Biopsychosocial health care needs and costs of elderly people: a comparison study between Germany and the Netherlands

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Over the past years, the proportion of elderly people has increased dramatically in many countries. To date, the highly heterogeneous group of elderly people consumes a disproportionate share of services and costs in health care. International comparisons can help gain a better knowledge regarding the distribution of health care use and costs and their relationship to health care systems. This study aims to investigate and compare health care use and costs of elderly people in Germany and in the Netherlands. To this end, two large population-based data sets from both Germany and the Netherlands will be analysed by using a person-centered segmentation approach. Person-centered care emphasizes the limitations of a disease-centered approach and asks for the evaluation of needs, values, and preferences of the patients. In a person-centered care system, it is important to know how the experienced health care needs are related to health care costs. Knowledge about the association between needs and costs are the basis for a good (re-) allocation of resources in the health care system. In this study, we will describe, explain, and compare health care use and costs of elderly people in association with their subjective bio-psycho-social needs and functioning. Specifically, in both epidemiologic study samples a person-centered segmentation will be conducted according to the bio-psycho-social needs and functioning of the elderly people. The segmentation analysis will apply a factor mixture model (FMM) combining a confirmatory factor analysis and a latent class analysis. Using this approach, we will determine various subpopulations (profiles) of elderly people, each with their own unique characteristics regarding subjective needs and functioning. The distribution of elderly people across these profiles will be compared between Germany and the Netherlands. Health care use and costs related to each segment will be evaluated in both samples. Differences between German and Dutch profiles regarding health care use and costs will be described. Important inferences regarding the association between health care use, costs, and health systems will be drawn. We anticipate that results of our study could be groundbreaking for the ongoing discussion regarding the re-organization of health care in the elderly and the re-allocation of resources in the health care systems. As a result of the study we will obtain an algorithm which assigns elderly people to specific risk profiles. This algorithm could be implemented in general practices and treatment plans could be organized according to the needs in specific profiles.