Differences in health care spending and utilization among older frail adults in high-income countries: ICCONIC hip fracture persona

Abstract

Objective: This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture.

Data sources: We used individual-level patient data from five care settings.

Study design: We compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized..

Data collection/extraction methods: The data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.

Principal findings: The sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post-acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting.

Conclusion: Across 11 high-income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post-acute rehab care.

Keywords: health systems; hip fracture; international comparisons.

FIGURE 1

Utilization across key care settings over 365 days. Note: *Primary care visits for Sweden represent average yearly consumption for this cohort rather than linked patient‐level data

FIGURE 2

Spending across key care settings over 365 days (USD). Note: All figures are shown in Intl. USD. For acute hospital spending, index spending is part of the total non‐index spending. For France and Spain, the breakdown for index spending is not available; therefore, only the total spending is shown (for both index and nonindex)

FIGURE 3

Utilization adjusted spending across key care settings over 365 days. Note: All figures are shown in Intl. USD. Panel A: General acute hospital spending/total hospitalizations. Panel B: Facility‐based rehab spending/total days in rehab facilities. Panel C: Home‐ or community‐based rehab spending/number of days in home‐ or community‐based rehab. Panel D: Total primary care spending/total visits to the primary care provider. Panel E: MD outpatient specialty spending/number of visits to the MD specialist. Panel E: Total outpatient pharmaceutical spending/number of unique drugs prescribed

FIGURE 4

Percent change in expenditure (look‐back year compared with current year). Note: Percentage values are calculated as (current year expenditure – look‐back year expenditure)/(look‐back year expenditure) for each care setting [Color figure can be viewed at wileyonlinelibrary.com]