Abstract
BackgroundElderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.MethodsWe investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.ResultsWe found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.ConclusionThe findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
Highlights
In need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care
We find that among the elderly with a renal failure diagnosis, 57% of those with a low level of long-term care need did not have a visit to a physician of internal medicine
There were hardly any effects of the level of long-term care on utilization of surgery: We found no significant effects among home care recipients, and no consistent effects among nursing home residents
Summary
In need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Elderly who live in nursing homes have less visits to medical specialists such as dentists, orthopedists, ophthalmologists and otorhinolaryngologist [7,8,9,10,11,12] If this lower level of medical utilization represents unmet care needs nursing home residents may be at risk of adverse outcomes, i.e. inadequate medication and therapy, avoidable hospitalizations, or falls [13,14,15,16,17,18].
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