Longitudinal Changes in the Government-Certified Index Stage and Requisite Costs for Long-Term Care Insurance System among the Community-Dwelling Demented Elderly in Japan
Background. A new public long-term care (LTC) insurance was launched in 2000 in Japan. However, there have been few studies involving factors that increase LTC costs of demented subjects; no follow-up studies involving the Government-Certified Index (GCI) and requisite costs related to the causes of dementia. Method. An epidemiological survey was conducted in a rural area in Japan in 1999, and 271 subjects were diagnosed as dementia patients. Age, sex, mini-mental state examination, clinical dementia rating, activity of daily living, causes of dementia, and coexisting physical disease were confirmed. After the LTC insurance has been launched, we tracked the GCI stages and payment amounts every month for 8 years. Result. 209 subjects were certified to be eligible for LTC insurance; however, 13 did not receive any payment. Only 49 out of 209 were alive after the follow-up period. The most common cause of dementia was Alzheimer’s disease (AD), followed by vascular dementia (VaD). There was no significant difference between the mortality rates of the two groups. VaD subjects required higher costs than AD subjects in the total certified period and in GCI stage 5. Conclusion. Our results indicate that causes of dementia can have an impact on the requisite costs for the LTC insurance. 1. Introduction A growth of the elderly population consequently increases the number of demented subjects, and dementia is one of the major challenges of health care systems in most countries, especially in aging societies such as Japan. The presence of dementia is strongly related to a decline in the level of daily functioning [1], and the severity of dementia is one of the predictors of higher levels of care [2]. Furthermore, the presence of dementia has an impact on patients’ physical condition, increase the burden on caregivers [3], and can even diminish the life expectancy of elderly people [4, 5]. In Japan, the public long-term care (LTC) insurance system was launched in 2000 to deal with an increasing number of impaired elderly and was revised in 2006. The aims of the LTC insurance system are to allocate limited resources to impaired elderly in a way that adequately reflects need and to reduce the burden on caregivers [6]. Services are allocated based on the Government-Certified Index (GCI), which indicates the amount that can be spent on services for a particular patient with a given GCI stage, basically ranging from 0 (need only support) to 5. Once this procedure has been completed, a care management agency steps are taken to provide the level of services indicated by
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