Increased Healthcare Service Utilizations for Patients with Dementia: A Population-Based Study

et al. (2014) Increased Healthcare Service Utilizations for Patients with Dementia: A Population-Based Study. PLoS ONE 9(8): e105789. doi:10.1371/journal.pone.0105789 Increased Healthcare Service Utilizations for Patients with Dementia: A Population-Based Study Shiu-Dong Chung 0 Shih-Ping Liu 0 Jau-Jiuan Sheu 0 Ching-Chun Lin 0 Herng-Ching Lin 0 Chao-Hung Chen 0 Robert Stewart, Institute of Psychiatry, United Kingdom 0 1 Division of Urology, Department of Surgery, Far Eastern Memorial Hospital , New Taipei City, Taiwan , 2 School of Medicine, College of Medicine, Fu Jen Catholic University , Taipei, Taiwan , 3 Sleep Research Center, Taipei Medical University Hospital , Taipei, Taiwan , 4 Department of Urology, National Taiwan University Hospital and College of Medicine , Taipei, Taiwan , 5 Department of Neurology, Taipei Medical University Hospital , Taipei, Taiwan , 6 Neuroscience Research Center, Taipei Medical University Hospital , Taipei, Taiwan , 7 Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University , Taipei, Taiwan , 8 School of Health Care Administration Taipei Medical University , Taipei, Taiwan , 9 Department of Thoracic Surgery, Mackay Memorial Hospital , Taipei, Taiwan , 10 Mackay Junior College of Medicine , Nursing, and Management, Taipei , Taiwan Background: The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan's National Health Insurance population-based database. Methods: This study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services. Results: As for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p,0.001) and significantly higher outpatient costs (US$124 vs. US$16, p,0.001) than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p, 0.001) and significantly higher outpatient costs (US$1754 vs. US$1322, p,0.001) than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p,0.001) and significantly higher outpatient costs (US$1878 vs. US$1338, p,0.001) than comparison subjects. Furthermore, the total cost was about 2fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p,0.001). Conclusions: We concluded that subjects who had received a clinical dementia diagnosis had significantly higher utilization of all healthcare services than comparison subjects. - Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. The sampled subjects and their health service utilization for this cross-sectional study were retrieved from the Taiwan Longitudinal Health Insurance Database (LHID2000). The LHID2000, which was open to the researchers in Taiwan, was available from the NHRI (http://nhird.nhri.org.tw/date_01.html). This study is based on de-identified secondary data from the LHID2000 released by the NHRI without restrictions for research purposes. Requests for the data may be sent to . Funding: The authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. . These authors contributed equally to this work. " These authors also contributed equally to this work. Dementia is a chronic disease in advanced age and is characterized by progressive cognitive decline that interferes with independent functioning, ultimately resulting in the need for longterm care [1,2]. Previous studies established its prevalence as 2%,10% of those over 65 years of age, and the incidence of dementia disorders increases exponentially beyond 65 years of age [38]. Dementia also incurs a significant economic burden of direct healthcare costs and non-healthcare costs [5,9,10]. Several studies reported the monetary impact of dementia in different populations [917]. For example, a study by Kane and Atherly found that dementia was associated with 2.4-times greater Medicare Part A (inpatient) payments and 1.3 times greater Part B (outpatient) payments for community-dwelling persons in the US [13]. Another study by Arling et al. in the US also reported that dementia combined with heavy nursing home (NH) use resulted in 2.5-fold greater Medicare and 12.6-fold greater Medicaid annual payments compared to a trajectory of dementia with little of no NH use [14]. Furthermore, one study stratified by care levels from German insurance claims data found that institutional care for dementia patients required additional yearly per capita expenses of ca. J200 on health and ca. J11,200 on long-term care [6]. Another study in Spain showed that mean numbers of patient visits for follow-up were 8.8 and 14.7 visits/semester to the primary care center for patients with Alzheimers disease (AD) and those with vascular dementia (VD), respectively, and medical costs per patient per semester were J2866 for AD and J3209 for VD patients [10]. While some studies reported the healthcare utilization of patients with dementia alone [1017], others have attempted to compare differences in healthcare utilization or costs between patients with and those without dementia [9,1820]. For example, a study by Fick et al. found that the annual costs were US$7557 and US$4766 for the dementia-only group and neither dementia nor delirium group, respectively, in the US [9]. In the analyses of 2006 health insurance claims data in Germany, Schwarzkopf et al. reported that the annual expenditure within the social security system was about J12,300 per dementia patient and about J4,000 per non-demented control subject [18]. However, all such studies investigating the health care utilization of people with dementia were conducted in Western societies, and there is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. In addition, almost no study attempted to differentiate health care service utilization due to psychiatric reasons and general health care service utili (...truncated)