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Liu N, Babazono A, Jamal A, Yoshida S, Yamao R, Ishihara R, Matsuda S, Li Y. Impact of fee-revision policy for gastrostomy on its implementation among older adults with dementia in Japan. Public Health 2024; 227:63-69. [PMID: 38118244 DOI: 10.1016/j.puhe.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES This study aimed to evaluate the impact of the policy to reduce the reimbursement fee for percutaneous endoscopic gastrostomy (PEG) on the number of PEG procedures performed among older adults with dementia. STUDY DESIGN Interrupted time series (ITS). METHODS We used the monthly aggregated data of the number of PEG procedures in older adults with dementia (both broad and narrow definitions), between 2012 and 2018, from the claims data in Fukuoka Prefecture, Japan. A single ITS design was used to estimate changes in the outcome following each intervention (i.e., first, second, and third interventions performed in 2014, 2015, and 2016, respectively). A controlled ITS design was applied to estimate the effects after the sequence of interventions (pre-intervention: 2012-2014; post-intervention: 2016-2018). The control group comprised patients with malignant head and neck tumors who underwent PEG procedures outside the scope of this policy restriction. RESULTS The number of PEG procedures decreased significantly only in the month wherein the third intervention was introduced (broad definition: IRR = 0.11, CI = 0.03-0.49; narrow definition: IRR = 0.15, CI = 0.03-0.75). No significant difference was observed between the treatment and control groups during the post-intervention phase. CONCLUSIONS The impact of fee-revision policy for PEG on the decrease in PEG procedures among older adults with dementia is remarkably minimal. It is difficult to reduce unnecessary PEG procedures by relying on this financial incentive alone. Policy decision-makers should consider methods to prevent inappropriate use of artificial nutrition for older adults at their end-of-life stage by reforming the health delivery system.
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Affiliation(s)
- Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-Nishi-Ku, Kitakyushu, Fukuoka, Japan.
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, 3-1-1 Maedashi, Higashi-Ku, Fukuoka, Fukuoka, Japan
| | - Aziz Jamal
- Health Administration Program, Faculty of Business and Management, University Teknologi MARA, PFI 2 Level 2, Selangor, Bandar Puncak Alam, Malaysia
| | - Shinichiro Yoshida
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, 3-1-1 Maedashi, Higashi-Ku, Fukuoka, Fukuoka, Japan
| | - Reiko Yamao
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, 3-1-1 Maedashi, Higashi-Ku, Fukuoka, Fukuoka, Japan
| | - Reiko Ishihara
- Department of Human Sciences, Osaka University of Economics, 2-2-8, Osumi, Higashiyodogawa-ku, Osaka, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-Nishi-Ku, Kitakyushu, Fukuoka, Japan
| | - Yunfei Li
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan.
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