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Room: Helsinki Hall
Time: Thu 14:30 PM-15:45 PM

Ageing and health care expenditures: New results from the Netherlands

Chair: Johan Polder (RIVM, centrum Volksgezondheid Toekomst Verkenningen)

Session Description

Ageing societies are expected to face a sharp increase in health care expenditures. To make projections of these expenditures, more insight into the interdependent relationship between mortality, health, and health care expenditures is needed. Projections of health care expenditures have already been extended by including time to death, instead of only age. However, time to death is still a proxy for health, which could be improved by using other indicators of health status. Also, the relevant predictors for costs may be different for cure and care.

In this issue panel we provide an overview of the results of recent research into the determinants of health care use and costs for both the cure and care sector in the Netherlands. We have used individually linked data on demography, health and expenditures to analyze the following issues that are relevant in the ageing debate:

1. The longitudinal relationship between health status and hospital expenditures
Better health is associated with lower annual costs of health care use, but also with longer life expectancy. Therefore, it is unclear whether better health leads to lower health care expenditures in the long run.

2. The predictors of long term care utilization for elderly hospital patients
Morbidity amongst hospital patients can be good predictor of future health care utilization. Identifying the diseases that lead to long-term care utilization may not only help in anticipating future long-term care needs given changes in epidemiology, but also tells us which diseases deserve to be the focus of attention in disease prevention.

3. The role of disability in explaining long term care utilization
According to the Dutch eligibility guidelines, disability is the main factor of access to publicly financed long-term care and should therefore determine use to a large extent. Quantifying the relationship between disability and use of both homecare and institutional long-term care – by controlling for demographic, socio-economic and morbidity - is of great importance to anticipate future LTC needs given future trends in disability.
4. Time to drop time-to-death in long-term care expenditure models
Next to age and sex, time-to-death is used in models to forecast long-term care expenditures. Time-to-death, however, is not a real predictor of long-term care as it are the disability and morbidity that precedes it and informal care availability that determine the use of public long-term care services. Does the inclusion of these real drivers of LTC expenditures leads to the redundancy of time-to-death as a determinant of LTC expenditures?
We conclude that expenditure models can be further improved by including variables that describe individual health at any point in time.

Session Organizer: Johan Polder (Tilburg University)

Presentations

1. Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

   Presenter: Albert Wong (National Institute for Public Health and the Environment (RIVM))

2. The Longitudinal Relationship between Health Status and Hospital Expenditures

   Presenter: Bram Wouterse (Tilburg University and National Institute for Public Health and the Environment)

3. Time to drop time-to-death? – Unraveling the Determinants of LTC Spending in the Netherlands

   Presenter: Claudine de Meijer (Erasmus MC)

4. The Role of Disability in Explaining Long-Term Care Utilization

   Presenter: Marc Koopmanschap (Erasmus MC)