Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization.
Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization.
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DOI：
10.1186/1472-6963-14-71
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发表时间：
2014-02-14
影响因子：
2.8
通讯作者：
König HH
中科院分区：
文献类型：
--
作者：
Heider D;Matschinger H;Müller H;Saum KU;Quinzler R;Haefeli WE;Wild B;Lehnert T;Brenner H;König HH
分析德国老年人医疗保健费用与易感因素、促成因素和需求因素之间的关系，这些因素由Andersen的医疗保健利用行为模型定义。采用横断面设计，分析了ESTHER队列研究8年随访中3，124名年龄在57-84岁之间的参与者的成本数据。在3个月的时间内，通过由训练有素的研究医生在受访者家中进行的访谈，回顾性地评估了医疗保健的利用情况。从社会的角度应用单位成本计算医疗保健成本。社会人口学和健康相关的变量被归类为诱发因素，使，或需要的安德森模型定义的因素。采用老年病累积疾病评定量表（CIRS-G）测量多发病率。通过SF-12心理健康总评（MCS）评分测量心理健康状况。通过多个Tobit回归模型分析了具体部门的成本。每个受访者在3个月期间的平均总成本为889欧元。在Andersen模型中，代表需求因素的CIRS-G评分和SF-12 MCS评分与总费用、住院费用、门诊费用和护理费用一致相关。在诱发因素中，年龄与门诊费用、护理费用和总费用呈正相关，BMI与门诊费用相关。多变量和心理健康状况都反映了安德森模型中的需求因素，是医疗保健费用的主要预测因素。诱发因素和促成因素对医疗费用的影响相对较小，这可能是由于德国社会医疗保险制度的特点。总体而言，安德森模型中使用的变量只能解释医疗保健成本总差异的一小部分。
To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. Using a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
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影响因子：
2.8
作者：
Fahlman, Cheryl;Lynn, Joanne;Finch, Mike
通讯作者：
Finch, Mike
影响因子：
3
作者：
Blackwell, Debra L.;Martinez, Michael E.;Berthelot, Jean-Marie
通讯作者：
Berthelot, Jean-Marie
影响因子：
4
作者：
Condelius, Anna;Edberg, Anna-Karin;Hallberg, Ingalill R.
通讯作者：
Hallberg, Ingalill R.
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM
影响因子：
7.2
作者：
Byles, JE;D'Este, C;Treloar, C
通讯作者：
Treloar, C