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

Japan launched a municipal financial incentive program in 2018 to promote higher-quality long-term care (LTC). We quantified the association between municipal incentive performance and subsequent incident LTC certification and all-cause mortality among community-dwelling older people. Baseline 2016 data from the Japan Gerontological Evaluation Study (N = 90 896 adults aged ≥65 years in 23 municipalities) were linked to 2018-2020 administrative records. Each municipality received a composite incentive score (0-612). Using multivariable logistic regression with fixed effects, we estimated odds ratios (ORs) per 1 SD score increase, adjusting for demographics, socioeconomic status, and health. Over three years, 10.7% newly required LTC certification and 5.1% died. A 1 SD higher incentive score was associated with lower odds of incident LTC (OR: 0.91) and all-cause mortality (OR: 0.66). These benefits were driven by the "Support Functional Independence/Prevent Progression" domain in less-urban areas, while plan-do-check-act-style activities predominated in cities. Overall, better municipal performance under Japan's financial incentive policy correlated with short-term reductions in LTC utilization and mortality among older residents, supporting continued monitoring and policy refinement.