Home and Community Care Digest
Injury Prevention Programs for the Frail Elderly: Do they yield substantial cost savings for acute and community care sectors?
Method: Estimates of Medicare (US government health care program for the elderly) spending for injuries in 1999 on all paid claims were based on a 5% sample of Medicare beneficiaries who were at least 65 years of age. Paid claims were obtained from Medicare's institutional claims files (inpatient, skilled nursing facility, hospice, home health and outpatient) and professional services/supplies claims files (physician/supplier and durable medical equipment). Only claims with a principal injury diagnosis were included.
Findings: In 1999, injury care claims for aged beneficiaries cost Medicare $8 billion which was approximately 6% of total Medicare claims spending for the elderly. During the study period, over one-fifth of aged Medicare beneficiaries (6 million people) filed at least one injury claim. The average expenditure for such beneficiaries was $1,272 and increased with age, with the spending for female beneficiaries increasing more sharply with age than for men. Fractures were the most costly injury category ($5.5 billion), representing 67% of all injury claims and 1.8 million people. The second largest category was open wounds, followed by internal injuries. Fractures were more common among women and open wounds were more common among men. Women also had higher average spending for fractures than men, attributable in part to women's disproportionate number of expensive lower extremity fractures. Men had higher average spending than women for internal injuries, burns, nerve injuries and blood vessel injuries.
Conclusions: Injuries in persons over the age of 65 lead to substantial use of health care services. Other costs not included in the study were: (a) long-term disability associated with injury, and (b) private costs born by the injured recipient, his/her family and private insurance companies. These costs could potentially be offset with implementation of injury prevention interventions. Prevention strategies, such as home assessment and modifications, protective devices that mitigate falls, smoke alarms or safer nightwear to reduce burn injuries have been developed by gerontologists and other practitioners. Targeting these strategies to particular populations may provide cost savings for the health sector. A barrier to implementation is that these strategies are largely dependent on funds from other sectors, which may not be directly responsible for the consequences of injury.
Reference: Christine E. Bishop, Daniel Gilden, Jacobus Blom, Joanna Kubisiak, Rosemarie Hakim, Angelina Lee, and Deborah W. Garnick, Medicare Spending For Injured Elders: Are There Opportunities For Savings? Health Affairs, 2003; 54: 215-223.
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