title: Increased health service utilization costs in the year prior to institutionalization: findings from the canadian study of health and aging.
abstract: OBJECTIVE
  The objective of this study was to characterize patterns of formal health service utilization costs during older adults' transition from community to institutional care.
  
  
  METHODS
  Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6-12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6-12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive.
  
  
  RESULTS
  Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6-12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6-12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs.
  
  
  CONCLUSIONS
  The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA;
authors.forename: John A
authors.initials: JA
authors.lastname: Naslund
authors.affiliation: University of British Columbia Okanagan, Kelowna, BC, Canada;
authors.forename: Agnes H
authors.initials: AH
authors.lastname: Sauter
authors.affiliation: Gerontology Research Center, Simon Fraser University Vancouver Campus, Vancouver, BC, Canada;
authors.forename: Gloria
authors.initials: G
authors.lastname: Gutman
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: B Lynn
authors.initials: BL
authors.lastname: Beattie
keywords: elderly; health service utilization; health-care costs; institutionalization; long-term care; nursing home; transitions