Overutilization of ambulatory medical care in the elderly German population? – An empirical study based on national insurance claims data and a review of foreign studies

Bussche, Hendrik van den; Kaduszkiewicz, Hanna; Schäfer, Ingmar; Koller, Daniela; Scherer, Martin; Schön, Gerhard

doi:10.1186/s12913-016-1357-y

Cited by 29 publications

(36 citation statements)

References 55 publications

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“…This finding is in line with a large US study that showed that 5% of high utilizers accounted for up to 47% of healthcare costs [43]. A recent German study reported two subgroups of high utilizers: the oldest patients who suffered from severe multimorbidity and younger elderly patients with psychiatric or psychosomatic conditions [40]. Future research is required to examine characteristics and utilization of the high utilizers identified in this study.…”

Section: Discussionsupporting

confidence: 88%

“…Healthcare utilization rates were 2-4 times higher than those for people without chronic conditions. The direct relationship between the number of chronic conditions and healthcare utilization is well-documented in the literature [14, 23, 24, 40, 41], but, to the best of our knowledge, the impact of multimorbidity on a broad spectrum of healthcare utilization has not been documented previously.…”

Section: Discussionmentioning

confidence: 99%

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Multimorbidity and healthcare utilization: A register-based study in Denmark

Frølich

Ghith

Schiøtz

et al. 2019

Preprint

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20Background 21 People with multimorbidity have reduced functional capacity, lower quality of life, and higher 22 mortality rates and use healthcare resources more intensively than healthy people or those with a 23 single chronic condition. The aim of this study was to explore associations between multimorbidity 24 and use of healthcare services and the impact of socioeconomic status on utilization of 25 hospitalizations and bed days. 26 Methods 27The study population included all individuals aged 16 years and older who lived in the Capital 28Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services 29 and demographics were obtained from Danish national administrative and health registries. Zero-30 inflated models were used to calculate anticipated annual use of hospitalizations and bed days. 31 Findings 32The study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. 33Prevalence was inversely related to educational attainment. For people with multimorbidity, 34 utilization of hospitalizations and bed days increased approximately linearly with the number of 35 chronic conditions. However, a steep increase in utilization of bed days was observed between five 36 and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed 37 days was observed regardless of the number of chronic conditions. Educational attainment was 38 strongly associated with healthcare utilization. 39 Conclusion 3 40 Multimorbidity was associated with a significant increase in utilization of all healthcare services in 41 Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and 42 bed days. 43 4 45 Introduction 46Multimorbidity is often defined as the coexistence of two or more chronic conditions in the 47 same person [1, 2]. People with multimorbidity have decreased functional competence [3], 48 lower quality of life [4], higher mortality rates [5] and use healthcare resources more 49 intensively than healthy people or those with just one chronic condition [6]. Most diseases 50 and consequences of poor health are unequally distributed among socioeconomic population 51 groups, and socioeconomic differences are obvious in the prevalence and consequences of 52 multimorbidity [7, 8]. The prevalence of multimorbidity is increasing internationally. The 53 overall prevalence of multimorbidity in Ontario, Canada increased in nearly all age groups, 54 reflecting a 40% total increase between 2003 and 2009 from 17.4% to 24.3% [9]. A study 55 from the Netherlands reported an increase in multimorbidity prevalence from 12.7% to 56 16.2% between 2004 and 2011 [10]. An American study showed that the prevalence of 57 multimorbidity rose between 2000 and 2010 from 22% to 30%, a trend that was most 58 pronounced among people younger than age 65 [11]. Expected continuing increases in the 59 prevalence of multimorbidity are recognized as a major public health and healthcare 60 challenge for modern societies [9]. 61...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Multimorbidity and healthcare utilization: A register-based study in Denmark

Frølich

Ghith

Schiøtz

et al. 2019

Preprint

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“…A large share of general practitioner (GP) and specialist visits can be attributed to a small proportion of health insured individuals [1]. For example, it has been shown that the most frequent 1% of attenders accounted for 6% of all GP consultations (Leeds, four general practices; 44,146 patients and 470,712 consultations; year 1991 to 1995) [2].…”

Section: Introductionmentioning

confidence: 99%

Which factors lead to frequent attendance in the outpatient sector among individuals in the second half of life? Evidence from a population-based longitudinal study in Germany

Hajek

König

2018

BMC Health Serv Res

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BackgroundDespite only constituting a small percentage of the population, frequent attenders place a tremendous burden on the healthcare system in Germany. Whilst there are some cross-sectional studies that examine the correlates of frequent attendance among older adults, there are only a few longitudinal studies that analyze the factors that lead to frequent attendance among middle-aged or older adults. Thus, the aim of this study was to investigate the factors leading to frequent attendance in the outpatient sector longitudinally.MethodsData was drawn from three waves of a large, population-based sample of community-dwelling individuals aged 40 and above in Germany (n = 1049 in fixed effects regression). Individuals were classified as frequent attenders (GP visits) if they had, on average, visited a GP every second month in the previous 12 months. The same logic was applied for specialist visits.ResultsConditional FE logistic regressions showed that the onset of frequent attendance (GP visits) was negatively associated with age [OR: 0.91, 95% CI: 0.87–0.95], a change in employment status from employed to unemployed [OR: 2.26, 1.17–4.39], decreases in physical functioning [OR: 0.98, 0.97–0.99], worsening self-rated health [OR: 1.40, 1.11–1.78], and increases in physical illnesses [OR: 1.18, 1.06–1.32]. Similarly, the onset of frequent attendance (specialist visits) was associated with age [OR: 0.95, 0.92–0.98], decreases in physical functioning [OR: 0.99, 0.98–1.00], worsening self-rated health [OR: 1.50, 1.25–1.79], and increases in physical illnesses [OR: 1.24, 1.13–1.35].ConclusionsNeed factors in particular were associated with the onset of frequent attendance. This relation did not vary by gender nor education, which may indicate that individuals only start to use health services more frequently when their needs increase.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3487-x) contains supplementary material, which is available to authorized users.

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“…Many studies have reported other strongly associated factors, such as severe or chronic physical disease [16,[18][19][20] and mental health problems [16,18,20]. In particular, patients with a high number of chronic diagnoses showed a 50% increased risk for being classified as frequent attenders [21]. Frequent attendance among patients with mental health problems may result from a more frequent presentation of unspecific medical complaints, high stress burden and increased anxiety or somatisation levels, which lead to increased medical treatments and prescriptions [22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

“…The present study aimed to identify sociodemographic, psychosocial and health-related factors associated with frequent primary care attendance in the German healthcare system, using a large representative sample of the German population aged 18-79 years. The German Health Interview and Examination Survey for Adults (DEGS) is a comprehensive health interview and examination survey [21,31,32]. It allows for analysis of frequent attendance related to a broad spectrum of medically diagnosed diseases, psychometric tests, sociodemographic and psychosocial determinants and subjective factors such as self-rated health.…”

Section: Introductionmentioning

confidence: 99%

Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS)

et al. 2020

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Background: In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system. Methods: The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany's national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of general practitioner contacts in the preceding 12 months as frequent attenders of primary care services. Binary logistic regression models with average marginal effects were used to identify potential determinants for frequent use of primary care services. Results: The sample comprised 7956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, factors related to medical need for care such as medically diagnosed chronic conditions and for subjective health. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect suggesting that the association between subjective health status and frequent attendance vanishes with a higher number of non-communicable diseases. Conclusions: We observed strong associations between frequent primary care attendance and medical need for care as well as subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization and to avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.

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Overutilization of ambulatory medical care in the elderly German population? – An empirical study based on national insurance claims data and a review of foreign studies

Cited by 29 publications

References 55 publications

Multimorbidity and healthcare utilization: A register-based study in Denmark

Multimorbidity and healthcare utilization: A register-based study in Denmark

Which factors lead to frequent attendance in the outpatient sector among individuals in the second half of life? Evidence from a population-based longitudinal study in Germany

Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS)

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