Evolution of the in-patient hospital expenditure for the elderly in Italy: 1996-2001 comparison

Hospital expenditure constitutes the main component of public health spending in Western countries. Among the elements most frequently indicated as a cause of the increase in expenditure is the aging of the population. All Italian hospitalizations of more than one day during the year 2001, involving persons over 65 years of age, were analyzed on the basis of the data gathered by the Ministry of Health, starting from the hospital discharge forms. A comparison between the same data gathered for the 1996 has been carried out. The analysis reveals the impact of both the aging of the population and the use of more expensive technology on the cost increase related to 30 most frequent diagnosis-related groups (DRG) reported from the hospital discharge form. The comparison highlight the relation between the level of the fee assigned to each DRG and the size of the percentage variation of cases between 2001 and 1996 expressed by a linear regression model (R(2)=0.45; p<0.001). The results of the study rise questions about the impact of several factors on the increase of hospitalization cost: notably the DRG-based payment system could affect negatively the cost of inpatient services if an outside supervision will not allow the needed correction.