Healthcare costs for people aged 65+ two years prior to their receiving long-term municipal care.

BACKGROUND AND AIMS: More knowledge is needed about patterns of healthcare consumption at different times during old age, particularly with regard to the relationship between various agents in the healthcare and social services system. One aim was to investigate healthcare costs in the public medical healthcare system in men and women (65+) and, with regard to age, in the two years prior to the start of long-term municipal care and services. Another aim was to investigate patterns and determinants of costs. METHODS: The study comprised 362 people who received decisions about municipal care and/or services during 2002-2003, and data were derived from the Swedish National Study of Aging and Care (SNAC) and county councils registers about healthcare consumption. SNAC provided data concerning demographics, functional dependency and informal care at the time of the decision, which were merged with data from the Skåne County Council patient administrative system regarding costs in the two years prior to decision. RESULTS: Cluster analysis revealed 13% overall higher healthcare costs. Those involved were more often younger, men, married, and diagnosed with circulatory diseases, cancer, or injuries. Most (58% for women, 54% for men) of the costs for acute inpatient care occurred within five months prior to municipal care. Men had significantly higher costs compared with women for visits to outpatient physicians (EUR 700 vs 400) and inpatient care (EUR 4700 vs 700) 12-0 months prior to municipal care. CONCLUSIONS: A share of 13% had higher healthcare costs throughout the two years. Those involved were more often younger, men, married, and diagnosed with circulatory diseases, cancer, or injuries. Those older people at risk of high healthcare costs should benefit from systematic clinical assessments and more proactive and integrated care, to prevent escalating costs in the period preceding long-term municipal care and services.