Comparison of medical care of inpatients aged 70 or more with different medical insurance.

Abstract

A recent trend in the hospital care of old persons is for the patients to be older and for the stay to be longer. This study was on the hospital care of elderly inpatients in terms of bed-days, admission rate, diseases and insurance points paid with either National Health Insurance (NHI) or Social Health Insurance (SHI). Data were obtained from the medical insurance records for the month of January 1985 for inpatients aged 70 or more of H city, Osaka prefecture. The number of inpatients covered by NHI was 360, and that covered by SHI was 447.More residents of this city aged from 70 to 79 were insured by NHI than by SHI, but fewer persons aged 80 or more. About half of the residents insured by NHI were men and half were women, but with SHI, twice as many insured residents were women.The admission rate (number of inpatients per 100 insured persons) was 5.0 with NHI and 7.0 with SHI, which difference was significant. The number of inpatients per 10, 000 insured persons who had diseases of the circulatory system, digestive system, musculoskeletal system and connective tissue with SHI was significantly higher than that of inpatients with NHI. The proportion of inpatients with a long stay (one year or more) was 23%. The rate was significantly higher with SHI than with NHI. With NHI, the proportion of patients who received more than 2, 000 points of insurance payments tended to be higher than with SHI. The proportion of patients who received 1, 000 to 1, 499 points tended to be higher with SHI than with NHI.The results suggested that social factors as well as medical ones affected the hospital care given to old persons. It is thought that especially women aged more than 75 tend to become insured by SHI, changing from NHI after the deaths of their spouses. This tendency caused the different structure of diseases or care at home, and a different situation in the medical care of elderly patients is observed. Thus, the recent trends in hospital care of elderly inpatients are more strongly affected by persons insured by SHI than by those insured by NHI.