORs) and 95% confidence intervals (CIs) for the utilization of home-based rehabilitation and home help services in the month following care needs certification were estimated using logistic regression analysis, and the risk ratios (RRs) of service expenditures were estimated using a generalized linear model for gamma-distributed data with a log-link function. Results: Among 3770 subjects, 681 (18.1%) used home-based rehabilitation and 1163 (30.8%) used home help services. There were 1419 (37.6%) low-income subjects, who were significantly less likely to use (OR: 0.813; 95%CI: 0.670–0.987) and spend on (RR: 0.910; 95%CI: 0.829–0.999) home-based rehabilitation services than middle/highincome subjects. Conversely, low-income subjects were significantly more likely to use (OR: 1.432; 95%CI: 1.232– 1.664) but less likely to spend on (RR: 0.888; 95%CI: 0.799–0.986) home help services than middle/high-income subjects. Conclusion: Household income was associated with the utilization of long-term home care services. To improve access to these services, the LTC insurance system should examine ways to decrease the financial burden of lowincome beneficiaries and encourage service utilization. Keywords: Aging, Economic status, Long-term care services, Claims data, Two-part model
* Correspondence: [email protected] 1 Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan 2 Dia Foundation for Research on Ageing Societies, Tokyo, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this arti
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