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面对老龄化，如何更经济地制定医保政策 | BMC Geriatrics |
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论文标题：The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan
期刊：
作者：Takahiro Mori, Shota Hamada, Satoru Yoshie, Boyoung Jeon, Xueying Jin, Hideto Takahashi, Katsuya Iijima, Tatsuro Ishizaki and Nanako Tamiya
发表时间：2019/03/07
数字识别码：10.1186/s12877-019-1057-7
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随着人口的老龄化，医疗保健的支出在不断增加，这给国家保障体系带来了很大的压力。最新发表在BMC Geriatrics上的一篇文章探讨了评估日本老年人慢性病经济负担的新方法，他们发现此前尚未被研究过的一种关联能用于人口老龄化程度类似的许多国家。
全球范围内疾病共患的现状
疾病共患，是指一个人同时患有多种慢性疾病，且其发病率在老年人中随着年龄的增长而增加。因此，老年人同时患有多种慢性疾病是很常见的，这样的共患会影响对每种疾病的治疗。疾病共患在世界范围内（尤其是在人口老龄化的国家）受到了越来越多的关注。有研究报道，疾病共患与身体机能下降（即老年人在某些方面无法自理）、生活质量下降和可能更高的死亡率密切相关，而这些方面正是老年人和他们的护理者所担忧的。除此之外，对相关患者的护理费用也是一个很大的社会负担。
日本的医疗和长期护理保障制度及相关的支出
日本于1961年建立了强制性的全民医疗保障制度。报销范围包括专业医护人员（如医生、护士、各种治疗师）的服务、诊断测试、处方、手术和麻醉。除了全民医疗保险制度，日本还于2000年推出了强制性的公共长期护理保障制度。65岁及以上的老年人以及40岁至64岁之间患有年龄相关特定疾病的人都有资格获得服务。这些服务包括在长期护理机构里长期住院或短期停留期间的机构护理，以及以社区和家庭为单位的护理如成人日托、门诊康复、家庭帮助或上门护理。其他国家如德国、荷兰和韩国也提供长期护理保障制度。
在人口老龄化国家，健康相关方面支出的稳步增长一直是一个大问题。例如，2016年日本每年的医疗支出约为3720亿美元，长期护理支出约为880亿美元，这些数字表明在过去五年医疗和长期护理的支出分别增加了9%和21%。随着日本和世界各地迅速进入老龄化社会，这些支出还将进一步增加。
疾病共患与医疗开销的关联
在本次研究中，研究者使用了日本东京都郊区柏市的医疗和长期护理报销数据，探讨了患多种疾病与医疗和长期护理支出总额之间的关系。除了众所周知的疾病共患与较高的医疗支出之间的关系，研究人员还发现疾病共患也与较高的长期护理支出相关，从而增加了两种类型支出的总和。研究进一步表明，相对于仅考虑医疗支出，通过医疗和长期护理支出的总和可以更好地评估疾病共患对社会造成的经济负担，从而提供了更准确的评估。
作为世界上老龄化速度最快的国家之一，日本不仅有医疗保险，还有长期护理保险制度。据我们所知，这是全球范围内首个研究了疾病共患与长期护理支出以及医疗和长期护理支出总和之间关系的研究。由于对于许多人口老龄化国家来说，健康相关支出的不断增长非常不利于维持可持续的医疗体系，因此这一研究结果不仅对日本意义重大，而且在全球范围内具有重要意义。减少疾病共患流行程度的有效策略不仅可以为个人和社会提供医疗和健康方面的利益，同时也具有经济意义。
摘要：
Background
The occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan.
Methods
Medical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level.
Results
The mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34% of the sum, respectively. Every increase in one unit of the CCI scores was associated with a ¥257,000 (US$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures (p < 0.001; n = 29,915).
Conclusions
Using a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone.
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期刊介绍:
BMC Geriatrics(,2.866 - ,3.159 - ) is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
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