title: Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization.
abstract: BACKGROUND
  To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population.
  
  
  METHODS
  Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models.
  
  
  RESULTS
  Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs.
  
  
  CONCLUSIONS
  Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
authors: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany. d.heider@uke.de.
authors: Dirk
authors: D
authors: Heider
authors: Herbert
authors: H
authors: Matschinger
authors: Heiko
authors: H
authors: Müller
authors: Kai-Uwe
authors: KU
authors: Saum
authors: Renate
authors: R
authors: Quinzler
authors: Walter Emil
authors: WE
authors: Haefeli
authors: Beate
authors: B
authors: Wild
authors: Thomas
authors: T
authors: Lehnert
authors: Hermann
authors: H
authors: Brenner
authors: Hans-Helmut
authors: HH
authors: König
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological