Effects of the increase in co-payments from 20 to 30 percent on the compliance rate of patients with hypertension or diabetes mellitus in the Employed Health Insurance System

Objectives: How to contain medical expenditures is a universal problem. The Japanese government has increased patient co-payments to control it. The purpose of this study is to clarify whether the increase in co-payments to 30 percent prevented patients with hypertension or diabetes mellitus from receiving necessary care in the Employee Health Insurance System. Methods: The subjects were 211 patients with hypertension and 66 patients with diabetes mellitus who regularly visited physicians from October 2001 to March 2002 and were defined as a cohort that needed health care, and their medical indicators were examined between April and September 2002 (prestage) and between April and September 2003 (poststage). Results: In the hypertensive patients with no complications, the compliance rate was 89.9 percent and 88.0 percent in the prestage, and poststage, respectively, showing no significant change. In the hypertensive patients with complications, the compliance rate was 90.5 percent and 92.1 percent in the prestage and poststage, respectively, showing no significant change. In the diabetic patients with complications, the compliance rate was 77.5 percent and 79.2 percent, in the prestage and poststage, respectively, with no significant change. In the diabetic patients with no complications, however, the compliance rate was 83.7 percent and 66.7 percent, in the prestage and poststage, respectively. A significant decrease was observed among diabetic patients without complications. Conclusions: Increasing co-payments reduced necessary preventive care in diabetic patients without complications.</p

Risk Factors for Nosocomial Infection in the Neonatal Intensive Care Unit by the Japanese Nosocomial Infection Surveillance (JANIS)

We evaluated the infection risks in the neonatal intensive care unit (NICU) using data of NICU infection surveillance data. The subjects were 871 NICU babies, consisting of 465 boys and 406 girls, who were cared for between June 2002 and January 2003 in 7 medical institutions that employed NICU infection surveillance. Infections were defined according to the National Nosocomial Infection Surveillance (NNIS) System. Of the 58 babies with nosocomial infections, 15 had methicillin-resistant Staphylococcus aureus (MRSA) infection. Multiple logistic regression analysis demonstrated that the odds ratio for nosocomial infections was significantly related to gender, birth weight and the insertion of a central venous catheter (CVC). When the birth weight group of more than 1, 500g was regarded as the reference, the odds ratio was 2.35 in the birth weight group of 1,000-1,499g and 8.82 in the birth weight group of less than 1,000g. The odds ratio of the CVC () for nosocomial infection was 2.27. However, other devices including artificial ventilation, umbilical artery catheter, umbilical venous catheter, and urinary catheter were not significant risk factors. The incidence of MRSA infection rapidly increased from 0.3% in the birth weight group of more than 1,500g to 2.1% in the birth weight group of 1,000-1,499g, and to 11.1% in the birth weight group of less than 1,000g. When the birth weight group of more than 1,500g was regarded as the reference, multiple logistic regression analysis demonstrated that the odds ratio was 7.25 in the birth weight group of 1,000-1,499g and 42.88 in the birth weight group of less than 1,000g. These odds ratios were significantly higher than that in the reference group. However, the application of devices did not cause any significant differences in the odds ratio for MRSA infection.</p

Effects of an increase in patient copayments on medical service demands of the insured in japan

Objectives:To examine quantitatively the effects of an increase in patient copayments from 10% to 20% on the demand for medical services in Japan. Methods: The subjects of the study were the employees insured by the 1,797 health insurance societies, belonging to the National Federation of Health Insurance Societies, in 1996 and 1998. Indicators of medical service demands analyzed include the inpatient, outpatient, and dental case rates, the number of serviced days per case, the medical cost per day and the medical cost per insured. Results: When the effects of an increase in patient copayments from 10% to 20% were evaluated, taking into account the average age, the average monthly salary, the total number, the gender (male-tofemale) ratio and the dependent ratio of the insured, the estimated change in the case rate was &#8722;6.96% for inpatient, &#8722;4.79% for outpatient, and &#8722;5.77% for dental care. The estimated change in the number of serviced day per case was &#8722;4.66% for inpatient, &#8722;5.67% for outpatient, and &#8722;1.82% for dental care. The estimated change in the medical cost per day was &#8722;3.15% for inpatient, &#8722;13.00% for outpatient, and &#8722;11.48% for dental care. The estimated change in the medical cost per insured was &#8722;14.08% for inpatient, &#8722;21.54% for outpatient, and &#8722;18.11% for dental care. Conclusions: The increase in patient copayments from 10% to 20% enabled insurers to substantially reduce medical costs by cost shifting from the insurer to the insured, with resultant changes in the case rate and the number of service days per case.</p

Women's anxiety in old age and long-term care provision for the elderly.

The purpose of this study was to verify the differences in women's anxiety in old age, the expected long-term care provision, and the expected final location for terminal care for the women themselves and for their parents. In addition, we examined factors that related to their anxiety and needs. The subjects were 1,000 women of the Seikatsu Club customer cooperative association in Chiba; 539 responded to our survey. The subjects were more anxious for their parents than for themselves. They more strongly expected long-term care for their parents to be provided by their family than they expected the same for themselves. Although no differences were observed in the expected location for terminal care, most subjects expected their home to be the terminal location. Analysis by the multiple logistic regression model indicated that the following factors were significantly related to the anxiety in old age: age odds ratio [OR = 1.81], employment [OR = 2.25] for women, and planning to live with parents [OR = 2.42], housing conditions [OR = 0.56] for parents. The following factors were significantly related to the expected long-term care provision: age [OR = 2.22] for women, and age [OR = 2.15], living with parents [OR = 3.58], and employment [OR = 2.33] for parents. Age [OR = 2.14] for women, and planning to live with parents [OR = 2.09] for parents were significantly related to the expected final location of terminal care. This survey showed that women expected long-term care for their parents to be provided by their family, while many expected public long-term care services for themselves. This is the biggest difference in women's outlook on long-term care for their parents and for themselves. Multivariate analysis suggested that women aged 40 years or over, who will need long-term care in the future, tended to expect public home care services for themselves. It is virtually certain that the demand for public home care services will increase in the future.</p

Comparative analysis on the physique and batting records of the players in the National Summer High School Baseball Tournaments before and after the adoption of metal bats.

To clarify the influence of the introduction of metal bats on the physique and batting records of the players in the National Summer High School Baseball Tournaments, a comparative analysis was conducted between height, body weight, body-weight ratio (body weight/height), batting average and home run average of the best four teams' players (n = 493) and those of the other teams' players (n = 4,590) in three periods: the period of the use of wooden bats, that of the use of both wooden and metal bats and that of the use of metal bats. In the period of metal bat use, the mean values of physique of the best four teams' players were significantly larger (P &#60; 0.05) and their average number of home runs was significantly higher than those of the other teams' players (P &#60; 0.01). The only significant differences between the two groups in those indices for each time period were for height in the wood and metal/wood periods. This study demonstrated that the differences between the home run average and physique, including height, body weight and body-weight ratio of the best four teams and the rest of the teams were the greatest after the use of metal bats. These findings suggest that the importance of the home run average increased and was associated with large-size of physique after the use of metal bats in the National Summer High School Baseball Tournaments.</p