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Background Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan. Methods Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization. Results The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization. Conclusions The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

We evaluated differences in the cumulative benefit costs of public long-term care (LTC) insurance services by employment status and frequency of community activities. A baseline survey was conducted on functionally independent older people from 12 municipalities as a nationwide survey from 2010 to 2011. Employment status was dichotomized, and community activity was assessed based on the frequency of participation in hobbies, sports clubs, or volunteering. We followed the respondents’ LTC service costs over a period of 6 years using public LTC claim records (n = 46,616). We adopted a classical linear regression analysis and an inverse probability weighting estimation with multiple imputation for missing values. Compared with non-participation in each community activity, the cumulative LTC costs among individuals who participated in hobbies or sports group activities at least twice a week were 1.23 (95% confidence interval: 0.73–1.72) to 1.18 (0.68–1.67) thousand USD lower per person over the 6-year period (28.7% to 30.1% lower, respectively). Similarly, the costs for employed persons were 0.55 (0.20–0.90) to 0.64 (0.29–0.99) thousand USD per person lower than among retirees (14.5% to 16.9% lower). Promoting employment opportunities and frequent participation in community activities among older adults may help reduce future LTC costs by around 20% as a result of extending healthy longevity.

Women of child-rearing age have the lowest uptake rates for health checkups in several developed countries. The time cost incurred by conflicting child-rearing roles may contribute to this gap in access to health checkups. We estimated the time cost of child rearing empirically, and analyzed its potential impact on uptake of free health checkups based on a sample of 1606 women with a spouse/partner from the dataset of a population-based survey conducted in the greater Tokyo metropolitan area in 2010. We used a selection model to estimate the counterfactual wage of non-working mothers, and estimated the number of children using a simultaneous equation model to account for the endogeneity between job participation and child rearing. The time cost of child rearing was obtained based on the estimated effects of women's wages and number of children on job participation. We estimated the time cost to mothers of rearing a child aged 0-3 years as 16.9 USD per hour, and the cost for a child aged 4-5 years as 15.0 USD per hour. Based on this estimation, the predicted uptake rate of women who did not have a child was 61.7%, while the predicted uptake rates for women with a child aged 0-3 and 4-5 were 54.2% and 58.6%, respectively. These results suggest that, although Japanese central/local governments provide free health checkup services, this policy does not fully compensate for the time cost of child rearing. It is strongly recommended that policies should be developed to address the time cost of child rearing, with the aim of closing the gender gap and securing universal access to preventive healthcare services in Japan.

Objective To evaluate the process value of care safety from the patient's view in perinatal services. Design Cross-sectional survey. Settings Fifty two sites of mandated public neonatal health checkup in 6 urban cities in West Japan. Participants Mothers who attended neonatal health checkups for their babies in 2011 (n = 1316, response rate = 27.4%). Main outcome measure Willingness to pay (WTP) for physician-attended care compared with midwife care as the process-related value of care safety. WTP was estimated using conjoint analysis based on the participants' choice over possible alternatives that were randomly assigned from among eight scenarios considering attributes such as professional attendance, amenities, painless delivery, caesarean section rate, travel time and price. Results The WTP for physician-attended care over midwife care was estimated 1283 USD. Women who had experienced complications in prior deliveries had a 1.5 times larger WTP. Conclusions We empirically evaluated the process value for safety practice in perinatal care that was larger than a previously reported accounting-based value. Our results indicate that measurement of process value from the patient's view is informative for the evaluation of safety care, and that it is sensitive to individual risk perception for the care process.

本研究は，看護師が，実施しているケアに対してどのように価値づけを行っているのかを経済的な観点から明らかにする．無作為抽出した500床以上の5総合病院に勤務する総数1,000名の看護師を対象に質問紙を配り，郵送による回収を行った．調査は，全身清拭，バイタルサイン測定，点滴管理，給与の4項目について実施回数および支給率を変化させた2つの仮想病院を提示し，二者択一で好ましい職場を回答するものである．それらの回答をコンジョイント分析し，ケアの労働量と同程度の金額がいくらになるのか推定を行った．以上の結果から，ケアを金額換算すると，月給が25万円の看護師の場合，全身清拭1回あたり93.38円，バイタルサイン測定は1回あたり35.98円，ルート管理1回あたり42.25円と推定された．