Heider Dirk, Matschinger Herbert, Müller Heiko, Saum Kai-Uwe, Quinzler Renate, Haefeli Walter Emil, Wild Beate, Lehnert Thomas, Brenner Hermann, König Hans-Helmut
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany.
BMC Health Serv Res. 2014 Feb 14;14:71. doi: 10.1186/1472-6963-14-71.
To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population.
Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models.
Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs.
Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
根据安德森医疗保健利用行为模型所定义的易患因素、促成因素和需求因素，分析德国老年人群体中医疗保健成本之间的关联。
采用横断面设计，对埃丝特队列研究8年随访中3124名年龄在57 - 84岁的参与者的成本数据进行分析。通过由经过培训的研究医生在受访者家中进行的访谈，回顾性评估3个月期间的医疗保健利用情况。从社会角度应用单位成本来计算医疗保健成本。社会人口统计学和健康相关变量按照安德森模型的定义被分类为易患因素、促成因素或需求因素。采用老年累积疾病评定量表（CIRS - G）测量多种疾病。采用SF - 12精神成分总结（MCS）评分测量心理健康状况。通过多元托比特回归模型分析特定部门的成本。
每位受访者在3个月期间的平均总成本为889欧元。代表安德森模型中需求因素的CIRS - G评分和SF - 12 MCS评分与总费用、住院费用、门诊费用和护理费用始终相关。在易患因素中，年龄与门诊费用、护理费用和总费用呈正相关，体重指数与门诊费用相关。
反映安德森模型中需求因素的多种疾病和心理健康状况是医疗保健成本的主要预测因素。易患因素和促成因素对医疗保健成本的影响相对较小，这可能归因于德国社会医疗保险系统的特点。总体而言，安德森模型中使用的变量仅解释了医疗保健成本总方差的一小部分。
