gms | German Medical Science

Background and Purpose: So far it is known that health care utilization of nursing home residents differs from home care patients and elderly people without need of care. However, it is not clear whether these differences in utilization are attributable to morbidity differences between these groups. We compare utilization of medical specialists between nursing home residents, home care patients and people without need of care, while controlling for differences in morbidity status.

Methods and Research Focus: We analyzed claims data of 100,000 Statutory-Health insurants aged 60 years or above. Zero-inflated poisson regression was used to analyze utilization differences of twelve specialties between nursing home residents and community-dwelling elderly.

Methodological and Theoretical Focus: For each model, we included all insurants with at least one diagnosis that is typical for the respective specialty. Moreover, we controlled for age, gender, additional diseases, regions and death.

Results: Regarding the probability of having a specialist consultation nursing home residents have a lower probability than community-dwelling elderly with the same health conditions. This pattern can be found for nearly all investigated specialties except for neurological and psychiatric specialist consultations. Regarding the expected number of consultations, being a nursing home resident was associated with less expected internal medicine consultations and more expected consultations of neurological and psychiatric specialists compared to people not in need of care.

Conclusions: Based on these findings, future research should investigate the underlying causes for the lower specialist utilization of nursing home residents.