Abstract
Long-term care beneficiaries using rehabilitation services under the medical care insurance system（MCIS）need to transfer their use of these services to the longterm care insurance system（LTCIS）. However, the LTCIS does not cover rehabilitation services beyond a specified upper limit for expenditures. This study examined the proportion and characteristics of patients who are unable to use rehabilitation services under the LTCIS within the specified upper limit. LTCIS data and health insurance claims data were obtained from Kashiwa city, Japan. The study population comprised individuals who had utilized rehabilitation services under the MCIS between April 2012 and September 2013, and were certified for long-term care. The expenditure needed for LTCIS rehabilitation services was estimated based on the median expenditure for actual LTCIS rehabilitation service utilization in Kashiwa city. Patients who are unable to use LTCIS rehabilitation services were identified as those whose current expenditure plus the median expenditure for LTCIS rehabilitation services exceeded the specified upper limit. Among 119 patients, 35（29％）were unable to use LTCIS rehabilitation services. A multivariable logistic generalized estimating equation model showed that age ≥77 years（adjusted odds ratio［AOR］：5.306, p-value＜0.001）, use of rehabilitation services for cerebrovascular disease（AOR：4.708, p-value＜0.001）, and mild functional impairment（AOR：2.435, p-value＝0.009）were associated with being unable to use LTCIS rehabilitation services. Because these characteristics are risk factors for functional decline and falls, it is important to monitor the functional status and fall risk in outpatients who are unable to use LTCIS rehabilitation services.
