U.S. Department of Health and Human Services

U.S.-Japan Collaborative Effort Study of Long-term Care Data Comparability

Executive Summary

Charlotte Muller, Mariann Fahs, Haruko Noguchi and Jianjin Ling

International Longevity Center, Mount Sinai School of Medicine

October 27, 1995

This report was prepared under contract between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Mount Sinai School of Medicine. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.

This report on the feasibility of comparison studies of long-term care in the US and Japan was undertaken to assist the US Department of Health and Human Services in gathering and analyzing information for policy purposes, especially with regard to enhancing the role of community-based care. The cooperation of the Koseisho, the International Leadership Center on Longevity and Society (Japan), and many individuals in Japan, as well as study directors and staffs in the US, was essential to this work.

Chapters 1 and 2 are more or less parallel reviews of features of the major national surveys in the US and Japan respectively. They summarize sponsorship, sampling, demographic and economic data items covered, functional limitations, utilization, and so forth is accompanied survey by survey. A separate chapter, Chapter 3, is devoted to a cost model and the precise location of the data elements required for the model (to the extent that they are actually collected) in each of the surveys in the two countries. The final chapter presents our conclusions and recommendations concerning the similarities and differences of the long-term care data systems of the two countries, and possible methods of combining different studies to trace the probable trajectories, or paths of experience, of representative patients with functional losses and needs for care. Appendices contain supplementary information on the visit of the Mount Sinai team to Tokyo; long-term care research using national databases in the US; special tabulations requested from the Koseisho; and Japanese statistical estimation formulas; and detailed tables showing the various features of each American and Japanese survey.

Japan and the US share an interest in and concern for their growing population of elderly, and their advanced economics support well-established governmental statistical organizations. Consequently, each country has developed a set of respected surveys. As a whole, each set is quite comprehensive, but no one of the surveys alone gives the full picture, in particular, details of institutional and community care systems, needs and costs, and acute care required by LTC patients over a period of time. The US has two surveys, the Medicare Current Beneficiary Survey and the National Health and Nutrition Examination Survey, which contain useful information on LTC, although this is not their focus.

Japan and the US differ in some important respects that affect LTC data. The US uses markets more extensively and some surveys gather information on prices and costs to users and their sponsors. In Japan, not only does the family system still provide virtually all of the community-based care, but also patients in some government-supported institutions are charged little or nothing. There is a lack of information on direct costs, detail on indirect costs, such as time lost from paid jobs because of informal caregiving within the family was gathered in a 1991 survey, Survey for Cost Analysis of Home Care Services to the Elderly, referring to help with ADLs only. In the U.S., the Informal Caregivers Survey of 1989 provides comparable data, but includes IADLs as well as ADLs. In both countries, the recent information applies only to primary caregivers. The Japanese surveys also ask more questions on plans and desires to use services.

Another difference is the actual physical demands of accomplishing ADLs and IADLs, e.g., because of raised beds versus tatami/futon, chopsticks versus forks/knives, and Japanese versus Western bathing styles. Whether activity in old age as against passive dependence is a norm of behavior may influence approaches to long-term care by families and social organizations. Such differences may or may not affect prevalence of needs and flow of services.

The development of useful comparisons will therefore require collaborative contributions of persons familiar with cultural differences, health care for the elderly, and economic analysis. It will also depend on special arrangements with the Koseisho because of national restrictions on outside use of official survey data.