TERMINAL CARE COSTS IN JAPAN USING LINKED HEALTH AND LONG-TERM CARE CLAIMS: WHICH IS MORE EXPENSIVE—HOSPITAL DEATH OR LONG-TERM CARE FACILITY DEATH?
Author(s)
Kosuke Iwasaki, MBA1, Naoki Ikegami, MD2, AYANO CHIDA, B.S.3;
1Milliman, Inc., Principal, Chiyoda-ku, Tokyo, Japan, 2Keio University, Tokyo, Japan, 3Milliman,Inc Japan, Tokyo, Japan
1Milliman, Inc., Principal, Chiyoda-ku, Tokyo, Japan, 2Keio University, Tokyo, Japan, 3Milliman,Inc Japan, Tokyo, Japan
OBJECTIVES: In 2006, Ministry of Health, Labour and Welfare (MHLW) introduced the Mitori Kaigo Add-on to the long-term care insurance (LTCI) fee schedule to strengthen end-of-life care in LTCI facilities and reduce reliance on acute-care hospitals. A secondary objective was the containment of terminal medical expenditures. This study quantified combined medical and LTCI expenditures in the last six months of life and compared costs between individuals who died in LTCI facilities and those who died elsewhere using real-world data.
METHODS: We analyzed linked health insurance and LTCI claims data from DeSC Healthcare Inc. covering April 2014 to November 2024. The LTCI data included care-need levels and service-specific reimbursements. The study population comprised beneficiaries of the National Health Insurance and the Late Elderly Healthcare System with available death information and LTCI records. Individuals with observable medical and LTCI claims during the final six months of life were included.
RESULTS: Among approximately 17 million beneficiaries, 3.2 million had both death information and LTCI records, and 432,831 had complete six-month observation. Medical expenditures approximately doubled before death, whereas LTCI expenditures increased by about 20%. Medical costs declined with age, while LTCI costs increased; however, because medical expenditures were substantially larger, total combined costs decreased with age. Higher LTCI care-need levels were associated with higher LTCI expenditures, while medical expenditures remained relatively stable. Individuals who died in LTCI facilities incurred higher LTCI costs but substantially lower medical costs than those who died elsewhere. Consequently, total medical plus LTCI expenditures were lower for LTCI facility deaths, with the largest difference among individuals with Care-need Level 5 (mean difference: ¥917,903 per person). Similar patterns were observed for cancer and non-cancer decedents.
CONCLUSIONS: End-of-life care in LTCI facilities is associated with lower combined medical and LTCI expenditures despite higher LTCI costs, supporting the fiscal rationale underlying the Mitori Kaigo Add-on policy.
METHODS: We analyzed linked health insurance and LTCI claims data from DeSC Healthcare Inc. covering April 2014 to November 2024. The LTCI data included care-need levels and service-specific reimbursements. The study population comprised beneficiaries of the National Health Insurance and the Late Elderly Healthcare System with available death information and LTCI records. Individuals with observable medical and LTCI claims during the final six months of life were included.
RESULTS: Among approximately 17 million beneficiaries, 3.2 million had both death information and LTCI records, and 432,831 had complete six-month observation. Medical expenditures approximately doubled before death, whereas LTCI expenditures increased by about 20%. Medical costs declined with age, while LTCI costs increased; however, because medical expenditures were substantially larger, total combined costs decreased with age. Higher LTCI care-need levels were associated with higher LTCI expenditures, while medical expenditures remained relatively stable. Individuals who died in LTCI facilities incurred higher LTCI costs but substantially lower medical costs than those who died elsewhere. Consequently, total medical plus LTCI expenditures were lower for LTCI facility deaths, with the largest difference among individuals with Care-need Level 5 (mean difference: ¥917,903 per person). Similar patterns were observed for cancer and non-cancer decedents.
CONCLUSIONS: End-of-life care in LTCI facilities is associated with lower combined medical and LTCI expenditures despite higher LTCI costs, supporting the fiscal rationale underlying the Mitori Kaigo Add-on policy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE415
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas