Population ageing and health care expenditure

Rolden, Hendrik Jan Albert (2016)

Doctoral Thesis

Population ageing affects health care expenditure (HCE) through a myriad of dynamics which can be categorized in three major components: rising life expectancy a higher share of older people, and increasing mortality rates in combination with high "costs of dying". By disentangling these dynamics, and relating the insights presented in this thesis on the determinants of old age mortality, HCE, and the costs of dying, we have shown that the effect of population ageing on HCE may be curtailed by different trends. Specific insights from this thesis are summarized below: - Counter-intuitively, the mortality risk of older people increases during times of economic growth. - The mortality risk and level of HCE of older people is markedly higher in the autumn and winter than in the spring and summer. - A transitional care programme improved the health outcomes of frail older people. - After the death of the spouse, HCE of older people increases with around 50%. This is probably mainly related to the loss of an informal care-giver, and not bereavement. - There is not much variation in the "costs of dying" amongst older people. Variation that exists can be mostly explained by age and preceding level of HCE.

• Widowhood
• Health economics
• Old age mortality
• Healthcare expenditure
• Population ageing

• All authors: Rolden, Hendrik Jan Albert
• Supervisor: Westendorp, R.G.J.
• Co-supervisor: Bodegom, D. van
• Qualification: Doctor (dr.)
• Awarding Institution: Department of Internal Medicine, Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2016-02-02
• ISBN (print): 9789462992658