The impact of self-rated health on medical care utilization for older people with depressive symptoms.
OBJECTIVE
To test the hypothesis whether self-rated health alone can explain the relationship between depression and medical care utilization for the older people and to determine whether the explanatory power of self-rated health is greater than that of the explanatory power of a major disease and activities of daily living.


METHODS
This study used the data from 1572 older people obtained from the 2005 National Health Interview Survey in Taiwan. The data from the National Health Interview Survey were linked to the 2005 computerized claims data from the National Health Insurance, and from that, the outpatient expenditures and number of outpatient episodes were identified. The contribution of self-rated health, activities of daily living, the presence of major diseases, and self-rated health were estimated using ordinary least squares regressions.


RESULTS
Controlling for self-rated health alone almost eliminates the positive relationship between depressive symptoms and number of outpatient visits. After controlling for self-rated health, the utilization ratio of outpatient visits for older people with depressive symptoms reduced significantly to only 1.01 and became insignificant. A similar pattern was observed for total outpatient costs.


CONCLUSIONS
It was found that self-rated health is an important factor in the depressive symptoms-outpatient utilization relationship. To reduce medical costs for older people with depressive symptoms, it is essential that the self-rated health for this group is improved. Future studies should test the mechanism through which self-rated health impacts on medical utilization for older people with depressive symptoms.
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
Christy
C
Pu
Ya-Mei
YM
Bai
Yiing-Jenq
YJ
Chou
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D059026:Diagnostic Self Evaluation; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D013624:Taiwan