2013 Volume 24 Issue 2 Pages 108-127
One of the major goals of establishing the Long-term Care Insurance System (LTC) was to resolve the problem of social hospitalization, unnecessary inpatient service use to compensate for limited access to nursing care. This paper investigates whether LTC has alleviated social hospitalization by analyzing the claim bill data of elderly beneficiaries（≤70 years) enrolled in Fukui Prefecture's National Health Insurance Program for fiscal year 2007.
A commonly used definition of social hospitalization often relies on the length of hospitalization, though it is susceptible to upward bias in the estimation of medical expenditure because it can include those patients with a need of chronic medical care. Instead, we follow Fukawa (1995) and identify cases of social hospitalization as those with per-diem expenditure less than 1.1 times of basic inhospital service expenditure.
In sum, we find the problem of social hospitalization does remain, but at the magnitude of a half to two-thirds compared to Fukawa's previous estimation in 1993. Specifically, social hospitalization accounts for 7.5% to 18.4% of total inpatient cases, 1.9% to 4.6% of the total number of health care insured patients, 6.9% to 23.5% of overall inpatient payments, and 3.2% to 10.9% of total health care expenditures. Hence, we conclude that the introduction of the LCT system alleviated the problem of social hospitalization to some extent, though it still remains prevailing in Japan.
