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首页> 外文期刊>BMC Geriatrics >Effect of reduced formal care availability on formal/informal care patterns and caregiver health: a quasi-experimental study using the Japanese long-term care insurance reform
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Effect of reduced formal care availability on formal/informal care patterns and caregiver health: a quasi-experimental study using the Japanese long-term care insurance reform

机译：规范正式护理可用性对正式/非正式护理模式和护理人员健康的影响：使用日本长期护理保险改革的准实验研究

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It is unclear how formal long-term care (LTC) availability affects formal /informal caregiving patterns and caregiver health. We tested the impact of reduced formal LTC availability on formal LTC service use, intensity of informal caregiving, and caregiver health. Using a representative, repeated cross-sectional sample of Japanese caregivers providing care to co-resident family members from 2001 to 2016, we applied a difference-in-differences approach by observing caregivers before and after the major reform of the public Japanese LTC insurance (LTCI) in 2006. The reform reduced coverage benefits for non-institutionalized older persons with low care needs, but not for those with high care needs. We analyzed 12,764 caregivers aged ≥30?years (mean age 64.3?±?11.8?years, 73.5% women) and measured indicators of formal LTC use, hours of informal caregiving, and caregiver self-reported health outcomes after propensity score matching to balance caregivers’ background characteristics. We found the 2006 LTCI reform relatively reduced the use of formal LTC services and relatively increased the percentage of experiencing long hours of informal caregiving (?3?h per day) among the caregivers for seniors with low care needs compared to those for seniors with high care needs. The effects of the LTCI reform for the caregivers for seniors with low care needs were 2.2 percentage point higher on caregivers’ experiencing poor self-rated health (95% confidence interval [CI]: 0.7–3.7; p?=?0.01), 2.7 percentage point higher on experiencing symptoms of a depressive state (95%CI: 0.5–4.8; p?=?0.03), and 4.7 percentage point higher on experiencing symptoms of musculoskeletal diseases (95%CI, 3.6–5.7; p??0.001), compared to those for seniors with high care needs. Reduced formal care availability under the Japanese LTCI reform increased hours of informal caregiving corresponding to reduced use of formal LTC and deteriorated multiple dimensions of caregiver health. Our findings may highlight the importance of enhancing the availability of formal LTC services for caregiver health.
机译：目前尚不清楚正式的长期护理（LTC）可用性如何影响正式/非正式的护理模式和护理人员健康。我们测试了在正式LTC可用性上减少的正式LTC可用性，非正式护理和护理人员健康的影响。使用日本护理人员的代表性，重复的横断面样本，从2001年到2016年提供护理到共同居民家庭成员，我们通过在公共日本LTC保险的主要改革之前和之后观察看护人界定差异差异化方法（ LTCI）于2006年。改革减少了不制度化的老年人，低保健需求的覆盖福利，但不适合受保健需求的人。我们分析了12,764岁的护理人员≥30岁？年（平均年龄64.3？±11.8岁，73.5％的女性）和衡量的正式LTC使用指标，非正式的护理时间，以及护理人员在倾向分数与平衡匹配后自我报告的健康结果。照顾者的背景特征。我们发现2006年LTCI改革相对减少了使用正式LTC服务的使用，相对增加了经历长时间的非正式护理（>？3？H每天）的百分比，与那些为老年人有关的老年人的照顾者优质的需求。 LTCI改革对低护理需求的指挥者的影响为42个百分点，护理人员的自我评价健康差（95％置信区间[CI]：0.7-3.7; P？0.01），2.7体验抑郁状态的症状（95％CI：0.5-4.8; p？= 0.03），在体验肌肉骨骼疾病症状（95％CI，3.6-5.7; p？<？ 0.001）与那些具有高护理需求的老年人相比。在日本LTCI改革下减少正式护理可用性，增加了非正式的护理时间，对应于使用正式LTC的使用，并使护理人员健康状况恶化。我们的调查结果可能突出了加强照顾者健康的正式LTC服务的可用性的重要性。

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