title: Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study.
abstract: BACKGROUND
  The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs.
  
  
  METHODS
  A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures.
  
  
  RESULTS
  A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to the caregivers of elderly hospitalized in the geriatric unit. The final model showed that type of service and satisfaction had the largest coefficients (-0.68 and 0.662 respectively, p<0.001).
  
  
  CONCLUSIONS
  This study allowed us to identify associated factors of economic burden in elderly hospitalized in acute care units. It opens as well, an issue that should not be overlooked in framing public policies regarding elderly health care.
authors: Instituto Nacional de Geriatría, Periférico Sur 2767, Colonia San Jerónimo Lídice, Delegación Magdalena Contreras, México D.F, Mexico.
authors: Mariana
authors: M
authors: López-Ortega
authors: Carmen
authors: C
authors: García-Peña
authors: Víctor
authors: V
authors: Granados-García
authors: José Juan
authors: JJ
authors: García-González
authors: Mario Ulises
authors: MU
authors: Pérez-Zepeda
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005851:Geriatric Nursing / Q000191:economics; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged
references: J Cross Cult Gerontol. 2008 Sep;23(3):265-82
references: 18324460
references: J Gerontol A Biol Sci Med Sci. 2002 Mar;57(3):M162-7
references: 11867652
references: Health Policy. 2007 Oct;83(2-3):353-62
references: 17386957
references: Med Care. 2006 Mar;44(3):200-9
references: 16501390
references: Bull World Health Organ. 2010 Jun;88(6):402
references: 20539847
references: J Am Geriatr Soc. 1984 Jul;32(7):503-12
references: 6736515
references: Cad Saude Publica. 2008 Dec;24(12):2819-26
references: 19082272
references: Salud Publica Mex. 2007;49 Suppl 1:S70-87
references: 17469400
references: Arch Intern Med. 1996 Mar 25;156(6):645-52
references: 8629876
references: Gac Sanit. 2001 Nov-Dec;15(6):498-505
references: 11858784
references: Int J Health Plann Manage. 2008 Jan-Mar;23(1):37-49
references: 18000949
references: Pharmacoeconomics. 1996 Nov;10(5):460-6
references: 10172868
references: J Am Geriatr Soc. 2010 Jan;58(1):83-92
references: 20002509
references: Br Med Bull. 2005 Jan 31;71:45-59
references: 15684245
references: Nurs Res. 2011 May-Jun;60(3 Suppl):S28-37
references: 21543959
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Arch Gerontol Geriatr. 2012 May-Jun;54(3):e370-5
references: 21782258
references: Med Care. 2003 Jul;41(7 Suppl):III13-III23
references: 12865723
references: Crit Care Med. 1985 Oct;13(10):818-29
references: 3928249
references: CMAJ. 2004 Jun 8;170(12):1795-801
references: 15184333
references: Gac Med Mex. 2007 Mar-Apr;143(2):93-100
references: 17585695
references: J Am Geriatr Soc. 2004 May;52(5):809-13
references: 15086667
references: Salud Publica Mex. 2007 Jul-Aug;49(4):286-94
references: 17710277
references: Soc Sci Med. 2009 Jan;68(2):228-34
references: 19028415
references: J Health Econ. 1995 Jun;14(2):171-89
references: 10154656
references: Arch Gerontol Geriatr. 2009 Jul-Aug;49(1):e77-84
references: 18990459
references: Eval Program Plann. 1979;2(3):197-207
references: 10245370