Total healthcare costs during the last 5 years in elderly with long-term care certification in a small Japanese rural municipality

Introduction: In Japan, since the Long-Term Care Insurance launched in 2000, elderly care has been supported with both medical and long-term care insurance, based on the community-based integrated care system aiming at living in the community to the end of lives. Medical expenses per person aged 75 and older show a decrease from US $8,192 in 1999 to US $7,197 in 2002, however, they gradually increased to US $9,352 in 2019. The long-term care costs also increased from US $4,248 in 2006 to US $5,182 in 2021. Meanwhile, the proportion of deaths in hospitals decreased from 82.4% in 2005 to 67.4% in 2021, showing a shift towards non-hospital settings. (US $1.00 = 102 Japanese yen) Aims, Objectives, Methods: This study focused on the last 5 years of life for 96 individuals aged 75 and older. They received their initial long-term care certification after 2016 and died during the fiscal year 2021. These individuals lived in a small rural municipality with a population of less than 20,000, an aging rate of 37.9%, and a long-term care certification rate of 19% in Japan. Individually, we linked medical fees and records of the long-term care insurance. Ultimately, we identified the location of end-of-life care. Subsequently, we categorized individuals with hospitalization expenses in the last month as ‘hospital-deaths’, while those without hospitalization expenses as ‘community-deaths’. Highlights, Results, or Key Findings: The average total care costs over the last five years amounted to US $116,241, including hospitalization expenses of US $55,250, outpatient expenses of US $25,997, and long-term care costs of US $34,995. The 80-84 age group had the highest total care costs. Places of death comprised 62.5% in hospital-deaths and 37.5% in community-deaths. The final severity of care required (range 0-5) for community-deaths was significantly higher at 3.5, compared to 2.9 for hospital-deaths. The residency at care facilities was significantly longer for community-deaths (8.4 months) than hospital-deaths (3.8 months) . Total care costs were markedly elevated for hospital-deaths, reaching US $129,830, in contrast to US $93,594 for community-deaths. Especially in the last month, total care costs were significantly higher, reaching US $7,616 for hospital-deaths and US $2,796 for community-deaths. Conclusion: This study examined the total care costs for elderly people with long-term care certification in a small municipality over the five years before death and analyzed the places of end-of-life care. The final severity of care required in community-deaths was significantly higher than that in hospital-deaths and the duration of residency in care facilities was significantly longer. This suggests that elderly people with substantial care and medical needs lived in the community to the end of lives. Meanwhile, the total care costs during the last five years were higher in hospital-deaths, particularly in the last month before death. In Japan, the community-based integrated care system since 2006 has facilitated end-of-life care in long-term care services and changed the situation where hospital deaths accounted for over 80% in 2005. This system appears to have gradually improved.