Regional disparities in home healthcare utilization for older adults and their associated factors

Tsukuba, Japan—The establishment of home care support clinics and hospitals (HCSCs) between 2006 and 2008 was intended to improve home healthcare in Japan, with a system for doctors to receive calls on a 24-hour basis and visit patients at home (home visits). The subsequent establishment of enhanced HCSCs in 2012 was intended to further promote 1) home visits for people who suddenly become ill and 2) end-of-life care at home. However, the effects of these measures may differ depending on the region. Local differences in the number of these facilities are also likely linked to regional disparities in the rate of home healthcare use.

Therefore, this study was intended to 1) identify regional differences in the rate of use of physician-led home-visit medical care among people aged 65 and above using nationwide data published by the Ministry of Health, Labor and Welfare, and 2) clarify related factors.

The analysis revealed that older adults had a higher rate of home-visit medical care use in areas with high population densities, such as Tokyo and Osaka. Differences also depended on the area of residence, with higher rates of home-visit medical care use in the Kanto, Chubu, Kinki, and Chugoku regions than in Hokkaido and Tohoku. In addition, the proportion of older adults receiving home-visit medical care, mainly from enhanced HCSCs, was higher in urban areas. However, in less populated areas, the proportion of older adults receiving home visits was low, with more people using conventional HCSCs. Furthermore, multivariate analysis showed that the proportion of older adults receiving home visits was high in areas with high population densities, particularly those with a large number of conventional HCSCs and enhanced HCSCs, while it was low in areas with many beds in long-term care facilities.

These results reveal significant regional disparities in the frequency of home visits among older adults. Furthermore, they indicate a relationship between medical and long-term care resources, population density, and residential area. In the context of Japan's ongoing population aging, these results highlight the importance of recognizing these regional disparities and developing a healthcare and long-term care provision system that is tailored to regional characteristics.

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This work was supported by the Institute for Health Economics and Policy.

_{Original Paper}

Title of original paper:
Regional Disparities in Home Healthcare Utilization for Older Adults and their Associated Factors at the Secondary Medical Area Level: A Nationwide Study in Japan

Journal:
Geriatrics & Gerontology International

DOI:
10.1111/ggi.15011

_{Correspondence}

Professor TAMIYA, Nanako
Assistant Professor SUN, Yu
Research and Development Center for Health Services / Institute of Medicine, University of Tsukuba

_{Related Link}

Institute of Medicine
Department of Health Services Research, Institute of Medicine