Dormont Brigitte, Grignon Michel, Huber Hélène
LEGOS, Université Paris Dauphine, Paris 16, France.
Health Econ. 2006 Sep;15(9):947-63. doi: 10.1002/hec.1165.
In this paper we evaluate the respective effects of demographic change, changes in morbidity and changes in practices on growth in health care expenditures. We use microdata, i.e. representative samples of 3441 and 5003 French individuals observed in 1992 and 2000. Our data provide detailed information about morbidity and allow us to observe three components of expenditures: ambulatory care, pharmaceutical and hospital expenditures. We propose an original microsimulation method to identify the components of the drift observed between 1992 and 2000 in the health expenditure age profile. On the one hand, we find empirical evidence of health improvement at a given age: changes in morbidity induce a downward drift of the profile. On the other hand, the drift due to changes in practices is upward and sizeable. Detailed analysis attributes most of this drift to technological innovation. After applying our results at the macroeconomic level, we find that the rise in health care expenditures due to ageing is relatively small. The impact of changes in practices is 3.8 times larger. Furthermore, changes in morbidity induce savings which more than offset the increase in spending due to population ageing.
在本文中，我们评估了人口结构变化、发病率变化以及医疗行为变化对医疗保健支出增长的各自影响。我们使用微观数据，即1992年和2000年观察到的3441名和5003名法国人的代表性样本。我们的数据提供了有关发病率的详细信息，并使我们能够观察到支出的三个组成部分：门诊护理、药品和医院支出。我们提出了一种原始的微观模拟方法，以确定1992年至2000年期间在医疗支出年龄分布中观察到的趋势的组成部分。一方面，我们发现了特定年龄健康改善的经验证据：发病率的变化导致分布曲线向下移动。另一方面，由于医疗行为变化导致的趋势是向上的且幅度较大。详细分析将这种趋势的大部分归因于技术创新。在将我们的结果应用于宏观经济层面后，我们发现老龄化导致的医疗保健支出增长相对较小。医疗行为变化的影响要大3.8倍。此外，发病率的变化带来了节省，足以抵消人口老龄化导致的支出增加。
