Abstract
BackgroundTo analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population.MethodsUsing a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models.ResultsMean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs.ConclusionsMultimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
Highlights
To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population
Nor did we find a significant association of marital status and health care costs; yet, associations of marital status and health service use have been reported in different directions by other studies applying the Andersen model [68,69]
The variables used in the Andersen model explained only a small proportion of the total variance in health care costs
Summary
To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. In the model which has been discussed and continuously refined over the years [8,9,10], it is assumed that individuals’ use of services is a function of their predisposition to use services (predisposing factors), factors that support or impede use (enabling factors), as well as their need for health care (illness level). Predisposing variables pertain to socio-demographic (e.g. age, sex, education, marital status) and belief characteristics (e.g. values concerning health and illnesses measurable in consequence such as smoking behavior, alcohol consumption, or body mass index) while enabling factors are those that support or impede health care service use (e.g. income, type of health insurance)
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