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Living longer in declining health: factors driving healthcare costs among older people

Maynou, Laia, Street, Andrew ORCID: 0000-0002-2540-0364 and García−altés, Anna (2023) Living longer in declining health: factors driving healthcare costs among older people. Social Science & Medicine, 327. p. 115955. ISSN 0277-9536

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Identification Number: 10.1016/j.socscimed.2023.115955


Background Developed countries are facing challenges in caring for people who are living longer but with a greater morbidity burden. Such people are likely to be regular users of healthcare. Objectives Our analytical aim is to identify factors that explain healthcare costs among: (1) people over 55 years old; (2) the top 5% and 1% high-cost users among this population; (3) those that transition into the top 5% and 1% from one year to the next; (4) those that appear in the top 5% and 1% over multiple years; and (5) those that remain in the top 5% and 1% over consecutive years. Methods The data covered 2011 to 2017 and comprised 1,485,170 observations for a random sample of 224,249 people aged over 55 years in the Catalan region of Spain. We analysed each person's annual healthcare costs across all public healthcare settings related to their age, gender, socio-economic status (SES), whether or not and when they died, and morbidity status, through Adjusted Morbidity Groups. Results After controlling for morbidity status, the oldest people did not have the highest costs and were less likely to be among the most costly patients. There was also only a modest impact on costs associated with SES and with dying. Healthcare costs were substantially higher for those with a neoplasm or four or more long term conditions (LTCs), costs rising with the complexity of their conditions. These morbidity indicators were also the most important factors associated with being and remaining in the top 5% or top 1% of costs. Conclusion Our results suggest that age and proximity to death are poor predictors of higher costs. Rather, healthcare costs are explained mainly by morbidity status, particularly whether someone has neoplasms or multiple LTCs. Morbidity measures should be included in future studies of healthcare costs.

Item Type: Article
Additional Information: © 2023 The Author(s).
Divisions: Health Policy
Subjects: R Medicine
Date Deposited: 18 May 2023 13:51
Last Modified: 15 Apr 2024 18:36

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