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

Includes supplementary material for the online appendix.

Detalles Bibliográficos
Autores: Maynou Pujolràs, Laia, Street, Andrew, García-Altés, Anna
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/58378
Acceso en línea:http://hdl.handle.net/10230/58378
http://dx.doi.org/10.1016/j.socscimed.2023.115955
Access Level:acceso abierto
Palabra clave:Multimorbidity
Long term conditions
Adjusted morbidity groups
Proximity to death
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spelling Living longer in declining health: factors driving healthcare costs among older peopleMaynou Pujolràs, LaiaStreet, AndrewGarcía-Altés, AnnaMultimorbidityLong term conditionsAdjusted morbidity groupsProximity to deathIncludes supplementary material for the online appendix.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.LM is funded by the Spanish Ministry of Science, Innovation and Universities (PID2019104319RB-I00). AS received no funding for this project. AGA was employed at AQuAS when the project was underway.Elsevier202320232023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/58378http://dx.doi.org/10.1016/j.socscimed.2023.115955reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésSocial Science & Medicine. 2023 Jun;327:115955info:eu-repo/grantAgreement/ES/2PE/PID2019104319RB-I00© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/583782026-06-12T07:21:37Z
dc.title.none.fl_str_mv Living longer in declining health: factors driving healthcare costs among older people
title Living longer in declining health: factors driving healthcare costs among older people
spellingShingle Living longer in declining health: factors driving healthcare costs among older people
Maynou Pujolràs, Laia
Multimorbidity
Long term conditions
Adjusted morbidity groups
Proximity to death
title_short Living longer in declining health: factors driving healthcare costs among older people
title_full Living longer in declining health: factors driving healthcare costs among older people
title_fullStr Living longer in declining health: factors driving healthcare costs among older people
title_full_unstemmed Living longer in declining health: factors driving healthcare costs among older people
title_sort Living longer in declining health: factors driving healthcare costs among older people
dc.creator.none.fl_str_mv Maynou Pujolràs, Laia
Street, Andrew
García-Altés, Anna
author Maynou Pujolràs, Laia
author_facet Maynou Pujolràs, Laia
Street, Andrew
García-Altés, Anna
author_role author
author2 Street, Andrew
García-Altés, Anna
author2_role author
author
dc.subject.none.fl_str_mv Multimorbidity
Long term conditions
Adjusted morbidity groups
Proximity to death
topic Multimorbidity
Long term conditions
Adjusted morbidity groups
Proximity to death
description Includes supplementary material for the online appendix.
publishDate 2023
dc.date.none.fl_str_mv 2023
2023
2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/58378
http://dx.doi.org/10.1016/j.socscimed.2023.115955
url http://hdl.handle.net/10230/58378
http://dx.doi.org/10.1016/j.socscimed.2023.115955
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Social Science & Medicine. 2023 Jun;327:115955
info:eu-repo/grantAgreement/ES/2PE/PID2019104319RB-I00
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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