Factors associated with the utilization and costs of health and social services in frail elderly patients

Research Department, Social Insurance Institution of Finland, Helsinki, Finland.
BMC Health Services Research (Impact Factor: 1.71). 07/2012; 12(1):204. DOI: 10.1186/1472-6963-12-204
Source: PubMed


Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients.
Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization.
The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure.
The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in the long run, result in increased costs of health care.

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    • "This study did not find significant differences in older people's service use between the two cities (Tampere and Jyv€ askyl€ a), though a previous study has observed variations in service provisions and use between different municipalities in Finland (e.g. Kehusmaa et al. 2012). The findings of this paper cannot be expected to reveal the national situation because the sample population represents only two cities in Finland. "
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    • "An earlier study of ours has shown that FIM is associated with social care service use, and HRQoL 15D appears to be a powerful indicator for the utilization of health care services [27]. Based on this prior knowledge, in Model 3, public care expenditure was controlled for independent disability level (FIM) and health-related quality of life (HRQoL 15D) [27]. These results show that FIM, HRQoL15D and Care Pattern are associated with expenditure (Model 3). "
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