痴呆症的额外费用以及年龄和性别因素的作用——基于德国健康和长期护理保险理赔数据的分析。
Excess costs of dementia disorders and the role of age and gender - an analysis of German health and long-term care insurance claims data.
机构信息
Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
出版信息
BMC Health Serv Res. 2012 Jun 19;12:165. doi: 10.1186/1472-6963-12-165.
BACKGROUND
Demographic ageing is associated with an increasing number of dementia patients, who reportedly incur higher costs of care than individuals without dementia. Regarding Germany, evidence on these excess costs is scarce. Adopting a payer perspective, our study aimed to quantify the additional yearly expenditures per dementia patient for various health and long-term care services. Additionally, we sought to identify gender-specific cost patterns and to describe age-dependent cost profiles.
METHODS
The analyses used 2006 claims data from the AOK Bavaria Statutory Health Insurance fund of 9,147 dementia patients and 29,741 age- and gender-matched control subjects. Cost predictions based on two-part regression models adjusted for age and gender and excess costs of dementia care refer to the difference in model-estimated means between both groups. Corresponding analyses were performed stratified for gender. Finally, a potentially non-linear association between age and costs was investigated within a generalized additive model.
RESULTS
Yearly spending within the social security system was circa €12,300 per dementia patient and circa €4,000 per non-demented control subject. About two-thirds of the additional expenditure for dementia patients occurred in the long-term care sector. Within our study sample, male and female dementia patients incurred comparable total costs. However, women accounted for significantly lower health and significantly higher long-term care expenditures. Long-term care spending increased in older age, whereupon health care spending decreased. Thus, at more advanced ages, women incurred greater costs than men of the same age.
CONCLUSIONS
Dementia poses a substantial additional burden to the German social security system, with the long-term care sector being more seriously challenged than the health care sector. Our results suggest that female dementia patients need to be seen as a key target group for health services research in an ageing society. It seems clear that strategies enabling community-based care for this vulnerable population might contribute to lowering the financial burden caused by dementia. This would allow for the sustaining of comprehensive dementia care within the social security system.
背景
人口老龄化与痴呆症患者人数的增加有关，据报道，痴呆症患者的护理费用高于没有痴呆症的患者。关于德国，关于这些超额成本的证据很少。从付款人的角度来看，我们的研究旨在量化各种医疗和长期护理服务中每位痴呆症患者的额外年度支出。此外，我们试图确定特定于性别的成本模式，并描述依赖年龄的成本概况。
方法
该分析使用了来自 AOK Bavaria 法定健康保险基金的 2006 年索赔数据，该基金涵盖了 9147 名痴呆症患者和 29741 名年龄和性别匹配的对照患者。基于两部分回归模型的成本预测调整了年龄和性别因素，并且痴呆症护理的超额成本是指两组之间模型估计均值的差异。针对性别进行了相应的分析。最后，在广义加性模型中研究了年龄与成本之间的潜在非线性关系。
结果
每位痴呆症患者的社会保障系统年度支出约为 12300 欧元，每位非痴呆对照患者的支出约为 4000 欧元。痴呆症患者额外支出的大约三分之二发生在长期护理部门。在我们的研究样本中，男性和女性痴呆症患者的总支出相当。然而，女性的医疗支出较低，而长期护理支出较高。随着年龄的增长，长期护理支出增加，而医疗保健支出减少。因此，在年龄较大时，女性的支出比同龄男性更高。
结论
痴呆症给德国社会保障系统带来了巨大的额外负担，长期护理部门比医疗保健部门受到的挑战更大。我们的研究结果表明，女性痴呆症患者应成为老龄化社会中医疗服务研究的重点目标群体。显然，为这一弱势群体提供基于社区的护理的策略可能有助于降低痴呆症带来的经济负担。这将有助于在社会保障系统中维持全面的痴呆症护理。
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