| Summary: | 碩士 === 長榮大學 === 醫務管理學研究所 === 96 === Objectives: Dementia is a chronic and progressive disease and it is expected to increase as the general population ages. It is important to study prevalence, health care utilization and costs of dementia in order to allocate health resource and make strategic decisions. However, to date, less national wide study available on this issue in Taiwan. Therefore, this study used the health insurance database to analyse prevalence, health care utilization and cost of dementia.Furthermore, we explored the effect of comorbidity on health care utilizations and costs.
Methods: This study adopted the National Health Insurance enrollment and claim data files provided by the National Health Research Institute in 2004. Beneficiaries who under the age of 65 years and were not eligible for NHI in 2004 were exclude, leaving 17,032 beneficiaries available for this study. Those beneficiaries who had at least one service claim in the year 2004 for either ambulatory or inpatient care, with diagnosis of dementia (ICD-9-CM 290, 294.1X and 331.0) were selected to estimate prevalence of dementia in elderly. Besides, considering the utilization and cost, the beneficiaries who under the age of 65 years and had not been continuously eligible for all of the year 2004 were exclude, leaving 15,232 beneficiaries available for this study. Comorbid conditions were based on the diagnostic classifications from the Charlson comorbidity index. We examine whether people diagnosed with dementia in the NHI have higher health care utilization and cost compared with a relevant comparison group.
Results: (1) In 2004, prevalence of dementia was 4.07%. (2) Age was the major risk factor of dementia and dementia prevalence increased with age. Prevalence doubles approximately, for every 5-year interval, from 1.43% among people 65-69 years of age to about 12.51% among those aged 85 and over. (3) Mean annual utilization of physician visits, hospital admissions and length of stay were 1.2 times (34.7 vs. 29.1), 3.0 times (0.9 vs. 0.3) and 3.7 times (12.3 days vs. 3.3 days) higher for patients with dementia relative to nondementia patients, relatively. (4) Mean annual costs of outpatient costs, inpatient costs and total costs were 1.5 times ($52,320 vs. $35,683), 2.7 times ($51,672 vs. $18,925) and 1.9 times ($103,992 vs. $54,608) higher for patients with dementia relative to nondementia patients, relatively. (5) While dementia patients accounted for 3.77% of the elderly, they accounted for 5.2%, 15.7%, 6.8%, 12.7% and 8.9% of physician visits, hospital days, outpatient costs, inpatient costs and total medical costs to the NHI, respectively.
Conclusions: In a nationally representative sample, higher medical expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients. The public should be educated the symptoms of early stage dementia in order to early diagnosis and medical treatment and decelerate deterioration of the health functions.
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