School of Economics, Centre for the Business and Economics of Health, The University of Queensland, St Lucia, QLD, Australia.
Erasmus School of Health Policy & Management, Erasmus University Rotterdam (EUR).
Med Care. 2021 Jun 1;59(6):543-549. doi: 10.1097/MLR.0000000000001539.
Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries.
The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics.
We use prospectively collected survey data from the United States-based Health and Retirement Study (n=48,877) and the Survey of Health, Ageing, and Retirement in Europe (n=98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm. After first reporting the observed differences in care use, we analyze how care use is associated with dementia using multivariate regressions, controlling for other health conditions and background characteristics.
Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD)=236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [4406 USD (95% confidence interval, 3914-4899) vs. 246 USD (73-418)-2017 price levels].
Health care use and OOP spending differ between Europe and the United States. The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.
痴呆症患者需要大量护理，但不同国家在提供哪些护理以及如何分担痴呆症患者、护理人员和公共计划之间的财务负担方面可能存在差异。
本研究旨在比较美国和欧洲在有或没有控制背景特征的情况下，痴呆症相关的医疗保健使用情况和自付费用（OOP）支出的差异。
我们使用来自美国健康与退休研究（n=48877）和欧洲健康、老龄化和退休调查（n=98971）的前瞻性收集的调查数据，其中包括所有 70 岁以上的成年人。痴呆症的状况是使用经过验证的算法推断的。在首次报告护理使用的观察差异后，我们使用多变量回归分析，控制其他健康状况和背景特征，分析护理使用与痴呆症的关系。
美国痴呆症患者每年使用的正规家庭护理比欧洲的痴呆症患者少 50%[平均值（标准差）=236.8 小时（1047.4）比 463.3 小时（1371.2）]，但使用更多的疗养院护理[75.1 天（131.4）比 45.5 天（119.4）]。与欧洲相比，痴呆症在美国与更高的 OOP 支出相关[4406 美元（95%置信区间，3914-4899）比 246 美元（73-418）-2017 年价格水平]。
欧洲和美国的医疗保健使用和 OOP 支出存在差异。在美国，对疗养院护理的高度依赖可能导致痴呆症患者和保险计划的支出大大增加。
