The Reduction in Medical and Care Costs for Diseases Associated with Being Bedridden in Rural Residents in Japan

OBJECTIVES: We previously showed that the Center for Healthy Aging Program (CHAP) in a Japanese rural area, Hirosaki, is associated with the reduction of cardiovascular-disease-related costs. This study aims to assess the effect of the CHAP on the medical and care costs for diseases related to being bedridden.

METHODS: We compared the all-cause medical and care costs in patients diagnosed as dementia, stroke, or a fracture in the period from 1st July 2015 to 30th June 2019 (follow-up) using the claims data of residents in Hirosaki between three groups, identified by the participation of checkups during a year before the follow-up period (baseline): CHAP participants (CHAP group), residents who received an annual standard health checkup (SHC) group, and everyone else (no checkup group). We used a multivariate hurdle model considering age, sex, care level, and Charlson Comorbidity Index to adjust the difference in baseline characteristics.

RESULTS: Of 42,819 eligible residents, the numbers of those in the CHAP, SHC, and no checkup groups were 384 (0.9%), 9,805 (22.9%), and 32,630 (76.2%), respectively. The all-cause medical costs in the follow-up period were lowest in the CHAP group for all three diseases. In patients with a fracture, both all-cause care costs in the follow-up period and in the year before the follow-up end were lower in the CHAP group than in the no checkup group (risk ratio [RR] = 0.097, p = 0.022 and RR = 0.091, p = 0.018, respectively), but in patients with dementia, the former were not different while the latter were lower in the CHAP group (RR = 0.365, p = 0.233 and RR = 0.086, p < 0.001, respectively).

CONCLUSIONS: We observed the high reduction of care costs for patients with bedridden-associated diseases in the CHAP group, especially in the last year of the follow-up, suggesting the long-term effect of the CHAP.