Spending-down to Medicaid in the Nursing Home and in the Community

Temkin‐Greener, Helena; Meiners, Mark R.; Petty, Elizabeth A.; Szydlowski, Jill

doi:10.1097/00005650-199308000-00001

Cited by 12 publications

(1 citation statement)

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“…The study period was set from 1999, three years after computerization, because previous studies of health services usage conducted in Europe and North America have revealed that the largest proportion of hospital services was consumed during the last 1-3 years of life. [18][19][20][21][22][23][24][25][26] The HA database with high coverage percentage would include the majority of death and the information on the utilization of hospital health services of the decedents during their last years of life.…”

Section: Methodsmentioning

confidence: 99%

A Geographical Study of Health Services Utilization among the Elderly in Hong Kong: From Spatial Variations to Health Care Implications

Wong

Chau

Goggins

et al. 2009

Health�Serv�Insights

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Introduction: Levels of utilization of health services vary socially and geographically. Differences in the rates of usage are also associated with geographical aspects of health care systems. The purpose of this study was to capture spatial variations in hospital health services utilization in the elderly population in Hong Kong, a Special Administrative Region of China. Materials and Methods:We carried out a secondary analysis of a database from the Hospital Authority (HA) which covers 98% (N = 243,245) of the total registered deaths in Hong Kong during 1999 to 2005. Deaths at age 65y and above (N = 184,671) were included in the analysis. Age-sex weighted mean utilization ratio of hospital services was calculated by dividing the age-sex weighted mean usage of a particular service for each district by that for the whole territory. The variation in utilization by the seniors was analyzed in terms of four types of services: length of stay (LOS) in HA hospitals, number of inpatient admissions, number of visits to specialist outpatient department (SOPD), and attendances at accident and emergency department (AED).Results: Deaths at age 65y and above contributed to 76% of the total registered deaths. Each district contributed 1.0% to 9.1% of the total number of deaths in Hong Kong. Spatial analysis of the age-sex weighted mean utilization ratio showed significant geographic variation in the use of hospital services: the range of difference in the LOS between the lowest and highest district was 44%, while some differences as high as 33%, 35% and 39% in utilization ratios were observed in relation to number of inpatient admissions, visits to SOPD, and attendances at AED respectively. However, the patterns of these variations were not consistent for the four types of service being analyzed.Conclusions: Geographic variation in the utilization of hospital health services across the 18 districts in Hong Kong among the elderly population during the last three years before death was demonstrated. However, the patterns of variation were different for the types of services being examined. Further studies using primary data at an individual level are needed to explain the variations. Detailed analysis examining the relationship between service provision, accessibility and health outcomes are also indicated in order to inform the planning of health service delivery.

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