Percentage of medical costs for the elderly

Elderly people are at the high stage of medical expenses. From the situation abroad, the medical cost of the elderly group accounts for more than 60% of the overall medical cost. As aging has become an international trend, the medical cost of the elderly population has become a major challenge for the medical insurance systems of various countries. The proportion of medical expenses of the elderly population in China's basic medical insurance also far exceeds that of other age groups. 2017 sampling data from the China Medical Insurance Research Society showed that the proportion of expenses for hospitalized medical expenses in basic medical insurance for the 60-69 year-old segment and the 70 year-old and above segment was as high as 23.7% and 29.6%, respectively, whereas the proportion of the population insured by the medical insurance for these two age groups was only 10.4% and 6.9%, respectively. 6.9%. Even including outpatient medical costs, the total cost of elderly people aged 60 and above accounted for nearly 50%, of which retired workers accounted for more than 70% of the cost.

With the deepening of China's aging, the proportion of elderly participants in employee health insurance and resident health insurance will be higher and higher, and the trend of using a large amount of health insurance funds for a small number of participants will become more and more obvious. So, what are the characteristics of the medical expenses of the elderly group compared with the non-elderly group, and whether there is a big difference in the flow of medical treatment between the elderly group and the non-elderly group.

In this paper, we use the non-elderly population (aged under 60) as a control, and describe the characteristics of the elderly population (aged 60 and above), which helps us to further understand the elderly population's consultation behavior and the flow of health insurance fund expenditure. In the sample selection, we analyzed the medical consultation situation of employees' medical insurance patients in a municipality directly under the central government, which is richer in medical resources and has greater pressure on the expenditure of the medical insurance fund.

Characteristics of medical costs of the elderly population

We ranked the outpatient and inpatient costs of elderly workers' medical insurance patients and non-elderly workers' medical insurance patients from small to large, and grouped the samples into five classes: low-cost group, lower-middle-cost group, middle-cost group, upper-middle-cost group, and high-cost group. Considering that there is a very small value of outpatient costs in the sample, which will have a greater impact on the average cost, we made a 5% exclusion.

The analysis found that, in the hospitalization medical expenditure of employees' health insurance patients, the average hospitalization cost of different cost groups of the elderly group is significantly higher than that of the non-elderly group, and on average, the elderly group is 1.51 times higher than that of the non-elderly group (51% higher on average). Among them, the low-cost group of the elderly population had an average hospitalization cost 2.37 times higher than that of the non-elderly population (137 per cent higher on average); the lower-middle-cost group was the next highest, with the former 1.65 times higher than the latter (65 per cent higher on average); and the high-cost group was the lowest, with the former 1.46 times higher than the latter (46 per cent higher on average). The difference tended to narrow as the costs got higher.

Similarly, in the outpatient medical expenditures of employees' health insurance patients, the average outpatient cost of the elderly group is 1.21 times higher than that of the non-elderly group (21% higher on average). Among them, in the lower-middle cost group and the middle cost group, the elderly group is 1.30 times higher than the non-elderly group (30% higher on average); followed by the upper-middle cost group, where the former is 1.25 times higher than the latter (25% higher on average); and in the low-cost group and the high-cost group, where the former is 1.16 times higher than the latter (16% higher on average). At higher costs, the gap between the two groups tended to widen and then narrow.

However, there is no significant difference in the proportion of total medical costs incurred by different cost groups between the elderly and non-elderly groups. As shown in Table 2, both the elderly and non-elderly high-cost groups account for more than 55% of the total hospitalization costs, and the total outpatient costs are also close to 55% or more than the proportion of other cost groups.

Table 1: Comparison of the average cost of medical treatment for employees' health insurance patients in different cost groups (yuan)

Table 2: Percentage of medical cost in different cost groups

Higher-level hospitals: the elderly group is lower than the non-elderly group

In terms of the flow of outpatient treatment, the elderly group chooses higher-level hospitals for treatment in a proportion slightly lower than that of non-elderly group. Among them, 47% of the elderly group went to tertiary hospitals and 16.5% went to secondary hospitals, totaling 63.5%, while 54.8% of the non-elderly group went to tertiary hospitals and 18.1% went to secondary hospitals, totaling 72.9%. However, the proportion of the elderly group choosing to go to the community and townships was significantly higher than that of the non-elderly group, with 27.6% for the former and 18.8% for the latter.

In terms of the outpatient flow of different cost groups, both the high-cost group and the low-cost group have the highest proportion of visits to tertiary hospitals for both the elderly and the non-elderly, while the proportion of visits to the community and townships is the lowest. However, the proportion of the lower middle cost group and the middle cost group of the elderly group choosing to go to the community and townships reached 36.8% and 34.8%, which was higher than that of the non-elderly group and significantly higher than that of other cost groups.

Figure 1: Outpatient flow of the elderly and non-elderly in different cost groups

The flow of hospitalization is similar to that of outpatient care. The proportion of the elderly group going to tertiary hospitals is 76.7%, and the proportion of the elderly group going to secondary hospitals is 18.3%, both totaling 95%; the proportion of the non-elderly group going to tertiary hospitals is 79.1%, and the proportion of the non-elderly group going to secondary hospitals is 17.7%, both totaling 96.8%.

From the point of view of the flow of hospitalization of different cost groups, both the elderly and non-elderly high-cost group chose tertiary hospitals with the highest proportion, as high as 85.6% and 86.3%, respectively, while the proportion of other cost groups going to tertiary hospitals is also above 70%.

Figure 2: Flow of hospitalization for the elderly and non-elderly in different cost groups

Average hospitalization days: about 4 days higher for the elderly than for the non-elderly

Overall, the number of hospitalization days for the elderly is higher than that for the non-elderly, with an average of about 4 days higher. Among them, the upper middle cost group had the largest difference in hospitalization days, about 5.9 days; the high cost group had the second largest difference, 4.4 days; and the low cost group had the smallest difference, 1.7 days.

In terms of the proportion of total hospitalization days in different cost groups, the proportion of total hospitalization days in the high-cost group and the upper-middle-cost group was the highest in the elderly population, with a combined total of 61%, while in the non-elderly population, the proportion was 63.1%.

Figure 3: The average hospitalization days of the elderly and non-elderly groups (days)

Figure 4: The ratio of the total hospitalization days of the elderly and non-elderly groups in different cost groups (days)

Conclusion and Reflection

Summarizing the above analysis, we find that the medical cost and hospitalization days of the elderly group are much higher than those of the non-elderly group, which is one of the main reasons why the medical cost of China's elderly population accounts for a much higher proportion than that of the rest of the age population. This is also one of the main reasons why the proportion of medical costs of the elderly population in China is much higher than that of other age groups. However, from the perspective of medical cost generation, compared with the non-elderly population, the outpatient flow of the elderly population is more reasonable, the proportion of the elderly population going to high-grade hospitals is even lower than that of the former, while the proportion of the elderly population going to the community and townships is higher than that of the former.

The logic behind this is that most of the elderly in the employee health insurance patients are retired workers, and with a higher level of treatment and security, their health investment and medical consumption ability are higher, and the change in the disease spectrum also contributes to a certain extent to the high frequency of medical care and the diversity of choices of medical care for the elderly. At the same time, the hierarchical diagnosis and treatment system and outpatient coordination system (with a high ceiling) in this sample area also meet the outpatient needs of the elderly, who mostly suffer from common diseases and frequent illnesses, and the function of "outpatient pharmacy" in the community and townships has a certain degree of attraction compared with that of high-level hospitals. However, in the case of high-quality medical resources are still gathered in high-grade hospitals, employee health insurance patients in the non-elderly group due to the higher cost of time, information search cost is also higher, whether it is outpatient or hospitalization to high-grade hospitals are gathered has been a common phenomenon, especially in the economically developed regions rich in medical resources.

But from the hospitalization flow, obviously not from the point of view of the convenience of medical care to explain. Compared with outpatient services, hospitalization services provided by different levels of medical institutions is not difficult to achieve standardization (or similar service content), but there are significant differences in the quality of service. This difference in service quality is essentially determined by the level of the hospital. For example, high-grade hospitals have more famous specialists, better physician resources, better examination equipment, more types of drugs, etc. In the free choice, it is difficult to standardize the service quality. Under free choice, it is difficult to control patients' pursuit of better medical services (high-grade hospitals), and even differential health insurance reimbursement policies are difficult to change this trend of agglomeration. In fact, the "siphoning effect" of high-grade hospitals on patients has become a common phenomenon across the country.

This brings us to the following thinking: with the basic health insurance coverage and treatment level, on the one hand, the overall health care resources are more abundant in the region, the tendency to high-grade hospitals will not be changed in a short period of time, on the health insurance fund expenditure has brought a greater challenge. On the other hand, due to the slowdown in population mobility, increasing downward pressure on the economy, and the aging of the population, the income of the basic medical insurance fund is facing more uncertainty. How to effectively utilize the basic medical insurance fund to protect the growing demand for medical services is a problem that the medical insurance system will have to face in the long run.