Aging, health expenditure, proximity to death, and income in Finland

Abstract

The study revisited the debate on the 'red herring" i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity of death with the predictions of a naive model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a naive model is used in health expenditure projections. Among individuals not in long-term care we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasise that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone as often claimed in public discussion. Thus the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.

A structured review of long-term care demand modelling

“…Outside of the UK, the international interest in LTC modeling is evident given the number and range of studies carried out in countries across the globe, for instance: United States (Manton, Lamb, & Gu, 2007); Sweden (Batljan, Lagergren, & Thorslund, 2009); Canada (Hare, Alimandad, Dodd, Ferguson, & Rutherford, 2009); Finland (Hakkinen, Martikainen, Noro, Nihtila, & Peltola, 2008); Japan (Fukawa, 2011);Taiwan (Ker-Tah & Tzung-Ming, 2008); Hong Kong (Chung, et al, 2009); and China (Peng, Ling, & He, 2010). Even though the focus of each paper was typically a single LTC system or country, our review did contain two papers that modeled and compared the projections of LTC cost and demand across several countries, including the UK, Germany Spain and Italy (ComasHerrera, et al, 2006) (Costa-Font, et al, 2008.…”

“…We did however find that on the whole, using a fairly broad definition, the aims of the papers fell into one of three key categories. The most common aim surrounded investigating costs or demand of LTC under different demographic or socioeconomic scenarios (Hare, Alimadad, Dodd, Ferguson, & Rutherford, 2009) (Wittenberg, Comas-Herrera, Pickard, & Hancock, 2004) (Comas-Herrera, et al, 2006) (Karlsson M. , Mayhew, Plumb, & Rickayzen, 2006) (Caley & Sidhu, 2011) (Costa-Font, et al, 2008 (Hakkinen, Martikainen, Noro, Nihtila, & Peltola, 2008). (Peng, Ling, & He, 2010).…”

“…Such data sets included: projected or current rates of disability (Ker-Tah & Tzung-Ming, 2008), household composition (Comas-Herrera, Whittenberg, Pickard, & Knapp, 2007), historic LTC care costs (Karlsson M. , Mayhew, Plumb, & Rickayzen, 2006) and hospital registers (Hakkinen, Martikainen, Noro, Nihtila, & Peltola, 2008). We could only find two studies which gathered their own data from primary sources, including a paper which used telephone surveying of care home residents was carried out to gauge the incidence of Dementia (Macdonald & Cooper, 2007) and one in which a Delphi process was used to gather expert opinion on assumptions surrounding future Dementia care (Comas-Herrera, Northey, Wittenberg, Knapp, Bhattacharyya, & Burns, 2011).…”

“…A more dynamic approach used the changes in the LCM model between two time periods to model future costs. Hakkinen et al (2008) played more attention to the proximity to death in estimating the future care costs of the elderly where it was found that 55.2% of total health expenditure on those 65+ in Finland was due to LTC. Data used comprised of a 40% sample of the Finish population linked to hospital registers, death registers, social insurance and the Finish hospital benchmarking project.…”

Sykehusutgifter mot livets slutt

“…Flere internasjonale studier viser at en betydelig andel av utgiftene i helsevesenet går til behandling i livets sluttfase, men anslagene varierer mye (1)(2)(3)(4)(5)(6). Noe av bakgrunnen for denne variasjonen er at de ulike studiene har forskjellige tidsperspektiv, inkluderer forskjellige utgifter og ser på ulike pasientgrupper.…”