Abstract
BackgroundThe burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs.MethodsA comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures.ResultsA total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to the caregivers of elderly hospitalized in the geriatric unit. The final model showed that type of service and satisfaction had the largest coefficients (-0.68 and 0.662 respectively, p<0.001).ConclusionsThis study allowed us to identify associated factors of economic burden in elderly hospitalized in acute care units. It opens as well, an issue that should not be overlooked in framing public policies regarding elderly health care.
Highlights
The burden of out of pocket spending for the Mexican population is high compared to other countries
Descriptive statistics The final sample in the study included 70 matched older adults admitted to a Geriatric Evaluation and Management Units (GEMU) and 140 older adults admitted to an Internal Medicine Wards (IMW) for a total of 210 older adults grouped in 70matched triplets
In this study, we investigated the economic burden associated with hospitalisation for acute care of older adults, by evaluating health care related and non-medical OOPE in two care settings: a GEMU and IMW at IMSS
Summary
The burden of out of pocket spending for the Mexican population is high compared to other countries. In addition, experience losses in productivity by taking up responsibilities in care giving activities This situation represents a mayor economic burden in an acute care setting for elderly population. The main social security provider is the IMSS covering approximately 40% of the total population in Mexico, through affiliated individuals and their dependents. Those affiliated to IMSS have access to a more comprehensive health care system as well as to economic benefits, compared with members of other social security institutions, the uninsured, and those who access services through the Ministry of Health [2]
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