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

在过去的几年里，老年人的比例在许多国家急剧增加。迄今为止，高度多样化的老年人群体消耗了不成比例的保健服务和费用。国际比较有助于更好地了解卫生保健使用和费用的分布及其与卫生保健系统的关系。本研究旨在调查和比较德国和荷兰老年人的医疗保健使用和费用。为此目的，将使用以人为中心的分割方法分析来自德国和荷兰的两个大型人口数据集。以人为本的护理强调以疾病为中心的方法的局限性，并要求对患者的需求、价值观和偏好进行评估。在以人为本的医疗保健系统中，了解经验丰富的医疗保健需求与医疗保健费用的关系是很重要的。了解需求和成本之间的关系是卫生保健系统中良好（重新）分配资源的基础。在这项研究中，我们将描述、解释和比较老年人的医疗保健使用和成本与他们的主观生物心理社会需求和功能。具体来说，在这两个流行病学研究样本中，将根据老年人的生物、心理、社会需求和功能进行以人为中心的细分。分割分析将采用因素混合模型（FMM）结合验证性因素分析和潜在类分析。使用这种方法，我们将确定老年人的不同亚群（概况），每个人在主观需求和功能方面都有自己独特的特征。将对德国和荷兰的老年人分布情况进行比较。将在这两个样本中评估与每个部分相关的医疗保健使用和成本。将描述德国和荷兰在医疗保健使用和费用方面的差异。将得出关于卫生保健使用、费用和卫生系统之间关系的重要推论。我们期望我们的研究结果对正在进行的关于老年人医疗保健重组和医疗保健系统资源重新分配的讨论具有开创性意义。作为研究的结果，我们将获得一种算法，将老年人分配到特定的风险概况。该算法可在全科实践中实现，并可根据具体概况的需要组织治疗方案。

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.