Human mortality tends to decline in the long run, which is fortunate for humans, but less so for pension and health insurance schemes and annuity providers. Empirical studies have shown that rates of mortality improvement depend heavily on the age, gender and country in question, and additionally, they also tend to change in time. More specifically, the historical acceleration of mortality decreases among the elderly and a simultaneous slowdown of improvement at younger ages, which are sometimes jointly referred to as the rotation of the age pattern of mortality decline, have been observed in several populations. After a concise summary of the most relevant literature, this paper suggests a simple, largely data-driven methodology with few assumptions for the empirical examination of the rotation phenomenon in historical mortality datasets. These techniques are then applied on United Nations data from the period between 1950 and 2015 for both genders and all 28 countries of the European Union. The results indicate that rotation has indeed taken place in numerous member states, but its presence is far from universal, and it appears to have been notably more prevalent in populations of women than among men. Life expectancies seem to predict degrees of rotation only in the former Eastern bloc despite prominent literature that suggests otherwise, while increments of life expectancies over the observed period are better predictors of the degrees of rotation in the case of Western European women. Keywords Mortality • Actuarial science • Demography • European Union • Rotation I would like to thank the anonymous referees and Patrick Gerland for their valuable comments.

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Közgazdasági szemle , lX ii. évf., 2015Közgazdasági szemle , lX ii. évf., . december (1229Közgazdasági szemle , lX ii. évf., -1257 bajKó attila-maKnics anita-tóth Krisztián-véKás Péter a magyar nyugdíjrendszer fenntarthatóságáról Sok más fejlett országhoz hasonlóan Magyarországnak is szembe kell néznie az öregedő társadalom miatti problémák sokaságával, többek között a nyugdíjrendszer fenntarthatóságának kérdésével. Tanulmányunkban a Lee-Cartermodell segítségével elemezzük a következő évtizedek statisztikai alapon várható demográfiai mutatóit. A kapott eredmények felhasználásával egy nyugdíjmo-dellt állítottunk fel, amellyel adott makrogazdasági feltételek mellett becsül-jük a nyugdíjrendszer egyenlegének jövőbeli alakulását. E modell segítségé-vel vizsgálhatóvá válik, hogy milyen hatást gyakorolnak a nyugdíjrendszerre az előre jelzett jövőbeli népességi mutatók és feltételezett makrogazdasági és nyugdíjparaméterek. Journal of Economic Literature (JEL) kód: C53, C54, H55.

Background Patient activation comprises the skills, knowledge and motivation necessary for patients’ effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. Methods A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test–retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. Results The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test–retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. Conclusion PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.

The sustainability of an unfunded pension system depends highly on demographic and labour market trends, i.e. how fertility, mortality, and employment rates change. In this paper we provide a brief summary of recent developments in these fields in Hungary and draw up a picture of the current situation. Then, we forecast the path of the economic old-age dependency ratio, i.e. the ratio of the elderly and employed populations. We make different alternative assumptions about fertility, mortality, and employment rates. According to our baseline scenario the dependency ratio is expected to rise from 40.6% to 77% by 2050. Such a sharp increase makes policy intervention inevitable. Based on our sensitivity analysis, the only viable remedy is increasing the retirement age.