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Session: Ageing and health care expenditures: New results from the Netherlands
Room: Helsinki Hall
Time: Thu 14:30-15:45

Presenter: Bram Wouterse (Tilburg University and National Institute for Public Health and the Environment. )

Abstract

Objective

The ageing of the Western population is expected to lead to increasing health care expenditures. To assess whether a part of the cost raising effects of ageing can be offset by an increase in general health, more insight in the longitudinal relationship between health and costs of health care use is needed. This relationship comprises two contradictory components: better health is associated with lower costs per life year but also with additional costs associated with a higher remaining life expectancy. We examine the relationship between health and costs of hospital use in the Netherlands over a period of eight years.

Methods

We link cross sectional health survey data form 1997 to 2005 with the Dutch national hospital register. Four different indicators of health (self-perceived health, long-term impairments, ADL limitations and comorbidity) are considered. We estimate the relationship between initial health status and costs of hospital use over the next seven years. We implement a three part model, modelling survival, probability of hospital use, and conditional costs separately.
Results
For ages 50 to 70, differences in hospital costs between initial good health and bad health are substantial and persistent over the whole seven year period. For these ages, severe ADL limitations are associated with considerably higher costs than other indicators of health. For higher ages, differences in long-term costs of hospital use between good and bad health are much less substantial. Expected hospital costs for individuals in bad health decline rapidly and become lower than those for people in good health after about six to seven years. The higher mortality rate among people in bad health is the primary cause here. Our results are confirmed for all four health indicators.

Conclusion

The interaction between health and mortality should be taken into account when projecting health care costs. Relying on better health to contain health care expenditures is too optimistic. Healthy ageing is important, but more for health gains than for cost savings.

Key Terms

ageing, health care expenditures, longitudinal analysis

Authors:

Bram Wouterse (Tilburg University and National Institute for Public Health and the Environment) , Bert Meijboom (Tilburg University) and Johan Polder (Tilburg University and National Institute for Public Health and the Environment)

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