Skip to main content

Advertisement

Log in

Gesundheitsausgaben und demografischer Wandel

Health care expenditures and the aging population

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Der Einfluss steigender Lebenserwartung auf die künftigen Gesundheitsausgaben wird aufgrund einer immer stärker ins hohe Alter verdrängten Mortalität einerseits und hoher Gesundheitsausgaben im letzten Lebensjahr (sogenannte Sterbekosten) andererseits moderat ausfallen. Da der Anstieg der individuellen Krankheitsausgaben nicht durch das Alter an sich, sondern durch die hohen Kosten in der Nähe zum Tod verursacht wird, hat der Aufschub der Mortalität in höhere Alter keinen starken Effekt auf die Lebensausgaben für Gesundheit. Eine Schätzung der GKV-Ausgabenentwicklung bis 2050, die die Sterbekosten explizit berücksichtigt, legt einen geringeren demografischen Einfluss nahe als eine Prognose auf Grundlage gegebener altersspezifischer Gesundheitsausgabenprofile.

Abstract

The impact of a longer life on future health care expenditures will be quite moderate because of the high costs of dying and the compression of mortality in old age. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not significantly affect lifetime health care expenditures, as death occurs only once in every life. A calculation of the demographic effect on health care expenditures in Germany up until 2050 that explicitly accounts for costs in the last years of life leads to a significantly lower demographic impact on per-capita expenditures than a calculation based on crude age-specific health expenditures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1

Literatur

  1. Breyer F, Costa-Font J, Felder S (2011) Ageing, health, and health care. Oxford Rev Econ Pol 26(4):674–690

    Article  Google Scholar 

  2. Cutler DM, McClellan M (2001) Productivity change in health care. Am Econ Rev 91(2), Papers & Proceedings:281–286

    Google Scholar 

  3. Cutler DM, McClellan M (2001) Is technological change in medicine worth it? Health Aff 20:11–29

    Google Scholar 

  4. Skinner J, Staiger D (2009) Technology diffusion and productivity growth in health care. NBER Working Paper 14865

  5. Felder S (2006) Lebenserwartung, Medizinischer Fortschritt und Gesundheitsausgaben: Theorie und Empirie. Perspektiven Wirtschaftspol 7:49–73

    Article  Google Scholar 

  6. Fries JF (1980) Aging, natural death and the compression of morbidity. N Engl J Med 303:130–135

    Article  PubMed  CAS  Google Scholar 

  7. Vita AJ, Terry RB, Hubert HB, Fries JF (1998) Aging, health risks and cumulative disability. N Engl J Med 338(15):1035–1041

    Article  PubMed  CAS  Google Scholar 

  8. Fries JF (1997) Exercise and the health of the elderly. Am J Geriatr Cardiol 6(3):24–32

    PubMed  Google Scholar 

  9. Crimmins EM (2004) Trends in the health of the elderly. Annu Rev Public Health 25(10):79–98

    Article  PubMed  Google Scholar 

  10. Cai L, Lubitz J (2007) Was there compression of disability for older American from 1992 to 2003? Demography 44(3):479–495

    Article  PubMed  Google Scholar 

  11. Crimmins EM, Saito Y (2000) Changes in the prevalence of diseases among older Americans: 1984–1994. Demographic Res 3:9

    Google Scholar 

  12. Freedman VA, Martin LG (2000) Contribution of chronic conditions to aggregate changes in old-age functioning. Am J Public Health 90(11):1755–1760

    Article  PubMed  CAS  Google Scholar 

  13. Freedman VA, Schoeni RF, Martin LG, Cornman JC (2007) Chronic conditions and the decline in late-life disability. Demography 44(3):459–477

    Article  PubMed  Google Scholar 

  14. Dinkel R (1999) Demographische Entwicklung und Gesundheitszustand: Eine empirische Kalkulation der Healthy Life Expectancy für die Bundesrepublik auf der Basis von Kohortendaten. In Häfner H (Hrsg) Gesundheit – unser höchstes Gut? Springer, Berlin, S 61–83

  15. Lubitz JD, Riley GF (1993) Trends in Medicare payments in the last year of life. N Engl J Med 328(15):1092–1096

    Article  PubMed  CAS  Google Scholar 

  16. Zweifel P, Felder S, Meier M (1999) Ageing of population and health care expenditure: a red herring? Health Econ 8:485–496

    Article  PubMed  CAS  Google Scholar 

  17. O’Neill CL, Groom L, Avery AJ et al (2000) Age and proximity to death as predictors of GP care costs: results from a study of nursing home patients. Health Econ 9(8):733–738

    Article  Google Scholar 

  18. Schellhorn M, Stuck AE, Minder CE, Beck JC (2000) Health services utilization of elderly Swiss: evidence from panel data. Health Econ 9:533–545

    Article  PubMed  CAS  Google Scholar 

  19. Stearns SC, Norton EC (2004) Time to include time to death? The future of health care expenditure predictions. Health Econ 13(4):315–327

    Article  PubMed  Google Scholar 

  20. Seshamani M, Gray A (2004) Ageing and health care expenditure: the red herring argument revisited. Health Econ 13(4):303–314

    Article  PubMed  Google Scholar 

  21. Seshamani M, Gray A (2004) A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ 23(2):217–235

    Article  PubMed  Google Scholar 

  22. Polder JJ, Barendregt JJ, Oers H van (2006) Health care costs in the last year of life – the Dutch experience. Soc Sci Med 63(7):1720–1731

    Article  PubMed  Google Scholar 

  23. Werblow A, Felder S, Zweifel P (2007) Population ageing and health care expenditure: a school of „red herrings“? Health Econ 16(10):1109–1026

    Article  PubMed  Google Scholar 

  24. Felder S, Werblow A, Zweifel P (2010) Do red herrings swim in circles? Controlling for the endogeneity of time to death. J Health Econ 29(2):205–212

    Article  PubMed  Google Scholar 

  25. Dormont B, Grignon M, Huber H (2006) Health expenditure growth: reassessing the threat of ageing. Health Econ 15:947–963

    Article  PubMed  Google Scholar 

  26. Zweifel P, Felder S, Werblow A (2004) Population ageing and health care expenditure: new evidence on the „red herring“, Geneva Papers on Risk and Insurance: Issues and Practice. Special Issue Health Insurance 29(4):653–667

    Google Scholar 

  27. Spillman BC, Lubitz J (2000) The effect of longevity on spending for acute and long-term care. N Engl J Med 342(19):1409–1415

    Article  PubMed  CAS  Google Scholar 

  28. Häcker J, Hackmann T (2011) Los(t) in long-term care: empirical evidence from German data 2000–2009. Health Econ, Wiley Online Library. doi: 10.1002/hec.1805

  29. Busse R, Krauth C, Schwartz FW (2002) Use of acute hospital beds does not increase as the population ages: results for a seven year cohort study in Germany. J Epidemiol Community Health 56:289–293

    Article  PubMed  CAS  Google Scholar 

  30. Felder S, Meier M, Schmitt H (2000) Health care expenditure in the last months of life. J Health Econ 19:679–695

    Article  PubMed  CAS  Google Scholar 

  31. Lubitz J, Beebe J, Baker C (1995) Longevity and Medicare expenditure. N Engl J Med 332:999–1003

    Article  PubMed  CAS  Google Scholar 

  32. Breyer F, Felder S (2006) Life expectancy and health care expenditures in the 21st century: a new calculation for Germany using the costs of dying. Health Policy 75:178–186

    Article  PubMed  Google Scholar 

  33. Breyer F, Ulrich V (2000) Gesundheitsausgaben, Alter und medizinischer Fortschritt: eine Regressionsanalyse. Jahrbücher für Nationalökonomie und Statistik 220:1–17

    Google Scholar 

  34. Callahan D (1987) Setting limits: Medical goals in an aging society. Simon and Schuster, New York

  35. Daniels N (1985) Just health care. Cambridge University Press, Cambridge

  36. Strech D, Synofzik M, Marckmann G (2008) How physicians allocate scarce resources at the bedside: a systematic review of qualitative studies. J Med Philos 33(1):80–99

    Article  PubMed  Google Scholar 

  37. Zweifel P, Steinmann L, Eugster P (2005) The Sisyphus syndrome in health revisited. Int J Health Care Finance Econ 5(2):127–145

    Article  PubMed  Google Scholar 

  38. Bech M, Christiansen T, Khoman E et al (2011) Ageing and health care expenditure in EU-15. Eur J Health Econ 12:469–478

    Article  PubMed  Google Scholar 

  39. Breyer F, Lorenz N, Niebel T (2011) Health care expenditures and longevity: Is there a Eubie Blake effect? Mimeo, University of Konstanz

  40. Fonseca R, Michaud PC, Galama T, Kapteyn A (2009) On the rise of health spending and longevity. RAND Working Paper, No. 722

  41. Hall RE, Jones CI (2007) The value of life and the rise in health spending. Q J Econ 122(1):39–72

    Article  Google Scholar 

  42. Buchner F, Wasem J (2006) „Steeping“ of health ependiture profiles. The Geneva Papers on Risk and Insurance: Issues and Practice 31(4):581–599

    Google Scholar 

  43. Felder S, Werblow A (2008) Do the age profiles of health care expenditure really steepen over time? New Evidence from Swiss Cantons. The Geneva Papers on Risk and Insurance: Issues and Practice. Special Issue on Health Insurance 33(4):710–727

    Google Scholar 

  44. Krämer W (1993) Wir kurieren uns zu Tode. Die Zukunft der modernen Medizin. Campus, Frankfurt

Download references

Danksagung

Der Autor dankt zwei anonymen Gutachtern für die gründliche Durchsicht des Manuskripts und die hilfreichen Kommentare und Hinweise.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Felder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Felder, S. Gesundheitsausgaben und demografischer Wandel. Bundesgesundheitsbl. 55, 614–623 (2012). https://doi.org/10.1007/s00103-012-1469-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-012-1469-4

Schlüsselwörter

Keywords

Navigation