Data show unplanned health care utilization increases cost burden for patients with cognitive impairment

Researchers from Duke-NUS Medical School and the NUS Yong Loo Lin School of Medicine (NUS Medicine) used data from the population-based Singapore Chinese Health Study, and found that individuals with cognitive impairment spend on average 17%, or S$700, more per year on their health care bills than people of the same age without cognitive impairment.

Published in the journal Annals of the Academy of Medicine Singapore, the researchers highlight that these costs are primarily due to emergency department visits and subsequent admissions.

Health economist Assistant Professor Chay Junxing, from the Lien Center for Palliative Care at Duke-NUS, who led the study, said, "This is the first time that we have been able to quantify the additional health expenditures of patients living with cognitive impairment in Singapore. What we found is that the primary drivers of the burden are emergency department visits and subsequent admissions. With this understanding, we can identify strategies to reduce these admissions."

In 2019, about 44,000 individuals in Singapore were estimated to live with some form of cognitive impairment, with the number slated to rise as Singapore's population ages.

The Ministry of Health projected that the number of people living with dementia alone could rise to 152,000 people in 2030 and 187,000 in 2050. Solely considering these increases, this would translate into an estimated additional health care spending of S$106 million and S$131 million, respectively, in these years the researchers observed.

The study's projections highlight the need for new strategies to manage the increasing burden of unplanned health care use. Suggestions by the study's authors include proactive monitoring of those with cognitive impairment to reduce risk factors for high-cost medical events.

Senior author Professor Eric Finkelstein, Executive Director of the Lien Center for Palliative Care at Duke-NUS said, "Rising rates of cognitive impairment, coupled with Singapore's aging population, indicate that health care resources will be further strained in the future. Planners must be prepared for this burden to grow exponentially, with efforts made to identify at-risk patients and intervention before a crisis occurs."

The researchers also suggest working with partners in nursing homes and other care facilities to improve care for these individuals throughout the illness journey. This will result in both health and financial benefits.

The study also highlights that individuals with cognitive impairment tend to access emergency services more frequently. Previous studies have shown that common causes for emergency department visits among those with cognitive impairment include pneumonia, heart failure, urinary tract infections, and fall-related injuries.

These individuals are more prone to injuries and infections, have poorer treatment compliance, and face greater difficulties and lessened contact with post-discharge care, possibly contributing to higher emergency service utilization.

Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, said, "Understanding how our health care services are used provides important insights on how we can provide not only more cost-effective care but care that will provide better quality of life to patients.

"The findings from this study highlight a need for more services that can identify individuals at risk of cognitive impairment early and greater education of their caregivers to help them proactively manage the care of their loved ones."

Duke-NUS is committed to improving patient care through pioneering biomedical and health services and systems research. This study's insights will help pave the way for a more resilient and future-ready health care system that empowers people to lead healthier lives longer.