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... Show morePopulation 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. Show less
Rolden, H.J.A.; Bodegom, D. van; Westendorp, R.G.J. 2014
The health care costs of population ageing are for an important part attributable to higher mortality rates in combination with high costs of dying. This paper answers three questions that remain... Show moreThe health care costs of population ageing are for an important part attributable to higher mortality rates in combination with high costs of dying. This paper answers three questions that remain unanswered regarding the costs of dying: (1) contributions of different health services to the costs of dying; (2) variation in the costs of dying; and (3) the influence of preceding health care expenses on the costs of dying.We retrieved data on 61,495 Dutch subjects aged 65 and older from July 2007 through 2010 from a regional health care insurer. We included all deceased subjects of whom health care expenses were known for 26 months prior to death (n ¼ 2833). Costs of dying were defined as health care expenses made in the last six months before death. Lorenz curves, generalized linear models and a two-part model were used for our analyses. (1) The average costs of dying are V25,919. Medical care contributes to 57% of this total, and long-term care 43%. The costs of dying mainly relate to hospital care (40%). (2) In the costs of dying, 75% is attributable to the costliest half of the population. For medical care, this distribution figure is 86%, and for long-term care 92%. Age and preceding expenses are significant determinants of this variation in the costs of dying. (3) Overall, higher preceding health care expenses are associated with higher costs of dying, indicating that the costs of dying are higher for those with a longer patient history. To summarize, there is not a large variation in the costs of dying, but there are large differences in the nature of these costs. Before death, the oldest old utilize more long-term care while their younger counterparts visit hospitals more often. To curb the health care costs of population ageing, a further understanding of the costs of dying is crucial. Show less
