INTERNATIONAL RESEARCH & OPINION

Cut hospital use in the elderly, spend savings more wisely?

US Medicare could safely cut hospital care in the elderly and spend the savings on extra community care, an option that is preferred by the elderly, suggest US-based researchers.

For example, if hospital use by Medicare enrollees aged ~ 80 years was reduced to the mean level for those representing the lowest quartile in terms of hospitalisation rates, then an extra $US560/patientJ year would be available to Medicare to spend on other healthcare resources. If hospital use was reduced to the mean level for the 2 lower quartiles or the 3 lower quartiles, then an extra $US203 or SUS 152 per patient per year would be available, respectively.

Annual mortality was similar between those patients in hospital service areas in the lowest quartile of use and those in hospital service areas in the higher quartiles of use (9.4 vs 9.1 %, respectively).

Provide extra community care The cost savings generated by reducing hospital

use to the lowest quartile level could be spent on providing 8 extra nurse home-visits per year for each Medicare enrollee aged ~ 80 years who needs nursing services. Alternatively, for each patient in need, these annual savings could buy 37 hours of housekeeping services, 6 days of hospice care, 19 telephone house calls by a primary-care physician, or 37 hours of assistance in the home when sick.

The researchers produced these estimates using September 1992 data for a representative sample drawn from the Medicare Current Beneficiary Survey, data from a telephone survey of 225 randomly selected Medicare beneficiaries aged ~ 80 years, and previously calculated Medicare hospital discharge rates.

Wasson ill, Bubolz TA, Lynn J, Teno J. Can we afford comprehensive, supportive care for the very old? Journal of the American Geriatrics Society 46: 829-832, Jul 1998 800693844

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