Determinants of Total Health and Totel Long-Term Care Enpenditures for Elderly in Japan

Abstract

Since the end of the World War II, the Japanese health care system has been achieving higher standards for health and medical care. However, since the middle of 1970s, Total Health Expenditure in Japan has been increasing annually due to the rapid aging of Japanese society. This study intends to identify the determinants of total health expenditure for elderly and total long-term care expenditure in Japan in 2000 for cost containment and the provision of the appropriate mix of health care and long-term care services. The methodology carried out in this study was the multiple regression anlysis using Total Health Expenditure for Elderly, inpatient care expenditure, outpatient care expenditure, Total Long-term Care expenditure, expenditure for care at nursing facilities and at homes as dependent variables. The data used as independent variables in this model were filteen variables related to health services availability, nursing facility availability, home care availability and area characteristics. The OLS was conducted with using all prefectures' data, and also data were classified into two groups: the higher life expectancy prefectures, and the lower life expectancy prefectures. The results of the multiple regression analysis using all prefecture data indicated that the number of general beds and sanatorium type beds positively influenced the Total Health Expenditure for Elderly. The number of sanatorium type beds Special Nursing Homes, Health Service Facilities for the Aged, and clinics positively influenced the Total Long-term Care Expenditure. From the result of the two-grouped data, the higher group had the tendency to be selected the same variables as the model with all prefectures. However, the shorter life expectancy group had tendency to different from the results of all prefecture data. Some variables showed the different sign between the model for the higher group and lower group. This implies that when controlling Total Health Expenditure for Elderly and Total Long-term Care Expenditure, the policies tailored to each prefecture are needed. The possible measures to control these expenditures and to reduce the gap of expenditures amongst prefectures would be: control of the supplier of the services, delegation to the insurers, improve of the payment system.