The impact of long-term care service on total lifetime medical expenditure among older adults with dementia

• Published in: Social science & medicine (1982) 2021-07, Vol.280, p.114072-114072, Article 114072
• Main Authors: Moon, Sungje, Park, Hee Jung, Sohn, Minsung
• Format: Article
• Language: English
• Subjects: Dementia; Expenditures; Health care expenditures; Health insurance; Hospitalization; Lifetime medical expenditure; Long term care insurance; Long term health care; Long-term care services; Medicine; Older adults; Older people; Outpatient treatment; Per capita; Population growth; Propensity; Treatment outcomes
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2021.114072

Along with the rapid increase in older adult population in South Korea, the management of dementia is becoming important. Higher dementia prevalence inevitably leads to an excessive burden on medical expenditure throughout one's life, so the catastrophic health expenditure for dementia should be protected in the aspect of both nation and family. Therefore, this study attempted to estimate the lifetime medical expenditures (LE) of older adults with dementia, and confirmed if the long-term care insurance (LTCI) is effective in reducing their medical expenses. The study analyzed LE of adults, aged over 70 years, using a cohort database and simulated the total LE per capita. In order to compare the differences in LE due to dementia, propensity score matching (PSM) was performed. As of 2015, the total LE per capita for older adults with dementia and without dementia was estimated to be 76,973 thousand won ($65,427) and 31,105 thousand won ($26,439). Older adults with dementia had 2.4 times more expenditure than those without dementia. In particular, the LE per capita for hospitalization of dementia patients was 63,945 thousand won ($54,353), which was about 5 times higher than LE per capita for outpatient treatment. In addition, as a result of confirming the political effectiveness of LTCI, the LE for older adults with dementia, who had not used the long-term care service (LTCS), was estimated to be about 85,769 thousand won ($72,904). Conversely, LTCS users were estimated to spend 70,487 thousand won ($59,914), which means that LTCS non-users spent about 22% more on total LE than LTCS users. Non-users spent about half of their LE after the age of 80. Based on these findings, this study confirmed that the LTCI system had the desired effect of reducing the total LE for older adults with dementia. •Older adults with dementia will spend more on lifetime medical costs compared to those without dementia.•Regarding gender, females with dementia spend more on lifetime medical costs than males.•Hospitalization accounts for increasing in the lifetime medical costs as compared to outpatient care.•Implementation of LTCS can contribute to reducing the lifetime cost for older adults with dementia.•14 years of longitudinal data was used including when the coverage of LTCI was expanded.