RUHR ECONOMIC PAPERS Magdalena A. Stroka Drug Oversupply in Nursing Homes An Empirical Evaluation of Administrative Data #475
Imprint Ruhr Economic Papers Published by Ruhr-Universität Bochum (RUB), Department of Economics Universitätsstr. 150, 44801 Bochum, Germany Technische Universität Dortmund, Department of Economic and Social Sciences Vogelpothsweg 87, 44227 Dortmund, Germany Universität Duisburg-Essen, Department of Economics Universitätsstr. 12, 45117 Essen, Germany Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI) Hohenzollernstr. 1-3, 45128 Essen, Germany Editors Prof. Dr. Thomas K. Bauer RUB, Department of Economics, Empirical Economics Phone: +49 (0) 234/3 22 83 41, e-mail: thomas.bauer@rub.de Prof. Dr. Wolfgang Leininger Technische Universität Dortmund, Department of Economic and Social Sciences Economics Microeconomics Phone: +49 (0) 231/7 55-3297, email: W.Leininger@wiso.uni-dortmund.de Prof. Dr. Volker Clausen University of Duisburg-Essen, Department of Economics International Economics Phone: +49 (0) 201/1 83-3655, e-mail: vclausen@vwl.uni-due.de Prof. Dr. Christoph M. Schmidt RWI, Phone: +49 (0) 201/81 49-227, e-mail: christoph.schmidt@rwi-essen.de Editorial Office Sabine Weiler RWI, Phone: +49 (0) 201/81 49-213, e-mail: sabine.weiler@rwi-essen.de Ruhr Economic Papers #475 Responsible Editor: Thomas K. Bauer All rights reserved. Bochum, Dortmund, Duisburg, Essen, Germany, 2014 ISSN 1864-4872 (online) ISBN 978-3-86788-537-9 The working papers published in the Series constitute work in progress circulated to stimulate discussion and critical comments. Views expressed represent exclusively the authors own opinions and do not necessarily reflect those of the editors.
Ruhr Economic Papers #475 Magdalena A. Stroka Drug Oversupply in Nursing Homes An Empirical Evaluation of Administrative Data
Bibliografische Informationen der Deutschen Nationalbibliothek Die Deutsche Bibliothek verzeichnet diese Publikation in der deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über: http://dnb.d-nb.de abrufbar. http://dx.doi.org/10.4419/86788537 ISSN 1864-4872 (online) ISBN 978-3-86788-537-9
Magdalena A. Stroka 1 Drug Oversupply in Nursing Homes An Empirical Evaluation of Administrative Data Abstract A widely discussed shortcoming of long-term care in nursing homes for elderly is the inappropriate or suboptimal drug utilization, in particular the utilization of psychotropic drugs. This paper estimates the effect of institutionalization on the drug intake of frail elderly using administrative data from the largest sickness fund in Germany. Difference-in-differences propensity score matching techniques are used to compare drug prescriptions of frail elderly who entered a nursing home with those who remained in the out-patient care system. The findings suggest that nursing home inhabitants receive more doses of antipsychotics, antidepressants and analgesics. The potential oversupply goes along with estimated drug costs of about 87 million per year. JEL Classification: I10 Keywords: Medication errors; patient safety; expenditures; drug over- and undersupply; medical costs February 2014 1 RUB, RWI, WINEG - Scientific Institute of TK for Benefit and Efficiency in Health Care. - Helpful comments by Thomas Bauer, Hendrik Schmitz, and participants of the Annual Meeting of the dggö (Bayreuth) are gratefully acknowledged. I am grateful to my colleagues from the WINEG for the access to the data of the Techniker Krankenkasse and to the German Research Foundation (DFG) for the financial support. All correspondence to: Magdalena A. Stroka, RUB, Universitätsstr. 150, 44801 Bochum, Germany, e-mail: Magdalena.Stroka@rub.de
1 IntroductionandLiteratureReview 1 4
2 5
6
2 EmpiricalStrategyandData 2.1 Matching 7
8
(1) 2.2 Data 9
2.2.1OutcomeVariables 2.2.2TreatmentandControlGroup 3 10
FigureIabouthere. 2.2.3DescriptiveStatisticsandthePropensityScore 11
TableIabouthere. 2.3 MatchingAlgorithms 5 6 12
3 MatchingQuality FigureIIabouthere. TableIIabouthere 13
4 Results TableIIIabouthere. 14
TableIVabouthere. 15
TableVabouthere. 5 Discussion 16
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Figures Beforetreatment Treatmentandcontrol group Treatment Treatmentgroup: Controlgroup: Aftertreatment Treatmentgroup: Controlgroup: FigureI: 0.2.4.6 Propensity Score Untreated Treated: Off support Treated: On support FigureII: 18
Tables TableI Means Difference PropensityScore Logit Variable Individualcharacteristics Pretreatmentcaredependency Pretreatmenthealthstatus Pretreatmentmedication[DDDsperyear] Notes: 19
TableII: Variable Idividualcharacteristics Pretreatmentcaredependency Pretreatmenthealthstatus Pretreatmentmedication Notes: 20
TableIII: Variable Means ATT Notes: 21
TableIV: Variable PCriticalat: Notes: 22
TableV: Effects Variable Notes: 23
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