The functional status, rehospitalization, and hospital cost reduction in geriatric patients after the implementation of the universal health coverage program in the national referral hospital Indonesia
DOI:
https://doi.org/10.13181/mji.v28i4.3214Keywords:
functional status, geriatrics, health insurance, hospital cost, hospitalizationAbstract
BACKGROUND Universal health coverage program (UHCP) might implicate negatively toward geriatric care with its impact on higher cost. The evaluation had to be made, especially in functional status, rehospitalization, and cost-effectiveness.
METHODS Retrospective cohort study with historical control was done. Seventy two geriatric inpatients in the pre-UHCP group and 86 in the UHCP group were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects with geriatric syndromes admitted from July to December 2013 (pre-UHCP era) and January to June 2014 (UHCP era). Functional status changes, rehospitalization, and process indicators were observed. Cost reduction was calculated using the incremental cost-effectiveness ratio (ICER), whereby costs, functional status changes, and rehospitalization of both groups were used to identify the differences.
RESULTS Proportions of functional status increase were 35.3% and 34.8% in the pre- UHCP and UHCP groups, respectively (p = 1.00) and the decrease were 5.9% and 4.5% in the pre-UHCP and UHCP group, respectively (p = 1.00). Rehospitalization rates were 21.7% and 18.1% (p = 0.603) in the pre-UHCP and UHCP groups, respectively. Mean hospital expenses were between 17.1 million IDR (1,221 USD; 1 USD = 14,000 IDR) for the pre-UHCP group and 20.8 million IDR (1,486 USD) for the UHCP group. ICER showed that hospitalization cost was 3.7 million IDR (264 USD) higher to increase 1 activity of daily living score in the UHCP era. As for rehospitalization, the cost was 600,000 IDR (43 USD) less, with 3.6% smaller in readmission.
CONCLUSIONS There was no changes in patientsâ functional status after the UHCP implementation. There was a reduction in rehospitalization with lower cost in the UHCP era.
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References
BPS - Statistics Indonesia. Indonesia population projection 2010-2035. Jakarta: BPS - Statistics Indonesia; 2013.
United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2012 revision, key findings and advance tables. Working paper No. ESA/P/WP.227.
National Institute on Aging, National Institute of Health, US Department of Health and Human Services. Global health and aging. World Health Organization; 2011. p. 11-7717.
Hendarwan H, Yuniar Y, Despitasari M. Prospects, facts, and so lution for Indonesia universal health coverage program: Indonesia health forum panell discussion. Research and development board, Ministry of Health. 2018;7:11-7.
Zabawa C, Cottenet J, Zeller M, Mercier G, Rodwin VG, Cottin Y, et al. Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: impact of postdischarge ambulatory care. Medicine. 2018;97(24):e11085. https://doi.org/10.1097/MD.0000000000011085
Hopman-Rock M, van Hirtum H, de Vreede P, Freiberger E. Activities of daily living in older community-dwelling persons: a systematic review of psychometric properties of instruments. Aging Clin Exp Res. 2019;31(7):917-25. https://doi.org/10.1007/s40520-018-1034-6
Ryg J, Engberg H, Mariadas P, Pedersen SGH, Jorgensen MG, Vinding KL, et al. Barthel index at hospital admission is associated with mortality in geriatric petients: a Danish nationwide population-based cohort study. Clin Epidemiol. 2018;10:1789-800. https://doi.org/10.2147/CLEP.S176035
Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, et al. What is comprehensive geriatric assessment (CGA)? an umbrella review. Age Ageing. 2018;47(11):149-55. https://doi.org/10.1093/ageing/afx166
Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017;9:CD006211. https://doi.org/10.1002/14651858.CD006211.pub3
Unutmaz GD, Soysal P, Tuven B, Isik AT. Cost of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging. 2018;13:607-13. https://doi.org/10.2147/CIA.S159966
Marventano S, Ayala A, Gonzalez N, Rodríguez-Blázquez C, Garcia-Gutierrez S, Forjaz MJ, et al. Multimorbidity and functional status in community-dwelling older adults. Eur J Intern Med. 2014;25(7):610-6. https://doi.org/10.1016/j.ejim.2014.06.018
Cheng L, Liu H, Zhang Y, Shen K, Zeng Y. The impact of health insurance on health outcomes and spending of the elderly: Seminar in National School of Development and Peking University. JEL Classification: I18, D04. 2012: 1-36. https://doi.org/10.2139/ssrn.2280202
Alzahrani SH, Alamri SH. Prevalence of malnutrition and associated factors among hospitalized elderly patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. BMC Geriatr. 2017;17(1):136. https://doi.org/10.1186/s12877-017-0527-z
Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-63. https://doi.org/10.1001/jama.2012.216476
Uchmanowicz I, Ku?nierz M, Wleklik M, Jankowska-Pola?ska B, Jaroch J, ?oboz-Grudzie? K. Frailty syndrome and rehospitalizations in elderly heart failure patients. Aging Clin Exp Res. 2018;30(6):617-23. https://doi.org/10.1007/s40520-017-0824-6
Ogbemudia E, Asekhame J. Rehospitalization for heart failure in elderly. Saudi Med J. 2016;37(10):1144-7. https://doi.org/10.15537/smj.2016.10.15259
Morandi A, Bellelli G, Vasilevskis EE, Turco R, Guerini F, Torpilliesi T, et al. Predictors of rehospitalization among elderly patients admitted to a rehabilitation hospital: the role of polypharmacy, functional status and length of stay. J Am Med Dir Assoc. 2014;14(10):761-7. https://doi.org/10.1016/j.jamda.2013.03.013
Greysen SR, Stijacic Cenzer I, Auerbach AD, Covinsky KE. Functional impairment and hospital readmission in Medicare seniors. JAMA Intern Med. 2015;175(4):559-65. https://doi.org/10.1001/jamainternmed.2014.7756
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