Inadequate coverage of needs of elderly patients by long-term care insurance or medical insurance: A Japanese survey study

In Japan, medical and long-term care services are provided by separate insurance systems.The elderly have multifaceted needs, and this study aims to identify gaps in services not adequately covered by these insurance policies and assess user satisfaction with the available services.A cross-sectional survey was conducted between April 2014 and December 2017, targeting 251 home healthcare service users in Japan.After excluding those with severe dementia or impairments, 95 service users and 156 caregivers participated.The survey included questions on service usage, satisfaction levels, unmet needs, and household information.Additionally, three care managers from different facilities were interviewed.The survey revealed a mismatch between the services provided and the needs of users.The most desired services were shopping for non-daily necessities and support for general outings, both of which were inadequately covered by the current insurance systems.Care managers noted that although no deficiencies were officially admitted, a more timely offering of householdspecific services could prevent hospitalization due to declines in activities of daily living (ADL) .Certain home-based services desired by users are not fully covered by Japans long-term care or medical insurance systems.Addressing these gaps could improve the wellbeing of care recipients and caregivers while potentially reducing healthcare costs.However, delays in service provision due to the lack of a centralized system may decrease ADLs, increasing the risk of hospitalization.