Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data

International Journal for Equity in Health

Antje Schwinger¹  Chrysanthi Tsiasioti¹  Stephan Kloep²  Annika Schmidt³  Guido Schmiemann³  Daniel Gand³  Karin Wolf-Ostermann³  Jonas Czwikla⁴  Franziska Heinze⁴  Heinz Rothgang⁴  Maike Schulz⁴ 

[1] Research Institute of the Local Health Care Funds (WIdO);University of Bremen, Competence Center for Clinical Trials (KKSB);University of Bremen, Institute for Public Health and Nursing Research (IPP);University of Bremen, SOCIUM Research Center on Inequality and Social Policy;

关键词: Elderly;    Medical care;    Claims data;    Nursing homes;    Nursing home residents;   

DOI  :  10.1186/s12939-020-1130-z

来源: DOAJ

【 摘 要 】

Abstract Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.

【 授权许可】

Unknown