JMIR Publications

ABSTRACT

Background:

In recent years, German long-term care (LTC) insurance has experienced an unprecedented increase in the number of beneficiaries. This raises the question of the role of healthcare in preventing or delaying the need for LTC. At present, related findings are limited. Addressing this research gap could promote longevity and improve quality of life, while reducing financial strain on the social security system.

Objective:

The aim of this study was to investigate associations between the utilization of healthcare services and first-time LTC need.

Methods:

This retrospective cohort study examined nationwide linked claims data from the German statutory health and LTC insurance fund AOK. The dataset included all individuals aged 60 years and older. Using multiple logistic regression, we investigated the association between healthcare utilization during the five-year exposure period from 2016 to 2020 and the occurrence of first-time LTC need during the first quarter of 2021. Physician care, pharmaceutical care, physiotherapy, and medical aids were analyzed while adjusting for age, gender, regional variables, and comorbidities. Metrically scaled variables were categorized using the Fisher-Jenks algorithm to explore possible non-linearities. Individuals who needed LTC prior to 2021 were excluded.

Results:

The study population comprised 5.7 million individuals. 54.3% were female and the mean age was 71.3 (standard deviation 8.16). Receiving more than two of the five recommended screenings and vaccinations examined compared to none was associated with a strong reduction in odds of first-time LTC need (odds ratio [OR] 0.62, 95% CI 0.60–0.64, P<.001). Odds of first-time LTC need were also significantly lower with low utilization levels of specialist physician care (fewer than five specialist groups consulted and fewer than 48 billing days) relative to none (OR 0.82, 95% CI 0.79–0.85, P<.001). Likewise, a physiotherapy prescription in between five and ten quarters of the five-year period instead of none was related to lower odds of first-time LTC need (OR 0.81, 95% CI 0.79–0.83, P<.001). Generalist care, hospitalizations, polypharmacy and potentially inadequate medication were concomitant with first-time LTC need. Among the disease management programs and medical aids examined, there were both positive and negative relationships with first-time LTC need.

Conclusions:

Utilization of recommended screenings, vaccinations, specialist physician care, and physiotherapy is substantially and significantly associated with the non-occurrence of first-time LTC need in the older German population. Our study provides a foundation for future research on orienting healthcare towards preventing functional decline.