Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Health Econ. 2011 Apr;20(4):379-400. doi: 10.1002/hec.1597.
It has been demonstrated repeatedly that time to death is a much better predictor of health care expenditures than age. This is known as the 'red herring' hypothesis. In this article, we investigate whether this is also the case regarding disease-specific hospital expenditures. Longitudinal data samples from the Dutch hospital register (n=11 253 455) were used to estimate 94 disease-specific two-part models. Based on these models, Monte Carlo simulations were used to assess the predictive value of proximity to death and age on disease-specific expenditures. Results revealed that there was a clear effect of proximity of death on health care expenditures. This effect was present for most diseases and was strongest for most cancers. However, even for some less fatal diseases, proximity to death was found to be an important predictor of expenditures. Controlling for proximity to death, age was found to be a significant predictor of expenditures for most diseases. However, its impact is modest when compared to proximity to death. Considering the large variation in the degree to which proximity to death and age matter for each specific disease, we may speak not only of age as a 'red herring' but also of a 'carpaccio of red herrings'.
已经反复证明，死亡时间是预测医疗保健支出的一个比年龄更好的指标。这被称为“红鲱鱼”假说。在本文中，我们研究了这是否也适用于特定疾病的医院支出。我们使用了来自荷兰医院登记处的纵向数据样本（n=11253455），以估计 94 个特定疾病的两部分模型。基于这些模型，我们使用蒙特卡罗模拟来评估接近死亡和年龄对特定疾病支出的预测价值。结果表明，接近死亡对医疗保健支出有明显的影响。这种影响存在于大多数疾病中，在大多数癌症中最为强烈。然而，即使对于一些不太致命的疾病，接近死亡也被发现是支出的一个重要预测因素。在控制接近死亡的情况下，年龄被发现是大多数疾病支出的一个重要预测因素。然而，与接近死亡相比，其影响是适度的。考虑到接近死亡和年龄对每种特定疾病的重要程度存在很大差异，我们不仅可以说年龄是“红鲱鱼”，而且可以说它是“红鲱鱼的薄片”。
