Background
Methods
Data source and sample selection
Assessment of service utilization and expenditures
The German health and long-term care system
SHI services
LTCI services
Statistical analysis
Results
Patient characteristics
Institution | Community | Entire sample | |
---|---|---|---|
Entire population
| |||
N | 2,934 | 5,484 | 8,418 |
Age | 84.3 (7.3) | 80.1 (7.1) | 81.6 (7.5) |
Charlson Index | 3.9 (2.2) | 4.1 (2.4) | 4.0 (2.3) |
Females (as a %) | 2,453 (83.6) | 3,827 (69.9) | 6,280 (74.6) |
Death in 2007 (as a %) | 747 (25.5) | 719 (13.1) | 1,466 (17.4) |
No care level
| |||
N | 1* | 3,325 | 3,326 |
Age | 78.8 (6.6) | 78.8 (6.65) | |
Charlson Index | 4.0 (2.4) | 4.0 (2.4) | |
Females (as a %) | 2,303 (69.3) | 2,304 (69.3) | |
Death in 2007 (as a %) | 257 (7.7) | 257 (7.7) | |
Care level 1
| |||
N | 705 | 1,059 | 1,764 |
Age | 83.4 (7.2) | 81.8 (7.0) | 82.4 (7.1) |
Charlson Index | 3.9 (2.2) | 4.1 (2.4) | 4.0 (2.3) |
Females (as a %) | 561 (79.6) | 762 (72.0) | 1,323 (75.0) |
Death in 2007 (as a %) | 141 (20.0) | 153 (14.4) | 294 (16.7) |
Care level 2
| |||
N | 1,201 | 729 | 1,930 |
Age | 84.1 (7.4) | 82.3 (7.3) | 83.5 (7.1) |
Charlson Index | 3.9 (2.3) | 4.4 (2.4) | 3.8 (2.2) |
Females (as a %) | 991 (82.5) | 502 (68.9) | 1,493 (77.4) |
Death in 2007 (as a %) | 293 (24.4) | 180 (24.7) | 473 (24.5) |
Care level 3
| |||
N | 1,028 | 371 | 1,399 |
Age | 85.3 (7.3) | 83.0 (7.7) | 84.7 (7.5) |
Charlson Index | 3.7 (2.2) | 4.1 (2.4) | 3.7 (2.3) |
Females (as a %) | 900 (87.6) | 260 (70.1) | 1,160 (82.9) |
Death in 2007 (as a %) | 313 (30.5) | 129 (34.8) | 442 (31.6) |
Care level-based comparison of service utilization
Setting-specific utilization quota of health care services according to care level adjusted for age, gender, comorbidity, mortality and single interactions | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
No care level | Care level 1 | Care level 2 | Care level 3 | |||||||
Community | Institution | Community | p-value | Institution | Community | p-value | Institution | Community | p-value | |
(n=3,325) | (n=705) | (n=1,059) | (n=1,201) | (n=729) | (n=1,028) | (n=371) | ||||
General practitioner (v) | 99.1% | 100.0% | 99.5% | ns | 100.0% | 100.0% | ns | 100.0% | 99.5% | ns |
Medical specialist (v) | 85.5% | 86.6% | 79.3% | ** | 87.1% | 72.9% | *** | 77.8% | 61.6% | *** |
Medication (p) | 99.1% | 100.0% | 99.9% | ns | 100.0% | 100.0% | ns | 99.7% | 100.0% | ns |
of which anti-dementia drugs (p)
|
16.5%
|
10.2%
|
21.2%
|
***
|
9.5%
|
15.4%
|
***
|
5.0%
|
8.5%
|
*
|
Hospital treatment (d) | 35.1% | 40.0% | 43.2% | ns | 46.3% | 45.5% | ns | 39.7% | 41.3% | ns |
Non-physician services (p) | 17.8% | 25.9% | 22.1% | * | 38.3% | 29.7% | ** | 31.6% | 33.3% | ns |
Medical aids (p) | 42.0% | 84.8% | 54.0% | *** | 94.6% | 59.8% | *** | 96.9% | 70.9% | *** |
Rehabilitation | 5.4% | 1.4% | 7.2% | *** | 0.9% | 3.6% | ** |
estimation not possible
| ./. | |
Home health care | 16.1% |
not provided
| 35.1% | ./. |
not provided
| 40.9% | ./. |
not provided
| 44.8% | ./. |
Setting-specific utilization volume of health care services per capita according to care level adjusted for age, gender, comorbidity, mortality and single interactions | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No care level | Care level 1 | Care level 2 | Care level 3 | |||||||||
Community | Institution | Community | p-value | Institution | Community | p-value | Institution | Community | p-value | |||
(n=3,325) | (n=705) | (n=1,059) | (n=1,201) | (n=729) | (n=1,028) | (n=371) | ||||||
General practitioner (v) | 28.9 | 52.4 | 33.2 | *** | 55.0 | 35.8 | *** | 54.5 | 40.8 | *** | ||
Medical specialist (v) | 10.8 | 12.6 | 8.7 | *** | 15.0 | 7.2 | *** | 12.3 | 6.4 | *** | ||
Medication (p) | 25.1 | 36.5 | 32.5 | *** | 42.1 | 37.9 | ** | 38.4 | 46.8 | *** | ||
of which anti-dementia drugs (p) | 0.7 | 0.5 | 1.0 | ** | 0.4 | 0.8 | * | 0.2 | 0.5 | ns | ||
Hospital treatment (d) | 5.8 | 6.3 | 8.4 | * | 7.6 | 8.3 | ns | 6.4 | 7.0 | ns | ||
Non-physician services (p) | 0.5 | 1.2 | 0.9 | * | 2.0 | 1.5 | * | 1.8 | 2.0 | ns | ||
Medical aids (p) | 0.8 | 3.3 | 1.2 | *** | 5.0 | 1.6 | *** | 6.3 | 3.6 | *** | ||
Rehabilitation (d) | 1.3 | 0.1 | 1.8 | *** | 0.3 | 4.2 | ** | 0.0 | 0.2 | ns | ||
Home health care (p) | 1.3 |
not provided
| 3.3 |
not provided
| 3.7 |
not provided
| 4.3 | ./. |
Development of utilization profiles across care levels
Service expenditures
Setting-specific expenditures (€) on health care and long-term care services per capita according to care level adjusted for age, gender, comorbidity, mortality and single interactions | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
No care level | Care level 1 | Care level 2 | Care level 3 | |||||||
Community | Institution | Community | p-value | Institution | Community | p-value | Institution | Community | p-value | |
(n=3,325) | (n=705) | (n=1,059) | (n=1,201) | (n=729) | (n=1,028) | (n=371) | ||||
Health insurance*
|
4,018
|
4,666
|
5,830
|
s
|
6,162
|
6,395
|
ns
|
5,962
|
7,139
|
s
|
without home health care*
|
3,593
|
4,681
|
4,888
|
ns
|
6,159
|
5,425
|
s
|
5,965
|
6,449
|
ns
|
General practitioner | 515 | 777 | 634 | s | 771 | 701 | s | 746 | 805 | s |
Medical specialist | 380 | 366 | 350 | s1 | 387 | 237 | s | 282 | 194 | s1 |
Medication | 824 | 1,221 | 1,195 | s | 1,638 | 1,416 | s | 1,762 | 2,251 | s |
of which anti-dementia drugs
|
125
|
81
|
177
|
s1
|
15
|
118
|
s2
|
29
|
90
|
s
|
Hospital treatment | 1,573 | 1,751 | 2,199 | s2 | 2,333 | 2,425 | ns | 1,908 | 2,037 | ns |
Non-physician services | 50 | 182 | 127 | s | 329 | 281 | s2 | 301 | 452 | s2 |
Medical aids | 85 | 391 | 150 | s | 676 | 201 | s | 932 | 632 | s |
Rehabilitation | 180 | 28 | 246 | s2 | 29 | 128 | s2 |
estimation not possible
| ./. | |
Home health care | 390 |
not provided
| 899 | ./. |
not provided
| 1,000 | ./. |
not provided
| 723 | ./. |
Long-term care insurance
|
0
|
12,068
|
3,173
|
s
|
14,850
|
7,168
|
s
|
16,714
|
10,929
|
s
|
of which transfers to informal care
|
not provided
|
not provided
|
1,752
|
./.
|
not provided
|
3,370
|
./.
|
not provided
|
5,561
|
./.
|
Social security system*
|
4,018
|
16,982
|
9,047
|
s
|
21,208
|
13,795
|
s
|
22,921
|
18,437
|
s
|
Comparison across all care levels
Service utilization and expenditures (€) per dementia patient across all care levels adjusted for age, gender, comorbidity, mortality and care level | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Institution (n=2,934) | Community (all) (n=5,584) | Difference | Community (care level) (n=2,159) | Difference | ||||||
Volume | Costs | Volume | Costs | Costs | p-value | Volume | Costs | Costs | p-value | |
Health insurance*
|
5,693
|
5,466
|
227
|
s
|
6,424
|
−731
|
s
| |||
without home health care*
|
5,678
|
4,759
|
919
|
ns
|
5,533
|
145
|
ns
| |||
General practitioner (v) | 54.3 | 761 | 33.2 | 626 | 135 | s | 37.6 | 705 | 56 | s |
Medical specialist (v) | 13.0 | 327 | 8.8 | 310 | 17 | s | 7.2 | 264 | 63 | s |
Medication (p) | 38.8 | 1,636 | 33.0 | 1,270 | 366 | ns | 41.1 | 1,569 | 67 | ns |
of which anti-dementia drugs (p)
| 0.3 |
49
| 0.7 |
129
|
−80
|
s
| 0.6 |
131
|
−82
|
s
|
Hospital treatment (d) | 6.2 | 1,904 | 7.2 | 1,990 | −86 | ns | 7.5 | 2,253 | −349 | s1 |
Non-physician services (p) | 1.7 | 295 | 1.1 | 189 | 106 | s2 | 1.7 | 281 | 14 | s2 |
Medical aids (p) | 5.3 | 742 | 1.5 | 216 | 526 | s | 2.6 | 303 | 439 | s |
Rehabilitation (d) | 0.1 | 16 | 1.1 | 140 | −124 | s2 | 0.7 | 128 | −112 | s2 |
Home health care (p) | not provided | 2.8 | 694 | −694 | ./. | 4.1 | 893 | −893 | ./. | |
Long-term care insurance
|
15,340
|
4,159
|
11,181
|
s
|
6,810
|
8,530
|
s
| |||
of which transfers to informal care
|
2,082
|
−2,082
|
./.
|
3,414
|
./.
| |||||
Social security system*
|
21,388
|
9,765
|
11,623
|
s
|
13,477
|
7,911
|
s
|