Longevity and Health Care Expenditures: The Real Reasons Older People Spend More

Zhou, Yang; Norton, Edward C.; Stearns, Sally C.

doi:10.1093/geronb/58.1.s2

Cited by 214 publications

(197 citation statements)

References 10 publications

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“…The pattern of decreasing cost ratio of decedents to survivors shown in Figure 4 is similar to other studies [34,31]. This suggests that, in terms of medication, the cost of dying relative to surviving actually decreases with age.…”

Section: Discussionsupporting

confidence: 84%

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The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Moore

Bennett

Normand

2014

Appl Health Econ Health Policy

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BackgroundConcerns about the long term sustainability of health care expenditures and in particular prescribing expenditures has become an important policy issue in most developed countries. Previous studies suggest that proximity to death (PTD) has a significant effect on total health care expenditures, with its exclusion leading to an overestimation of likely growth. There are limited studies of pharmaceutical expenditures taking PTD into account. ObjectiveThis paper presents an empirical analysis of public medication expenditure on older individuals in New Zealand (NZ). The aim of the study is to examine the individual effects of age and proximity to death (PTD) using individual level data. MethodsThis study uses individual level dispensing data from 2008/2009 covering the whole population of medication users age 70 years or more and resident in New Zealand. A case control methodology is used to examine individual cost and medication use for a 12 month period for decedents (cases) and survivors (controls). A random effects two part model, with a Probit and Generalized Linear Model (GLM) is used to explore the effect of age and proximity to death on expenditures. ResultsThe impact of proximity to death on prescription expenditure is not as dramatic as studies reporting on Acute and/or long term care. The 12 month decedent to survivor mean expenditure ratio was 1.95, 2 2.09 for males and 1.82 for females. The additional cost of dying in terms of prescription drugs decreases with age, with those who die at 90 years of age or older consuming fewer drugs on average and having a lower mean expenditure than those who died in their 70s and 80s. The following variables were found to have a decreasing effect on the mean monthly prescription expenditures, a reduction of 2.2% for each additional year of age, 4.2% being in the Mãori ethnic group and 7.8% for Pacific Islanders. Increases in monthly expenditure were associated with being a decedent 32.1%-62.6% (depending on month), being of Asian origin 16.2% or a male 12.6%. ConclusionsGiven the variance reported between survivors and decedents, to improve accuracy future projections should include PTD in their models. Policies targeted at reducing expenditures should not focus on age but on ensuring appropriate and cost effective prescribing especially towards the end of life. Key points for decision makers: Despite prescription medications being the most common medical intervention there is limited evidence on how proximity to death and ageing affect prescribing expenditures for older people. In terms of expenditure on prescription medications, proximity to death would appear to be a more important driver than ageing and should therefore be considered in any future expenditure projections.

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Section: Discussionsupporting

confidence: 84%

“…Studies looking at total health care expenditures have reported increasing expenditures with age [34,12] with some attributing it to proximity to death [10,31,35]. This study has focused on prescribing expenditures and found that they do not steadily increase with age for the older population even before accounting for PTD.…”

Section: Discussionmentioning

confidence: 84%

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Moore

Bennett

Normand

2014

Appl Health Econ Health Policy

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“…16 While workload (dashed line, Fig. 2) may gradually increase as a person approaches death, 22,23 physical and cognitive capacity (solid line, Fig. 2) to manage this workload gradually decreases.…”

Section: Common Factors and Common Gaps Across Modelsmentioning

confidence: 99%

A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development

et al. 2015

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BACKGROUND: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes. OBJECTIVE: Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models. DATA SOURCES: We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process. RESULTS: From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors. CONCLUSIONS/IMPLICATIONS: This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients.

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“…Cette hausse, si elle n'est pas uniforme (elle a été plus forte pour les tranches d'âges élevés 6 ), ne peut s'expliquer par des évolutions démographiques, puisqu'on raisonne par tête et à âge donné. C'est donc du côté des détermi-nants non démographiques des dépenses de santé que s'est tournée la recherche [17,18]. Des travaux en épidémiologie et en économie ont établi qu'à un âge donné, l'état de santé est bien meilleur aujourd'hui qu'il y a un siècle [19].…”

Section: Les Déterminants Non Démographiques De La Dépense De Santé Iunclassified

Hausse des dépenses de santé

Tenand

2016

Med Sci (Paris)

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Longevity and Health Care Expenditures: The Real Reasons Older People Spend More

Cited by 214 publications

References 10 publications

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development

Hausse des dépenses de santé

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