Portal de Periódicos da CAPES

IMPROVEMENT EN SELF‐CARE MAY LOWER THE INCREASING RATE OF MEDICAL EXPENSES FOR COMMUNITY‐DWELLING OLDER PEOPLE IN JAPAN

1998; Wiley; Volume: 46; Issue: 11 Linguagem: Inglês

10.1111/j.1532-5415.1998.tb06027.x

1532-5415

Kozo Matsubayasbi, Kiyohito Okumiya, Tomoko Wada, Yasushi Osaki, Michiko Fujisawa, Yoshinori Dot, Toshio Ozawa,

Migration, Aging, and Tourism Studies

To the Editor: A rapidly growing older population brings concerns about increasing medical expenses for older people as well as concerns about society's ability to care for older people with disabilities in Japan in the future.1 In December 1997, legislation was passed for a new public long-term care insurance scheme, to be fully operational in Japan by the year 2000, the purpose of which is to reduce medical expenses for older people.2 Since 1991, we have assessed annually the activities of daily living (ADL) dependencies of those aged 65 or older living in the rural Japanese town of Kahoku, and we have watched the trends in medical care costs. Kahoku, which has a population of about 6000, is one of 53 towns in Kochi Prefecture, the population of which is about 800,000. In 1996, the proportion of residents aged 65 years or older to the total population was 34% in Kahoku and 22% in the entire prefecture. We assessed eight basic ADL items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, grooming, and taking medicine) annually and noted the help required on a validated disability scale.3 We also examined the trends in medical expenses for 1 year for a subject aged 65 years or older covered by National Health Insurance and paid by the Kahoku Town Office from 1990 to 1996. The number of subjects investigated in Kahoku from 1990 through 1996 were 1445 (1990), 1488 (1991), 1578 (1992), 1618 (1993), 1643 (1994), 1710 (1995), and 1770 (1996); these numbers are, respectively, 97%, 91%, 90%, 91%, 91%, 92%, and 90% of Kahoku residents aged 65 years or older. In this paper, we report yearly trends in medical expenses for older people as well as the proportion of older people in Kahoku who were independent in every ADL item from 1990 to 1996. Figure 1 shows yearly trends of the average medical expenses for an older subject for 1 year in Kahoku and in all of Kochi Prefecture as well as the trend for ADL independence of older people living in Kahoku from 1990 to 1996. The proportion of the independent older adults in Kahoku aged 65 years or more increased significantly from 1991 to 1996 (71% in 1991, 71% in 1992, 75% in 1993, 79% in 1994, 83% in 1995, and 85% in 1996) as reported previously.3, 4 Although average medical expenses for one older subject for 1 year increased annually both in Kahoku and in the entire Kochi Prefecture from 1990 to 1996, the rate increase in Kahoku during this 6-year period (794,672 yen in 1990 and 889,776 yen in 1996, a 12% increase) was lower than the average increase in the entire Kochi Prefecture (750,901 yen in 1990 and 949,418 yen in 1996, a 26% increase). . Yearly trends in average medical expenses for one older subject in Kahoku for 1 year (closed circles) and in the entire Kochi Prefecture (open circles) as well as trends in ADL-independent rate (bars) of the older people living in Kahoku from 1990 to 1996. These data suggest that improvement in ADL-independence in the older people may lower the rate of increase of medical expenses. Community-based strategies that promote the health of older people, specifically community-dwelling older people, may control the increase in medical expenses for this population.