Fig. 1 Conceptual framework of effect of healthcare utilization on Insurance renewal.
Rather than estimate a fully specified model, we used a simplified model that focused on the effects of the utilization rate of insurance benefits, disability status and institutional care services used, while controlling for a limited number of relevant factors.
The utilization rate of insurance benefits (hereafter, URB; i.e., the proportion of insurance benefits units effectively used by a recipient over the fixed limits of benefits defined by each certified care needs level in the Japanese LTCI system) depends on the care plan designed by the care manager and the family.
Three dimensions of the LTC services utilized, including type of service, number of different types of services, and services delivered (days/month) were examined as potential predictors for length of stay at CL1. Age, gender, income level, length of stay in the LTCI system, and utilization rate of insurance benefits were included in the overall model as potential confounders.
Because we focused on predictors of the highest LTC expenditures, we decided also to exclude individuals who exhibited a marginal utilization of LTC insurance benefits (n = 23), to improve the stability of the model.
Operationally a marginal utilization of LTC insurance benefits (URB) was defined as an URB less than 10% at baseline time or at the end month of the study period.
Our results demonstrated that an increase in relative utilization rate of insurances benefits as main effect was a strong predictor of the higher LTC expenditures.
In extensions to the main analyses I examine whether leaving school in an economic downturn influences access to a second form of non-monetary compensation (life insurance) and utilization of public health insurance as measured by Medicaid coverage.
One of the least understood problems is the lack of utilization of social health insurance among the insured [5] [8].
We analyzed the utilization of social health insurance in 30 hospital districts in the central regions of the Philippines between 2003 and 2007.
