Drug overprescription in nursing homes: an empirical evaluation of administrative data

Abstract

A widely discussed shortcoming of long-term care in nursing homes for the elderly is the inappropriate or suboptimal drug utilization, particularly of psychotropic drugs. Using administrative data from the largest sickness fund in Germany, this study was designed to estimate the effect of institutionalization on the drug intake of the frail elderly. Difference-in-differences propensity score matching techniques were used to compare drug prescriptions for the frail elderly who entered a nursing home with those who remained in the outpatient care system; findings suggest that nursing home residents receive more doses of antipsychotics, antidepressants, and analgesics. The potential overprescription correlates with estimated drug costs of about €87 million per year.

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Notes

  1. 1.

    German nursing homes do not carry the costs for medication, as they are paid for by the health insurance fund or by patients themselves.

  2. 2.

    In an average German nursing home, 23 physicians and nurses provide input into the need for medical checkups in roughly 86 % of all cases and in 72 % of cases choose the respective physician [7].

  3. 3.

    In Germany, care recipients are classified into three care levels by the Medical Review Board of the Statutory Health Insurance Funds. While care level 1 goes along with nursing needs of, on average, at least 90 min per day, care level 2 includes, on average, at least 180 min of daily nursing needs. Care level 3 is the highest and stands for, on average, more than 300 min of daily care.

  4. 4.

    A data set on admissions to nursing homes of frail elderly insured by the TK provides evidence that the number is equally distributed over all months of a year. However, the data set on admissions and the underlying data set used for this study cannot be merged due to data privacy protection reasons.

  5. 5.

    However, the results are robust to not trimming the data. The respective regression results are available from the author upon request.

  6. 6.

    Results refer to marginal effects that are not presented in addition to the coefficients for the cause of brevity.

  7. 7.

    This matching assigns the five closest control group observations to any treatment group observation.

  8. 8.

    Results are available upon request.

  9. 9.

    This information (as well as the other information on prices for DDDs of certain drugs) is obtained from the underlying data set for the year 2009.

  10. 10.

    Calculations. Antipsychotics: €4.36/DDD × 717,490 dependent persons in nursing homes × 12.72 effect from NN with Repl.; antidepressants: €0.74/DDD × 717,490 dependent persons in nursing homes × 23.88 effect from NN with Repl.; analgesics: €2.00/DDD × 717,490 dependent persons in nursing homes × 24.29 effect from NN with Repl.

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Acknowledgments

Helpful comments by Thomas Bauer, Hendrik Schmitz, and participants of the Annual Meeting of the DDGÖ (Bayreuth) are gratefully acknowledged. I am grateful to my colleagues from the WINEG for access to data of the Techniker Krankenkasse and to the German Research Foundation (DFG) for the financial support.

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Correspondence to Magdalena A. Stroka.

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Stroka, M.A. Drug overprescription in nursing homes: an empirical evaluation of administrative data. Eur J Health Econ 17, 257–267 (2016). https://doi.org/10.1007/s10198-015-0676-y

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Keywords

  • Medication errors
  • Patient safety
  • Expenditures
  • Drug over- and undersupply
  • Medical costs

JEL Classification

  • I10