Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico
Background: Dependence is a significant health-related condition for older adults (OA) and implies that self-care is transferred to other people, the community or institutions. Recent studies have analyzed the relationship between out-of-pocket (OOP) healthcare expenditures and dependence. Nonethele...
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doaj-ed85ce5ede2f487ca503856bd9d683412020-11-25T03:51:39ZengFrontiers Media S.A.Frontiers in Public Health2296-25652020-07-01810.3389/fpubh.2020.00329536476Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in MexicoAarón Salinas-Rodríguez0Betty Manrique-Espinoza1Irina Torres Mussot2Julio Cesar Montañez-Hernández3Center for Surveys and Evaluation, National Institute of Public Health, Cuernavaca, MexicoCenter for Surveys and Evaluation, National Institute of Public Health, Cuernavaca, MexicoCenter for Health Systems Research, National Institute of Public Health, Cuernavaca, MexicoCenter for Health Systems Research, National Institute of Public Health, Cuernavaca, MexicoBackground: Dependence is a significant health-related condition for older adults (OA) and implies that self-care is transferred to other people, the community or institutions. Recent studies have analyzed the relationship between out-of-pocket (OOP) healthcare expenditures and dependence. Nonetheless, these studies were not specifically designed to estimate the economic impact of dependence. Our aim was to estimate the total adjusted annual OOP healthcare expenditures in dependent older adults compared to independent ones. Additionally, we explore the potential combined effect of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) dependence on OOP healthcare expenditures.Methods: Data comes from the cross-sectional study “Economic impact of physical dependence in older adults and the burden of informal care” conducted in 2018 with a sample of 735 community-dwelling older Mexican adults ages 60 and older. We used direct (medical and non-medical) and indirect costs to estimate the OOP healthcare expenditures associated with dependence. We applied the Katz scale to assess dependence in ADL and the Lawton scale to assess dependence in IADL. Two-Part regression models were used to analyze the relationship between dependence and OOP health expenditures.Results: Presence of ADL dependence represented a higher level of expenditure, 107% compared to non-dependent OA (β = 1.07, CI95%: 0.43–1.71), and 97% for IADL dependence (β = 0.97, CI95%: 0.49–1.45). The combined effect of ADL and IADL dependence (132%) was greater (β = 1.32, CI95%: 0.74–1.90) than the effect of ADL or IADL dependence alone. In monetary terms, OA with ADL dependence had a total annualized mean OOP healthcare expenditure of $31,865 (Mexican pesos), OA with IADL $26,912, and combined ADL and IADL $39,520.Conclusions: ADL and IADL dependence are associated with the total annualized OOP healthcare expenditures. This association is even higher when both conditions are present together. These findings highlight the economic implications of the dependence for individuals, their families, and the health system. Given that current evidence on effective interventions to prevent dependence in OA is insufficient, future studies should be conducted to estimate their costs and determine what interventions work, as well as their effectiveness and cost-effectiveness in different sub-groups of the population, and how these might be appropriately implemented.https://www.frontiersin.org/article/10.3389/fpubh.2020.00329/fulldependent older adultsOOP healthcare expenditurestwo-part regression modelbasic activities of daily livinginstrumental activities of daily living |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Aarón Salinas-Rodríguez Betty Manrique-Espinoza Irina Torres Mussot Julio Cesar Montañez-Hernández |
spellingShingle |
Aarón Salinas-Rodríguez Betty Manrique-Espinoza Irina Torres Mussot Julio Cesar Montañez-Hernández Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico Frontiers in Public Health dependent older adults OOP healthcare expenditures two-part regression model basic activities of daily living instrumental activities of daily living |
author_facet |
Aarón Salinas-Rodríguez Betty Manrique-Espinoza Irina Torres Mussot Julio Cesar Montañez-Hernández |
author_sort |
Aarón Salinas-Rodríguez |
title |
Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico |
title_short |
Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico |
title_full |
Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico |
title_fullStr |
Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico |
title_full_unstemmed |
Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico |
title_sort |
out-of-pocket healthcare expenditures in dependent older adults: results from an economic evaluation study in mexico |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Public Health |
issn |
2296-2565 |
publishDate |
2020-07-01 |
description |
Background: Dependence is a significant health-related condition for older adults (OA) and implies that self-care is transferred to other people, the community or institutions. Recent studies have analyzed the relationship between out-of-pocket (OOP) healthcare expenditures and dependence. Nonetheless, these studies were not specifically designed to estimate the economic impact of dependence. Our aim was to estimate the total adjusted annual OOP healthcare expenditures in dependent older adults compared to independent ones. Additionally, we explore the potential combined effect of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) dependence on OOP healthcare expenditures.Methods: Data comes from the cross-sectional study “Economic impact of physical dependence in older adults and the burden of informal care” conducted in 2018 with a sample of 735 community-dwelling older Mexican adults ages 60 and older. We used direct (medical and non-medical) and indirect costs to estimate the OOP healthcare expenditures associated with dependence. We applied the Katz scale to assess dependence in ADL and the Lawton scale to assess dependence in IADL. Two-Part regression models were used to analyze the relationship between dependence and OOP health expenditures.Results: Presence of ADL dependence represented a higher level of expenditure, 107% compared to non-dependent OA (β = 1.07, CI95%: 0.43–1.71), and 97% for IADL dependence (β = 0.97, CI95%: 0.49–1.45). The combined effect of ADL and IADL dependence (132%) was greater (β = 1.32, CI95%: 0.74–1.90) than the effect of ADL or IADL dependence alone. In monetary terms, OA with ADL dependence had a total annualized mean OOP healthcare expenditure of $31,865 (Mexican pesos), OA with IADL $26,912, and combined ADL and IADL $39,520.Conclusions: ADL and IADL dependence are associated with the total annualized OOP healthcare expenditures. This association is even higher when both conditions are present together. These findings highlight the economic implications of the dependence for individuals, their families, and the health system. Given that current evidence on effective interventions to prevent dependence in OA is insufficient, future studies should be conducted to estimate their costs and determine what interventions work, as well as their effectiveness and cost-effectiveness in different sub-groups of the population, and how these might be appropriately implemented. |
topic |
dependent older adults OOP healthcare expenditures two-part regression model basic activities of daily living instrumental activities of daily living |
url |
https://www.frontiersin.org/article/10.3389/fpubh.2020.00329/full |
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