title: [An analysis of medical expenses of outpatient service for the elderly at one health insurance society in Fukuoka prefecture--focused on medical service and concentration of medical expenses].
abstract: To determine the best way to reduce medical expenses of the elderly, we analyzed the aged outpatients' receipts covered by the Health and Medical Service Law for the Aged at one health insurance society in Fukuoka prefecture. We used 312 medical receipts during July, 1997. The proportion of frequency of each medical service was 89.7% for medications, 45.8% for laboratory tests and 26.3% for procedures. The proportion of expenses of each medical service was 38.3% for medications, 20.0% for examinations and 12.1% for laboratory tests. Medication is considered as one of the main causes of increasing medical expenses. As a result of multiple regression analysis, the number of consulting days, urinary and genital disorder, the number of diseases, home care, laboratory tests and prescriptions for outside pharmacies were detected as statistically significant factors associated with medical expenses. There was a concentration of medical expenses, i.e. about 10% of higher rank receipts consumed around 40% of total outpatients' expenses and included 6 of 10 home medical care receipts. One of the causes of expensive outpatients' medical expenses was medication. The separation of dispensary and prescription of drugs does not contribute to the reduction of medical expenses. In the higher rank of the expenses group, compared with the lower rank of the expenses group, the consultation days were longer, the number of diseases was greater and the proportions of expenses for procedures and home care were larger. Medical expenditures for patients receiving home medical care were higher than those of others, but home care should be compared with admissions. Because the insurance societies are now facing financial difficulties in Japan, analyzing the data of medical receipts is very important. During our analysis, we had to make an enormous effort to combine two data sources, because the receipts were made separately by clinics and pharmacies. It is strongly suggested that a computerized information system with a standardized format for clinics and pharmacies be developed.
authors.affiliation: Department of Preventive Medicine and Community of Health, School of Medicine, University of Occupational and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Homan
authors.forename: S
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D000368:Aged; D011307:Drug Prescriptions / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007564:Japan; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D012044:Regression Analysis