Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo: A retrospective study

Chie Teramoto, Tatsuro Ishizaki, Seigo Mitsutake, Haruhisa Fukuda, Takashi Naruse, Sayuri Shimizu, Hideki Ito

Research output: Contribution to journalArticle

Abstract

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January–February, February–March, March–April, and April–May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March–April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

Original languageEnglish
Pages (from-to)899-906
Number of pages8
JournalHealth and Social Care in the Community
Volume27
Issue number4
DOIs
Publication statusPublished - Jul 1 2019

Fingerprint

Medical Fees
Fee Schedules
outpatient care
House Calls
Tokyo
fee
Retrospective Studies
physician
Physicians
Ambulatory Care
outpatient clinic
insurance claim
Ambulatory Care Facilities
health insurance
Odds Ratio
Residential Facilities
assistance
Federal Government
Japan
resident

All Science Journal Classification (ASJC) codes

  • Social Sciences (miscellaneous)
  • Sociology and Political Science
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo : A retrospective study. / Teramoto, Chie; Ishizaki, Tatsuro; Mitsutake, Seigo; Fukuda, Haruhisa; Naruse, Takashi; Shimizu, Sayuri; Ito, Hideki.

In: Health and Social Care in the Community, Vol. 27, No. 4, 01.07.2019, p. 899-906.

Research output: Contribution to journalArticle

Teramoto, Chie ; Ishizaki, Tatsuro ; Mitsutake, Seigo ; Fukuda, Haruhisa ; Naruse, Takashi ; Shimizu, Sayuri ; Ito, Hideki. / Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo : A retrospective study. In: Health and Social Care in the Community. 2019 ; Vol. 27, No. 4. pp. 899-906.
@article{c61f5c33578f48afb7012938eb90df87,
title = "Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo: A retrospective study",
abstract = "As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January–February, February–March, March–April, and April–May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March–April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.",
author = "Chie Teramoto and Tatsuro Ishizaki and Seigo Mitsutake and Haruhisa Fukuda and Takashi Naruse and Sayuri Shimizu and Hideki Ito",
year = "2019",
month = "7",
day = "1",
doi = "10.1111/hsc.12707",
language = "English",
volume = "27",
pages = "899--906",
journal = "Health and Social Care in the Community",
issn = "0966-0410",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Impact of a national medical fee schedule revision on the cessation of physician home visits among older patients in Tokyo

T2 - A retrospective study

AU - Teramoto, Chie

AU - Ishizaki, Tatsuro

AU - Mitsutake, Seigo

AU - Fukuda, Haruhisa

AU - Naruse, Takashi

AU - Shimizu, Sayuri

AU - Ito, Hideki

PY - 2019/7/1

Y1 - 2019/7/1

N2 - As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January–February, February–March, March–April, and April–May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March–April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

AB - As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January–February, February–March, March–April, and April–May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March–April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

UR - http://www.scopus.com/inward/record.url?scp=85058844446&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058844446&partnerID=8YFLogxK

U2 - 10.1111/hsc.12707

DO - 10.1111/hsc.12707

M3 - Article

C2 - 30565785

AN - SCOPUS:85058844446

VL - 27

SP - 899

EP - 906

JO - Health and Social Care in the Community

JF - Health and Social Care in the Community

SN - 0966-0410

IS - 4

ER -