Skip to main content
Erschienen in: The European Journal of Health Economics 8/2014

01.11.2014 | Original Paper

Population ageing and healthcare expenditure projections: new evidence from a time to death approach

verfasst von: Claudia Geue, Andrew Briggs, James Lewsey, Paula Lorgelly

Erschienen in: The European Journal of Health Economics | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Health care expenditure (HCE) is not distributed evenly over a person’s life course. How much is spent on the elderly is important as they are a population group that is increasing in size. However other factors, such as death-related costs that are known to be high, need be considered as well in any expenditure projections and budget planning decisions.

Objective

This article analyses, for the first time in Scotland, how expenditure projections for acute inpatient care are influenced when applying two different analytical approaches: (1) accounting for healthcare (HC) spending at the end of life and (2) accounting for demographic changes only. The association between socioeconomic status and HC utilisation and costs at the end of life is also estimated.

Methods

A representative, longitudinal data set is used. Survival analysis is employed to allow inclusion of surviving sample members. Cost estimates are derived from a two-part regression model. Future population estimates were obtained for both methods and multiplied separately by cost estimates.

Results

Time to death (TTD), age at death and the interaction between these two have a significant effect on HC costs. As individuals approach death, those living in more deprived areas are less likely to be hospitalised than those individuals living in the more affluent areas, although this does not translate into incurring statistically significant higher costs. Projected HCE for acute inpatient care for the year 2028 was approximately 7 % higher under the demographic approach as compared to a TTD approach.

Conclusion

The analysis showed that if death is postponed into older ages, HCE (and HC budgets) would not increase to the same extent if these factors were ignored. Such factors would be ignored if the population that is in their last year(s) of life were not taken into consideration when obtaining cost estimates.
Fußnoten
1
SMR01 has episode-based patient records that relate to all acute inpatient and day cases. A record is generated when a patient completes an episode of inpatient or day case care and episodes are summarised into ‘Continuous Inpatient Stays’, CIS.
 
2
An initial exploration of the data showed that costs increased markedly in the last two quarters of life. Exploratory regression analysis determined when TTD became an insignificant predictor for costs. It was therefore decided to analyse the last 5 years of life, measured in quarters to provide variance for the analysis. Quarters have also been used in previous studies [4, 5].
 
3
Since population estimates are only available until 2033 and since it is required for the TTD approach to be able to calculate the proportion of the population in year 1 to 5 before death, the last estimate can be obtained for the year 2028.
 
Literatur
1.
Zurück zum Zitat Payne, G., Laporte, A., Deber, R., Coyte, P.C.: Counting backward to health care’s future: using time-to-death modelling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures. Milbank Q. 85(2), 213–257 (2007)PubMedCrossRefPubMedCentral Payne, G., Laporte, A., Deber, R., Coyte, P.C.: Counting backward to health care’s future: using time-to-death modelling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures. Milbank Q. 85(2), 213–257 (2007)PubMedCrossRefPubMedCentral
2.
Zurück zum Zitat Zweifel, P., Felder, S., Meiers, M.: Ageing of population and health care expenditure: a red herring? Health Econ. 8(6), 485–496 (1999)PubMedCrossRef Zweifel, P., Felder, S., Meiers, M.: Ageing of population and health care expenditure: a red herring? Health Econ. 8(6), 485–496 (1999)PubMedCrossRef
3.
Zurück zum Zitat Zweifel, P., Felder, S., Werblow, A.: Population ageing and health care expenditure: new evidence on the ‘red herring’. Geneva Pap. Risk Insur. 29(4), 652–666 (2004)CrossRef Zweifel, P., Felder, S., Werblow, A.: Population ageing and health care expenditure: new evidence on the ‘red herring’. Geneva Pap. Risk Insur. 29(4), 652–666 (2004)CrossRef
4.
Zurück zum Zitat Seshamani, M., Gray, A.M.: Ageing and health-care expenditure: the red herring argument revisited. Health Econ. 13(4), 303–314 (2004)PubMedCrossRef Seshamani, M., Gray, A.M.: Ageing and health-care expenditure: the red herring argument revisited. Health Econ. 13(4), 303–314 (2004)PubMedCrossRef
5.
Zurück zum Zitat Seshamani, M., Gray, A.: Time to death and health expenditure: an improved model for the impact of demographic change on health care costs. Age Ageing 33(6), 556–561 (2004)PubMedCrossRef Seshamani, M., Gray, A.: Time to death and health expenditure: an improved model for the impact of demographic change on health care costs. Age Ageing 33(6), 556–561 (2004)PubMedCrossRef
6.
Zurück zum Zitat Breyer, F., Lorenz, N., Niebel, T.: Health care expenditures and longevity: is there a Eubie Blake effect? Discussion Paper 1226, DIW Berlin (2012) Breyer, F., Lorenz, N., Niebel, T.: Health care expenditures and longevity: is there a Eubie Blake effect? Discussion Paper 1226, DIW Berlin (2012)
7.
Zurück zum Zitat Moorin, R.E., Holman, C.D.: The cost of in-patient care in Western Australia in the last years of life: a population-based data linkage study. Health Policy 85(3), 380–390 (2008)PubMedCrossRef Moorin, R.E., Holman, C.D.: The cost of in-patient care in Western Australia in the last years of life: a population-based data linkage study. Health Policy 85(3), 380–390 (2008)PubMedCrossRef
8.
Zurück zum Zitat Moorin, R., Gibson, D., Holman, D., Hendrie, D.: The contribution of age and time-to-death on health care expenditure for out-of-hospital services. J. Health Serv. Res. Policy 17(4), 197–205 (2012)PubMedCrossRef Moorin, R., Gibson, D., Holman, D., Hendrie, D.: The contribution of age and time-to-death on health care expenditure for out-of-hospital services. J. Health Serv. Res. Policy 17(4), 197–205 (2012)PubMedCrossRef
9.
Zurück zum Zitat McGrail, K., Green, B., Barer, M.L., Evans, R.G., Hertzman, C., Normand, C.: Age, costs of acute and long-term care and proximity to death: evidence for 1987–88 and 1994–95 in British Columbia. Age Ageing 29(3), 249–253 (2000)PubMedCrossRef McGrail, K., Green, B., Barer, M.L., Evans, R.G., Hertzman, C., Normand, C.: Age, costs of acute and long-term care and proximity to death: evidence for 1987–88 and 1994–95 in British Columbia. Age Ageing 29(3), 249–253 (2000)PubMedCrossRef
10.
Zurück zum Zitat Baal, P.H., Wong, A.: Time to death and the forecasting of macro-level healthcare expenditures: some further considerations. J. Health Econ. 31(2012), 876–887 (2012)PubMedCrossRef Baal, P.H., Wong, A.: Time to death and the forecasting of macro-level healthcare expenditures: some further considerations. J. Health Econ. 31(2012), 876–887 (2012)PubMedCrossRef
11.
Zurück zum Zitat Cookson, R., Laudicella, M.: Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008. Soc. Sci. Med. 72(2), 173–184 (2011)PubMedCrossRef Cookson, R., Laudicella, M.: Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008. Soc. Sci. Med. 72(2), 173–184 (2011)PubMedCrossRef
13.
Zurück zum Zitat Graham, B., Normand, C.: Proximity to death and acute health care utilisation in Scotland. Final Report, Chief Scientist Office (2001) Graham, B., Normand, C.: Proximity to death and acute health care utilisation in Scotland. Final Report, Chief Scientist Office (2001)
14.
Zurück zum Zitat Hattersley, L., Boyle, P: The Scottish longitudinal study. An introduction. LSCS working paper 1.0. Edinburgh/St Andrews, Longitudinal Studies Centre Scotland (2007) Hattersley, L., Boyle, P: The Scottish longitudinal study. An introduction. LSCS working paper 1.0. Edinburgh/St Andrews, Longitudinal Studies Centre Scotland (2007)
15.
Zurück zum Zitat Hattersley, L., Raab, G., Boyle, P.: The Scottish longitudinal study. Tracing rates and sample quality for the 1991 census SLS sample. LSCS Working Paper 2.0. Edinburgh/St Andrews: Longitudinal Studies Centre Scotland (2007) Hattersley, L., Raab, G., Boyle, P.: The Scottish longitudinal study. Tracing rates and sample quality for the 1991 census SLS sample. LSCS Working Paper 2.0. Edinburgh/St Andrews: Longitudinal Studies Centre Scotland (2007)
16.
Zurück zum Zitat Hattersley, L., Boyle, P.: The Scottish longitudinal study, a technical guide to the creation, quality and linkage of the 2001 census SLS sample. LSCS working paper 3.0. Edinburgh/St Andrews, Longitudinal Studies Centre Scotland (2009) Hattersley, L., Boyle, P.: The Scottish longitudinal study, a technical guide to the creation, quality and linkage of the 2001 census SLS sample. LSCS working paper 3.0. Edinburgh/St Andrews, Longitudinal Studies Centre Scotland (2009)
17.
Zurück zum Zitat Hattersley, L., Boyle, P.: The Scottish longitudinal study, The 1991–2001 Scottish longitudinal study census link. LSCS Working paper 4.0. Edinburgh/St Andrews, Longitudinal Studies Centre Scotland (2009) Hattersley, L., Boyle, P.: The Scottish longitudinal study, The 1991–2001 Scottish longitudinal study census link. LSCS Working paper 4.0. Edinburgh/St Andrews, Longitudinal Studies Centre Scotland (2009)
18.
Zurück zum Zitat Geue, C., Lewsey, J., Lorgelly, P., Govan, L., Hart, C., Briggs, A.: Spoilt for choice: implications of using alternative methods of costing hospital episode statistics. Health Econ. 21(10), 1201–1216 (2012)PubMedCrossRef Geue, C., Lewsey, J., Lorgelly, P., Govan, L., Hart, C., Briggs, A.: Spoilt for choice: implications of using alternative methods of costing hospital episode statistics. Health Econ. 21(10), 1201–1216 (2012)PubMedCrossRef
19.
Zurück zum Zitat Cleves, M., Gould, W., Gutierrez, R., Marchenko, Y.: An introduction to survival analysis using STATA, 2nd edn. STATA Press, College Station (2008) Cleves, M., Gould, W., Gutierrez, R., Marchenko, Y.: An introduction to survival analysis using STATA, 2nd edn. STATA Press, College Station (2008)
21.
Zurück zum Zitat Pregibon, D.: Goodness of link tests for generalized linear models. Appl. Stat. 29, 15 (1980)CrossRef Pregibon, D.: Goodness of link tests for generalized linear models. Appl. Stat. 29, 15 (1980)CrossRef
22.
Zurück zum Zitat Pearson, E.S., Please, N.W.: Relation between the shape of population distribution and the robustness of four simple test statistics. Biometrika 62, 223–241 (1975)CrossRef Pearson, E.S., Please, N.W.: Relation between the shape of population distribution and the robustness of four simple test statistics. Biometrika 62, 223–241 (1975)CrossRef
23.
Zurück zum Zitat Stearns, S.C., Norton, E.C.: Time to include time to death? The future of health care expenditure predictions. Health Econ. 13(4), 315–327 (2004)PubMedCrossRef Stearns, S.C., Norton, E.C.: Time to include time to death? The future of health care expenditure predictions. Health Econ. 13(4), 315–327 (2004)PubMedCrossRef
25.
Zurück zum Zitat Capewell, S., MacIntyre, K., Stewart, S., Chalmers, J.W.T., Boyd, J., Finlayson, A., Redpath, A., Pell, J.P., McMurray, J.J.V.: Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986–95: a retrospective cohort study. Lancet 358, 1213–1217 (2001)PubMedCrossRef Capewell, S., MacIntyre, K., Stewart, S., Chalmers, J.W.T., Boyd, J., Finlayson, A., Redpath, A., Pell, J.P., McMurray, J.J.V.: Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986–95: a retrospective cohort study. Lancet 358, 1213–1217 (2001)PubMedCrossRef
26.
Zurück zum Zitat Hakkinen, U., Martikainen, P., Noro, A., Nihtila, E., Peltola, M.: Aging, health expenditure, proximity to death, and income in Finland. Health Econ. Policy Law 3(Pt 2), 165–195 (2008)PubMed Hakkinen, U., Martikainen, P., Noro, A., Nihtila, E., Peltola, M.: Aging, health expenditure, proximity to death, and income in Finland. Health Econ. Policy Law 3(Pt 2), 165–195 (2008)PubMed
27.
Zurück zum Zitat Serup-Hansen, N., Wickstroem, J., Kristiansen, I.S.: Future health care costs–do health care costs during the last year of life matter? Health Policy 62(2), 161–172 (2002)PubMedCrossRef Serup-Hansen, N., Wickstroem, J., Kristiansen, I.S.: Future health care costs–do health care costs during the last year of life matter? Health Policy 62(2), 161–172 (2002)PubMedCrossRef
Metadaten
Titel
Population ageing and healthcare expenditure projections: new evidence from a time to death approach
verfasst von
Claudia Geue
Andrew Briggs
James Lewsey
Paula Lorgelly
Publikationsdatum
01.11.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
The European Journal of Health Economics / Ausgabe 8/2014
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-013-0543-7

Weitere Artikel der Ausgabe 8/2014

The European Journal of Health Economics 8/2014 Zur Ausgabe