Wouterse Bram, Huisman Martijn, Meijboom Bert R, Deeg Dorly J H, Polder Johan J
Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
Center for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, >The Netherlands.
BMC Health Serv Res. 2015 Dec 24;15:574. doi: 10.1186/s12913-015-1239-8.
The effect of population aging on future health services use depends on the relationship between longevity gains and health. Whether further gains in life expectancy will be paired by improvements in health is uncertain. We therefore analyze the effect of population ageing on health services use under different health scenarios. We focus on the possibly diverging trends between different dimensions of health and their effect on health services use.
Using longitudinal data on health and health services use, a latent Markov model has been estimated that includes different dimensions of health. We use this model to perform a simulation study and analyze the health dynamics that drive the effect of population aging. We simulate three health scenarios on the relationship between longevity and health (expansion of morbidity, compression of morbidity, and the dynamic equilibrium scenario). We use the scenarios to predict costs of health services use in the Netherlands between 2010 and 2050.
Hospital use is predicted to decline after 2040, whereas long-term care will continue to rise up to 2050. Considerable differences in expenditure growth rates between scenarios with the same life expectancy but different trends in health are found. Compression of morbidity generally leads to the lowest growth. The effect of additional life expectancy gains within the same health scenario is relatively small for hospital care, but considerable for long-term care.
By comparing different health scenarios resulting in the same life expectancy, we show that health improvements do contain costs when they decrease morbidity but not mortality. This suggests that investing in healthy aging can contribute to containing health expenditure growth.
人口老龄化对未来医疗服务使用的影响取决于寿命延长与健康状况之间的关系。预期寿命的进一步延长是否会伴随着健康状况的改善尚不确定。因此，我们分析了在不同健康情景下人口老龄化对医疗服务使用的影响。我们关注健康不同维度之间可能出现的不同趋势及其对医疗服务使用的影响。
利用关于健康和医疗服务使用的纵向数据，估计了一个包含不同健康维度的潜在马尔可夫模型。我们使用这个模型进行模拟研究，并分析推动人口老龄化影响的健康动态。我们模拟了关于寿命与健康关系的三种健康情景（发病期延长、发病期压缩和动态平衡情景）。我们利用这些情景预测2010年至2050年荷兰医疗服务使用的成本。
预计2040年后医院使用量会下降，而长期护理将持续增长至2050年。发现在预期寿命相同但健康趋势不同的情景之间，支出增长率存在显著差异。发病期压缩通常导致最低的增长。在相同健康情景下，额外的预期寿命延长对医院护理的影响相对较小，但对长期护理的影响相当大。
通过比较导致相同预期寿命的不同健康情景，我们表明，当健康改善降低发病率但不降低死亡率时确实会产生成本。这表明投资于健康老龄化有助于控制医疗支出增长。
