Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data

Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical an...
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Autor*in:	Schulz, Maike [verfasserIn] Czwikla, Jonas Tsiasioti, Chrysanthi Schwinger, Antje Gand, Daniel Schmiemann, Guido Schmidt, Annika Wolf-Ostermann, Karin Kloep, Stephan Heinze, Franziska Rothgang, Heinz

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	Elderly Medical care Claims data Nursing homes Nursing home residents

Anmerkung:	© The Author(s). 2020

Übergeordnetes Werk:	Enthalten in: International journal for equity in health - London : BioMed Central, 2002, 19(2020), 1 vom: 07. Feb.
Übergeordnetes Werk:	volume:19 ; year:2020 ; number:1 ; day:07 ; month:02

Links:	Volltext

DOI / URN:	10.1186/s12939-020-1130-z

Katalog-ID:	SPR028719018

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520			\|a Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
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allfields	10.1186/s12939-020-1130-z doi (DE-627)SPR028719018 (SPR)s12939-020-1130-z-e DE-627 ger DE-627 rakwb eng Schulz, Maike verfasserin (orcid)0000-0001-7229-0914 aut Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. Elderly (dpeaa)DE-He213 Medical care (dpeaa)DE-He213 Claims data (dpeaa)DE-He213 Nursing homes (dpeaa)DE-He213 Nursing home residents (dpeaa)DE-He213 Czwikla, Jonas aut Tsiasioti, Chrysanthi aut Schwinger, Antje aut Gand, Daniel aut Schmiemann, Guido aut Schmidt, Annika aut Wolf-Ostermann, Karin aut Kloep, Stephan aut Heinze, Franziska aut Rothgang, Heinz aut Enthalten in International journal for equity in health London : BioMed Central, 2002 19(2020), 1 vom: 07. Feb. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:19 year:2020 number:1 day:07 month:02 https://dx.doi.org/10.1186/s12939-020-1130-z kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 19 2020 1 07 02
spelling	10.1186/s12939-020-1130-z doi (DE-627)SPR028719018 (SPR)s12939-020-1130-z-e DE-627 ger DE-627 rakwb eng Schulz, Maike verfasserin (orcid)0000-0001-7229-0914 aut Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. Elderly (dpeaa)DE-He213 Medical care (dpeaa)DE-He213 Claims data (dpeaa)DE-He213 Nursing homes (dpeaa)DE-He213 Nursing home residents (dpeaa)DE-He213 Czwikla, Jonas aut Tsiasioti, Chrysanthi aut Schwinger, Antje aut Gand, Daniel aut Schmiemann, Guido aut Schmidt, Annika aut Wolf-Ostermann, Karin aut Kloep, Stephan aut Heinze, Franziska aut Rothgang, Heinz aut Enthalten in International journal for equity in health London : BioMed Central, 2002 19(2020), 1 vom: 07. Feb. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:19 year:2020 number:1 day:07 month:02 https://dx.doi.org/10.1186/s12939-020-1130-z kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 19 2020 1 07 02
allfields_unstemmed	10.1186/s12939-020-1130-z doi (DE-627)SPR028719018 (SPR)s12939-020-1130-z-e DE-627 ger DE-627 rakwb eng Schulz, Maike verfasserin (orcid)0000-0001-7229-0914 aut Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. Elderly (dpeaa)DE-He213 Medical care (dpeaa)DE-He213 Claims data (dpeaa)DE-He213 Nursing homes (dpeaa)DE-He213 Nursing home residents (dpeaa)DE-He213 Czwikla, Jonas aut Tsiasioti, Chrysanthi aut Schwinger, Antje aut Gand, Daniel aut Schmiemann, Guido aut Schmidt, Annika aut Wolf-Ostermann, Karin aut Kloep, Stephan aut Heinze, Franziska aut Rothgang, Heinz aut Enthalten in International journal for equity in health London : BioMed Central, 2002 19(2020), 1 vom: 07. Feb. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:19 year:2020 number:1 day:07 month:02 https://dx.doi.org/10.1186/s12939-020-1130-z kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 19 2020 1 07 02
allfieldsGer	10.1186/s12939-020-1130-z doi (DE-627)SPR028719018 (SPR)s12939-020-1130-z-e DE-627 ger DE-627 rakwb eng Schulz, Maike verfasserin (orcid)0000-0001-7229-0914 aut Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. Elderly (dpeaa)DE-He213 Medical care (dpeaa)DE-He213 Claims data (dpeaa)DE-He213 Nursing homes (dpeaa)DE-He213 Nursing home residents (dpeaa)DE-He213 Czwikla, Jonas aut Tsiasioti, Chrysanthi aut Schwinger, Antje aut Gand, Daniel aut Schmiemann, Guido aut Schmidt, Annika aut Wolf-Ostermann, Karin aut Kloep, Stephan aut Heinze, Franziska aut Rothgang, Heinz aut Enthalten in International journal for equity in health London : BioMed Central, 2002 19(2020), 1 vom: 07. Feb. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:19 year:2020 number:1 day:07 month:02 https://dx.doi.org/10.1186/s12939-020-1130-z kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 19 2020 1 07 02
allfieldsSound	10.1186/s12939-020-1130-z doi (DE-627)SPR028719018 (SPR)s12939-020-1130-z-e DE-627 ger DE-627 rakwb eng Schulz, Maike verfasserin (orcid)0000-0001-7229-0914 aut Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. Elderly (dpeaa)DE-He213 Medical care (dpeaa)DE-He213 Claims data (dpeaa)DE-He213 Nursing homes (dpeaa)DE-He213 Nursing home residents (dpeaa)DE-He213 Czwikla, Jonas aut Tsiasioti, Chrysanthi aut Schwinger, Antje aut Gand, Daniel aut Schmiemann, Guido aut Schmidt, Annika aut Wolf-Ostermann, Karin aut Kloep, Stephan aut Heinze, Franziska aut Rothgang, Heinz aut Enthalten in International journal for equity in health London : BioMed Central, 2002 19(2020), 1 vom: 07. Feb. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:19 year:2020 number:1 day:07 month:02 https://dx.doi.org/10.1186/s12939-020-1130-z kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 19 2020 1 07 02
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Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. 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author	Schulz, Maike
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topic_title	Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data Elderly (dpeaa)DE-He213 Medical care (dpeaa)DE-He213 Claims data (dpeaa)DE-He213 Nursing homes (dpeaa)DE-He213 Nursing home residents (dpeaa)DE-He213
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title	Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data
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title_full	Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data
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author_browse	Schulz, Maike Czwikla, Jonas Tsiasioti, Chrysanthi Schwinger, Antje Gand, Daniel Schmiemann, Guido Schmidt, Annika Wolf-Ostermann, Karin Kloep, Stephan Heinze, Franziska Rothgang, Heinz
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title_sort	differences in medical specialist utilization among older people in need of long-term care – results from german health claims data
title_auth	Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data
abstract	Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. © The Author(s). 2020
abstractGer	Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. © The Author(s). 2020
abstract_unstemmed	Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care. © The Author(s). 2020
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title_short	Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data
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author2	Czwikla, Jonas Tsiasioti, Chrysanthi Schwinger, Antje Gand, Daniel Schmiemann, Guido Schmidt, Annika Wolf-Ostermann, Karin Kloep, Stephan Heinze, Franziska Rothgang, Heinz
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Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. 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Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data

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