Abstract
BackgroundThe majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan’s National Health Insurance population-based database.MethodsThis study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services.ResultsAs for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p<0.001) and significantly higher outpatient costs (US$124 vs. US$16, p<0.001) than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p<0.001) and significantly higher outpatient costs (US$1754 vs. US$1322, p<0.001) than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p<0.001) and significantly higher outpatient costs (US$1878 vs. US$1338, p<0.001) than comparison subjects. Furthermore, the total cost was about 2-fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p<0.001).ConclusionsWe concluded that subjects who had received a clinical dementia diagnosis had significantly higher utilization of all healthcare services than comparison subjects.
Highlights
Dementia is a chronic disease in advanced age and is characterized by progressive cognitive decline that interferes with independent functioning, resulting in the need for longterm care [1,2]
The LHID2000, which was open to the researchers in Taiwan, was available from the NHRI
Another study by Arling et al in the US reported that dementia combined with heavy nursing home (NH) use resulted in 2.5-fold greater Medicare and 12.6-fold greater Medicaid annual payments compared to a trajectory of dementia with little of no NH use [14]
Summary
Dementia is a chronic disease in advanced age and is characterized by progressive cognitive decline that interferes with independent functioning, resulting in the need for longterm care [1,2]. Several studies reported the monetary impact of dementia in different populations [9,10,11,12,13,14,15,16,17]. Another study in Spain showed that mean numbers of patient visits for follow-up were 8.8 and 14.7 visits/semester to the primary care center for patients with Alzheimer’s disease (AD) and those with vascular dementia (VD), respectively, and medical costs per patient per semester were J2866 for AD and J3209 for VD patients [10]. The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. This study investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan’s National Health Insurance population-based database
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