Health services research. Determinants of health service use and expenditure among the elderly Finnish population

Background: There is a need to identify significant determinants of physician and public health nurse visits, hospital in-patient and home care, use of prescribed medication and total expenditure among elderly people for planning of health policy. Methods: The data were obtained from three annual computer-assisted telephone interview surveys in 1992-1994. Each year a systematic sample of approximately 2,300 non-institutionalized people aged 25-79 years were interviewed. The 60-79 year old respondents were Included In our analysis (n=l,707); the response rates in this age group were approximately 75% each year. In this study we tested the suitability of four regression models: Poisson, negative binomial, log it plus zero-truncated Poisson and logit plus zero-truncated negative binomial. Results: The use of services increased with age, particularly hospital in-patient and home care. Although women were more likely to use services, particularly primary care, their share of total expenditure was lower than that for men. Significant predictors of higher expenditure were own personal doctor, other specific doctor, perceived health status, psychosomatic symptoms, chronic illness and difficulties in functional ability. Those living alone had significantly higher expenditures. Conclusion: It emerged that, while a large number of elderly people had used services, only a small minority had accounted for the majority of expenditure. Although the personal doctor system may produce high quality of care, It cannot achieve cost savings.