Costs for Statutorily Insured Dental Services in Older Germans 2012-2017.

Aleksander Krasowski,Falk Schwendicke,Hendrik Meyer-Lueckel,Joachim Krois,Sebastian Paris,Adelheid Kuhlmey

doi:10.3390/ijerph18126669

Abstract

Objectives: We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. Methods: A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. Results: 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. Conclusions: Costs were associated with sex, social hardship status, place of living and general health conditions. Clinical significance: Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.

Highlights

There is an increasing focus in health services research to study the effects of high age on medical services costs, mainly as populations are ageing and the elderly are the only growing age group in many high-income countries
Total mean costs decreased with increasing age, and this was found for all service blocks except outreach and preventive services
Total mean costs were higher in Berlin than Brandenburg and Mecklenburg-Vorpommern, and in particular prosthetic, prevention and outreach costs were higher in Berlin

Summary

Introduction

There is an increasing focus in health services research to study the effects of high age on medical services costs, mainly as populations are ageing and the elderly are the only growing age group in many high-income countries. Knowledge on costs in this group and drivers of it are useful for health services planning, and to assist developing targeted interventions for improving health at increased efficiency. Compared with medical costs throughout most of the life course, end-of-life costs have been found to be high, mainly driven by repeated inpatient (hospital) admissions [1]. Costs have been associated with aspects like sex

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