Sirven Nicolas, Rapp Thomas
LIRAES (EA 4470), Université Paris Descartes, Sorbonne-Paris-Cité, 45 rue des Saints Pères, 75006, Paris, France.
Eur J Health Econ. 2017 Mar;18(2):243-253. doi: 10.1007/s10198-016-0772-7. Epub 2016 Feb 25.
The objective of the present work is to explore the incremental costs of frailty associated with ambulatory health care expenditures (HCE) among the French population of community-dwellers aged 65 or more in 2012. We make use of a unique dataset that combines nationally representative health survey with respondents' National Health Insurance data on ambulatory care expenditures. Several econometric specifications of generalized linear models are tested and an exponential model with gamma errors is eventually retained. Because frailty is a distinct health condition, its contribution to HCE was assessed in comparison with other health covariates (including chronic diseases and functional limitations, time-to-death, and a multidimensional composite health index). Results indicate that whatever health covariates are considered, frailty provides significant additional explanative power to the models. Frailty is an important omitted variable in HCE models. It depicts a progressive condition, which has an incremental effect on ambulatory health expenditures of roughly €750 additional euros for pre-frail individuals and €1500 for frail individuals.
本研究的目的是探讨2012年法国65岁及以上社区居民中，与门诊医疗保健支出（HCE）相关的衰弱增量成本。我们使用了一个独特的数据集，该数据集将具有全国代表性的健康调查与受访者的门诊医疗支出国家健康保险数据相结合。测试了广义线性模型的几种计量经济学规范，最终保留了具有伽马误差的指数模型。由于衰弱是一种独特的健康状况，因此将其对HCE的贡献与其他健康协变量（包括慢性病和功能限制、死亡时间以及多维综合健康指数）进行了比较评估。结果表明，无论考虑何种健康协变量，衰弱都为模型提供了显著的额外解释力。衰弱是HCE模型中一个重要的遗漏变量。它描述了一种渐进性状况，对门诊医疗支出有增量影响，对于脆弱前期个体，额外增加约750欧元，对于衰弱个体，额外增加1500欧元。
