European Journal of Ageing

, Volume 10, Issue 4, pp 353–361 | Cite as

The effect of population aging on health expenditure growth: a critical review

  • Claudine de MeijerEmail author
  • Bram Wouterse
  • Johan Polder
  • Marc Koopmanschap


Although the consequences of population aging for growth in health expenditures have been widely investigated, research on this topic is rather fragmented. Therefore, these consequences are not fully understood. This paper reviews the consequences of population aging for health expenditure growth in Western countries by combining insights from epidemiological and health economics research. Based on a conceptual model of health care use, we first review evidence on the relationship between age and health expenditures to provide insight into the direct effect of aging on health expenditure growth. Second, we discuss the interaction between aging and the main societal drivers of health expenditures. Aging most likely influences growth in health expenditures indirectly, through its influence on these societal factors. The literature shows that the direct effect of aging depends strongly on underlying health and disability. Commonly used approximations of health, like age or mortality, insufficiently capture complex dynamics in health. Population aging moderately increases expenditures on acute care and strongly increases expenditures on long-term care. The evidence further shows that the most important driver of health expenditure growth, medical technology, interacts strongly with age and health, i.e., population aging reinforces the influence of medical technology on health expenditure growth and vice versa. We therefore conclude that population aging will remain in the centre of policy debate. Further research should focus on the changes in health that explain the effect of longevity gains on health expenditures, and on the interactions between aging and other societal factors driving expenditure growth.


Population aging Morbidity Technology Health expenditures Acute care Long-term care 



This study was part of the projects “Living longer in good health,” which was financially supported by the Network for Studies on Pensions, Aging and Retirement (NETSPAR), and “Healthy aging and health care expenditure,” financed by the National Institute for Public Health and the Environment (RIVM). We thank two anonymous referees and the editor (Howard Litwin) for their extensive comments on an earlier version of the paper.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Claudine de Meijer
    • 1
    • 2
    Email author
  • Bram Wouterse
    • 3
    • 4
  • Johan Polder
    • 3
    • 4
  • Marc Koopmanschap
    • 1
    • 2
  1. 1.Institute of Health Policy and Management, Erasmus University RotterdamRotterdamThe Netherlands
  2. 2.Institute for Medical Technology AssessmentRotterdamThe Netherlands
  3. 3.National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
  4. 4.Tranzo, Tilburg UniversityTilburgThe Netherlands

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