Association of healthcare expenditures with aggressive versus palliative care for cancer patients at the end of life: a cross-sectional study using claims data in Japan.

[Background] End-of-life (EOL) care imposes heavy economic burdens on patients and health insurers. Little is known about the association between the types of EOL care and healthcare costs for cancer patients across various providers. [Objective] To explore the association of healthcare expenditures with benchmarking indicators of aggressive versus palliative care among terminally ill cancer patients, from the perspective of health insurers. [Design] Cross-sectional retrospective study using health insurance claims data. [Setting/participants] Cancer patients who had died in Kyoto prefecture, Japan, between April 2009 and May 2010. [Main outcome measure] Claims data were analyzed using multilevel generalized linear models to examine whether aggressive care and palliative care were associated with expenditures during the last 3 months of life, after adjusting for patient characteristics, hospital characteristics and other non-indicator procedures. [Results] We analyzed 3143 decedents from 54 hospitals. Median expenditure per patient during the last 3 months was US$13 030. Higher expenditures were associated with the aggressive care indicators of higher mortality at acute-care hospitals and use of chemotherapy in the last month of life, as well as with the palliative care indicators of increased hospice care and opioid use in the last 3 months of life. However, increased physician home care in the last 3 months was associated with lower expenditure. [Conclusions] Indicators of both aggressive and palliative EOL care were associated with higher healthcare expenditures. These results may support the coherent development of measures to optimize aggressive care and reduce the financial burdens of terminal cancer care

高額医療技術における資源配置と需給バランスの評価

京都大学0048新制・課程博士博士(社会健康医学)甲第15608号社医博第33号新制||社医||6(附属図書館)28135京都大学大学院医学研究科社会健康医学系専攻(主査)教授 吉原 博幸, 教授 中原 俊隆, 教授 川上 浩司学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDA

The effects of dementia and long-term care services on the deterioration of care-needs levels of the elderly in Japan

To investigate the associations between dementia, the use of long-term care (LTC) services, and the deterioration of care-needs levels of elderly persons in Japan. Using a retrospective cohort study, we analyzed 50, 268 insurance beneficiaries aged 65 years and older who had utilized LTC services between 2010 and 2011 in Kyoto prefecture, Japan. Logistic regression analyses were used to identify predictors of care-needs level deterioration. Dementia, facility care services, the male sex, older age, and lower baseline care-needs levels were associated with care-needs level deterioration. The disparity between odds ratios of home care services, dementia diagnoses, and facility care services on care-needs level deterioration diminished with increasing baseline care-needs levels. The other risk factors of care-needs level deterioration showed stronger associations as care-needs levels and age increased. The effects of baseline care-needs levels and dementia should be considered when developing LTC policies

Survival analyses of postoperative lung cancer patients: an investigation using Japanese administrative data.

Long-term survival rates of cancer patients represent important information for policymakers and providers, but analyses from voluntary cancer registries in Japan may not reflect the overall situation. In 2003, the Diagnosis Procedure Combination Per-Diem Payment System (DPC/PDPS) for hospital reimbursement was introduced in Japan; more than half of Japan's acute care beds are currently covered under this system. Administrative data produced under the DPC system include claims data and clinical summaries for each admission. Due to the large amount of data spanning multiple institutions, this database may have applications in providing a more general and inclusive overview of healthcare. Here, we investigate the use of administrative data for analyses of long-term survival in cancer patients. We analyzed postoperative survival in 7,064 patients with primary non-small cell lung cancer admitted to 102 hospitals between April 2008 and March 2013 using DPC data. Survival was defined at the last date of examination or discharge within the study period, and the event was mortality during the same period. Overall survival rates for different cancer stages were calculated using the Kaplan-Meier method. Additionally, survival rates of cancer patients at clinical stage IA were compared between low- and high-volume hospitals using the Log-rank test. Postoperative 5-year survival for patients at stage IA was 85.8% (95% CI = 78.6%-93.0%). High-volume hospitals had higher survival rates than hospitals with lower volume. Our findings using large-scale administrative data were similar to previous clinical registry reports, showing potential applications as a new method in analyzing up-to-date healthcare information

Examining sufficiency and equity in the geographic distribution of physicians in Japan: A longitudinal study

Objectives: The objective of this study was to longitudinally examine the geographic distribution of physicians in Japan with adjustment for healthcare demand according to changes in population age structure. Methods: We examined trends in the number of physicians per 100 000 population in Japan's secondary medical areas (SMAs) from 2000 to 2014. Healthcare demand was adjusted using health expenditure per capita. Trends in the Gini coefficient and the number of SMAs with a low physician supply were analysed. A subgroup analysis was also conducted where SMAs were divided into 4 groups according to urban-rural classification and initial physician supply. Results: The time-based changes in the Gini coefficient and the number of SMAs with a low physician supply indicated that the equity in physician distribution had worsened throughout the study period. The number of physicians per 100 000 population had seemingly increased in all groups, with increases of 22.9% and 34.5% in urban groups with higher and lower initial physician supply, respectively. However, after adjusting healthcare demand, physician supply decreased by 1.3% in the former group and increased by 3.5% in the latter group. Decreases were also observed in the rural groups, where the number of physicians decreased by 4.4% in the group with a higher initial physician supply and 7.6% in the group with a lower initial physician supply. Conclusions: Although the total number of physicians increased in Japan, demand-adjusted physician supply decreased in recent years in all areas except for urban areas with a lower initial physician supply. In addition, the equity of physician distribution had consistently deteriorated since 2000. The results indicate that failing to adjust healthcare demand will produce misleading results, and that there is a need for major reform of Japan's healthcare system to improve physician distribution