Association Between Financial Incentives for Regional Care Coordination and Health Care Resource Utilization Among Older Patients after Femoral Neck Fracture Surgery: A Retrospective Cohort Study Using a Claims Database

The incidence rates of hip fracture have been increasing in Japan. Length of stay among hip fracture patients in Japan is much longer than other developed countries, and the Japanese government introduced financial incentives for regionally coordinated femoral neck fracture care to reduce health care resource utilization. The objective of this study was to evaluate whether the financial incentives reduce health care resource utilization among patients 75 years or older with femoral neck fracture in Japan. Claims data from the Fukuoka Prefecture Regional Association for Late-Stage Healthcare for Older People were analyzed for the period from April 2010 to March 2016. The authors identified 4641 eligible subjects after femoral neck fracture surgery, and categorized them into groups based on care pathways: coordinated care, integrated care, and other. Length of stay by care phase and total charges were used as measures of health care resource utilization. The models showed that coordinated and integrated care were significantly associated with shorter length of stay during perioperative care: coordinated care, multiplicative effect, 0.90 (P<0.001); integrated care, 0.77 (P<0.001). However, only integrated care was associated with shorter rehabilitation and overall length of stay: 0.66 (P<0.001) in rehabilitation; 0.70 (P<0.001) in overall duration. Integrated care also was associated with lower total charges: 0.70 (P<0.001). Current financial incentives for regionally coordinated femoral neck fracture care do not affect health care resource utilization. Further health care reforms should be implemented to promote effective regional care coordination in Japan.