Out-of-Municipality Long-Term Care Insurance Benefits and Public Hospital Revenue Patterns in the Remote Oki Islands,...

Area of Science:

• Healthcare Management
• Rural Health Policy
• Gerontology

Background:

• Population aging and depopulation present significant challenges to rural healthcare sustainability.
• Remote communities, particularly island areas, face unique pressures on healthcare and long-term care systems.
• Understanding temporal trends in healthcare utilization and financial indicators is crucial for policy development.

Purpose of the Study:

• To analyze temporal trends in out-of-municipality long-term care insurance (LTCI) benefits.
• To examine contemporaneous public hospital management indicators in two remote Japanese island areas.
• To explore the relationship between LTCI benefit trends and hospital financial shifts.

Main Methods:

• An exploratory descriptive ecological study design was employed.
• Data spanned fiscal years 2015-2023 from the Oki Islands, Japan.
• Included aggregated municipality-level LTCI/population data and hospital-level financial/operational data.

Main Results:

• Both study areas experienced population decline.
• The Dozen region saw a significant increase in out-of-municipality LTCI benefits (9.5% to 21.9%).
• Hospitals in both regions shifted revenue from inpatient to outpatient services, with outpatient-to-inpatient ratios increasing.

Conclusions:

• Increased out-of-municipality LTCI benefits in the Dozen region correlated with a shift in hospital revenue composition.
• These ecological findings are hypothesis-generating and do not establish causality or individual relocation.
• Further evaluation of out-of-municipality LTCI benefits with individual-level data is recommended for health policy and resource allocation.