Service utilization and health-care costs in the advanced elderly
Service utilization and health-care costs in the advanced elderly
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DOI：
10.1111/j.1524-4733.2007.00285.x
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发表时间：
2008-07-01
期刊：
影响因子：
4.5
通讯作者：
Koenig, Hans-Helmut
中科院分区：
文献类型：
--
作者：
Heinrich, Sven;Luppa, Melanie;Koenig, Hans-Helmut
目的：尽管高龄老年人的重要性与日俱增，但他们在服务利用和成本研究中往往被忽视。本研究的目的是从社会的角度分析高龄老年人口的服务利用和直接医疗保健成本及其预测因素。方法：采用德国75岁以上的初级保健横断面样本(n=452)进行自下而上的成本计算研究。主要工具是面试者管理的服务利用和费用调查问卷以及慢性病评分(CDS)。结果：在2004/2005年的价格中，受访者造成的平均直接成本为3730(95%可信区间3203-4257)。这包括住院服务34%，药品服务29%，门诊医生服务15%，护理服务10%，医疗用品和假牙6%，门诊非医生提供者5%，辅助生活1%，交通2%。中低教育程度和CDS每增加一个点分别导致(SIC)1678(95%可信区间250~3369)和(SIC)482(95%可信区间316~654)增加。总平均直接成本在不同性别之间没有显著差异。缺血性心脏病和糖尿病与(SIC)711和(SIC)290的超额费用相关，两者均不显著。共55%的受访者直接费用占总直接费用的90%。结论：高龄老年人使用的卫生服务范围广。我们的研究仍然低估了社会的真实成本。进一步的研究应该侧重于对这一日益重要的年龄段的新医疗保健计划进行经济评估。
Objectives: Despite their increasing importance, the advanced elderly are often neglected in service utilization and costing studies. The purpose of this study was to analyze from societal perspective service utilization and direct health-care costs and its predictors in the advanced elderly population.Methods: A bottom-up costing study was conducted using a cross-sectional primary care sample aged 75+ (n = 452) in Germany. The main instruments were a questionnaire of service utilization and costs administered by an interviewer and the chronic disease score (CDS). Predictors were derived by means of multivariate regression models.Results: Respondents caused mean direct costs of (sic)3730 (95% CI 3203-4257) in prices of 2004/2005. This included inpatient care 34%, pharmaceuticals 29%, outpatient physician services 15%, nursing care 10%, medical supply and dentures 6%, outpatient nonphysician providers 5%, assisted living 1%, and transportation 2%. A shift from lower to middle education and a one-point increase in CDS were associated with an increase of (sic)1678 (95% CI 250-3369) and (sic)482 (95% CI 316-654), respectively. Total mean direct costs did not differ significantly between sexes. Ischemic heart disease and diabetes mellitus were associated with excess costs of (sic)711 and (sic)290, both being not significant. Altogether 55% of the respondents accounted for 90% of total direct costs.Conclusions: Advanced elderly used a wide range of health services. Our study still underestimates the true costs to society. Further research should focus on economic evaluation of new health-care programs for this increasingly important age group.