Abstract
A good understanding of the health heterogeneity of elderly people, their characteristics, patterns of health care utilization and subsequent expenditures is necessary to adequately evaluate the policy options and interventions aimed at improving quality and efficiency of care for older people. This article reviews studies that used Latent Class Analysis to identify four health profiles among elderly people in Taiwan: High Comorbidity (HC), Functional Impairment (FI), Frail (FR), and Relatively Healthy (RH). Variables associated with increased likelihood of being in the FR group were older age, female gender, and living with one’s family, and these also correlated with ethnicity and level of education. The HC group tended to use more ambulatory care services compared with those in the RH group. The HC group tended to be younger, better educated, and was more likely to live in urban areas than were people in the FI group. The FI group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the RH group. The FI group had relatively high probabilities of needing assistance, and the FR group had higher healthcare expenditures. A person-centered approach would better satisfy current healthcare needs of elderly people and help forecast future expenditures.
Highlights
Taiwan’s population is aging faster than that in most other developed countries [1] and faces an increased prevalence of age-related diseases and escalating healthcare costs
The Functional Impairment (FI) group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the Relatively Healthy (RH) group
We examined the socio-demographic and economic characteristics associated with the health profiles of elderly people, and secondly we examined the effects of different health profiles on the utilization of and expenditures for healthcare services
Summary
Taiwan’s population is aging faster than that in most other developed countries [1] and faces an increased prevalence of age-related diseases and escalating healthcare costs. To identify the health profiles of elderly people in Taiwan, a model based on Latent Class Analysis (LCA) was used. This model utilizes the methodology that is part of the Mplus program [6], and is suitable for dealing with the issue of heterogeneity. Due to its person-centered approach, LCA can be used to reveal health profiles of even the smallest unobserved groups of individuals (i.e., latent classes), and this can adequately account for the associations among observed health dimensions. According to the statistics [8], nearly 35% of the total health care expenditure of NHI in Taiwan was used by elderly people aged 65 and over. Since NHI covers all medical care costs with limited co-payments up to 10%, and has recently extensively reimbursed some intermediate-care and long-term care services, such as rehabilitation, home nursing care, and other services [8], it is possible that some long-term care needs of elders were partially shifted to and covered by NHI
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