Association of the 2018 Japanese Financial Incentive Policy With Long-Term Care Needs and Mortality

Area of Science:

• Gerontology
• Public Health Policy
• Health Services Research

Background:

• Japan introduced a municipal financial incentive program in 2018 to enhance long-term care (LTC) quality.
• Understanding the impact of such policies on older populations is crucial for public health.
• Previous research has not fully quantified the association between municipal incentive performance and health outcomes.

Purpose of the Study:

• To evaluate the association between municipal financial incentive program performance and subsequent long-term care (LTC) certification and all-cause mortality.
• To analyze these associations among community-dwelling older adults in Japan.

Main Methods:

• Utilized baseline data (2016) from the Japan Gerontological Evaluation Study (N=90,896, aged ≥65).
• Linked participant data with 2018-2020 administrative records for LTC certification and mortality.
• Employed multivariable logistic regression with fixed effects, adjusting for demographic, socioeconomic, and health factors, to calculate odds ratios (ORs) per 1 standard deviation (SD) increase in composite incentive scores.

Main Results:

• Over three years, 10.7% experienced incident LTC certification and 5.1% died.
• A 1 SD higher municipal incentive score was associated with significantly lower odds of incident LTC (OR: 0.91, 95% CI [0.90, 0.92]).
• A 1 SD higher incentive score was also linked to substantially lower odds of all-cause mortality (OR: 0.66, 95% CI [0.54, 0.81]).

Conclusions:

• Improved municipal performance in Japan's financial incentive policy correlated with short-term decreases in LTC utilization and mortality.
• The "Support Functional Independence/Prevent Progression" domain was key in less-urban areas, while cities focused on process-oriented activities.
• Findings support continued policy monitoring and refinement to optimize long-term care for older residents.