[An individual based analysis of medical expenses of outpatient services for the elderly at one health insurance society in Fukuoka Prefecture. Focus on multiple or redundant consultations].

PURPOSE

To ascertain way to reduce medical expenses of the elderly, we analyzed old outpatients' receipts covered by the Health and Medical Services Law for the Aged at one health insurance society in Fukuoka prefecture. In addition, an attempt was made to find better ways to share medical information and construct a system of receipt analysis.

SUBJECTS AND METHODS

We used 312 receipts for 179 old outpatients in July in 1997. The number of prescriptions was internalized into the number of outpatients' receipt. We classified the patients as "multiple" who consulted several clinics a month and as "redundant" who consulted several clinics for the same diseases.

RESULTS AND CONCLUSION

1. The expenses of outpatients accounted for about 1/3 of the total. Average values for patients were 78.3 years old of age, 7.7 diseases, 1.5 pharmacies, 1.7 clinics, 7 consulting days, and the medical expenses of 40,482 yen per month. 2) The rate of multiple including redundant consultations was 49.7% and that for those that were redundant was 9.5%. Redundant consultations increased as the number of consultation clinics increased. 3) Factors considered to increase medical expenses were the number of diseases, the consulting days, and the number of consultation/prescription organizations. Multiple and redundant consultations amounting to half of the whole fulfilled all of these criteria. 4) The average medical expense for non-multiple and non-redundant patients was 28,314 yen, as compared with 52,786 yen for multiple and redundant and 64,306 yen for redundant cases. If there were no multiple consultations, thirty percent of the expenses could be avoided and if there were no redundant consultations, the reduction might be 6%, although more detailed clinical records are necessary for firm conclusions. To reduce excess expenditure, instructions for patients having home doctors and passing through introductions are important. 5) Regarding the expense of medical services, medication was accounted for 39.2% as the greatest outlay. Cautions for suitable use of drugs are required for multiple and redundant patients, because they tend to visit many pharmacies. Considering the rate rise of separation of pharmacy and clinic, fixing of field division of work and the sharing of medical information are inadequate. For example, introduction of an IC card system might be very useful to facilitate the development of community-based medical information system. 6) It is strongly suggested that a computerized information system with a standardized format should be developed on the initiative of a national organization such as the National Federation of Health Insurance Societies.