Comas-Herrera Adelina, Wittenberg Raphael, Pickard Linda, Knapp Martin
Personal Social Services Research Unit, London School of Economics and Political Science, UK.
Int J Geriatr Psychiatry. 2007 Oct;22(10):1037-45. doi: 10.1002/gps.1830.
Projections are presented of future numbers of older people with cognitive impairment (CI) in England, their demand for long-term care (LTC) services and future costs of their care. The sensitivity of the projections to factors that are likely to affect future LTC expenditure is explored. These factors include future numbers of older people, prevalence rates of CI, trends in household composition, informal care provision, care service patterns and unit costs.
A macrosimulation (or cell-based) model was developed to produce the projections, building on an earlier PSSRU model. Base case assumptions are made about trends in key factors expected to impact on future LTC expenditure, and variant assumptions about the key factors are introduced to test for sensitivity.
Expenditure on LTC services for older people with CI is projected to rise from 0.60% of Gross Domestic Product (GDP) ( pound5.4 billion) in 2002 to 0.96% of GDP ( pound16.7 billion) in 2031, under base case assumptions. Under variant assumptions, the projection for 2031 ranges from 0.83% to 1.11% of GDP. These figures do not include the opportunity costs of informal care.
Sensitivity analysis shows that projected demand for LTC is sensitive to assumptions about the future numbers of older people and future prevalence rates of CI and functional disability. Projected expenditure is also sensitive to assumptions about future rises in the real unit costs of services.
本文呈现了英国未来认知障碍（CI）老年人数量、他们对长期护理（LTC）服务的需求以及未来护理成本的预测。探讨了这些预测对可能影响未来长期护理支出的因素的敏感性。这些因素包括未来老年人数量、认知障碍患病率、家庭构成趋势、非正式护理提供情况、护理服务模式和单位成本。
在早期的PSSRU模型基础上，开发了一个宏观模拟（或基于单元格）模型来进行预测。对预计会影响未来长期护理支出的关键因素的趋势做出了基准假设，并引入了关于关键因素的变体假设以测试敏感性。
在基准假设下，预计2002年患有认知障碍的老年人的长期护理服务支出将占国内生产总值（GDP）的0.60%（54亿英镑），到2031年将升至GDP的0.96%（167亿英镑）。在变体假设下，2031年的预测范围为GDP的0.83%至1.11%。这些数字不包括非正式护理的机会成本。
敏感性分析表明，预计的长期护理需求对关于未来老年人数量以及未来认知障碍和功能残疾患病率的假设敏感。预计支出对关于未来服务实际单位成本上升的假设也敏感。
