de Meijer Claudine, Wouterse Bram, Polder Johan, Koopmanschap Marc
Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
Institute for Medical Technology Assessment, Rotterdam, The Netherlands.
Eur J Ageing. 2013 May 15;10(4):353-361. doi: 10.1007/s10433-013-0280-x. eCollection 2013 Dec.
Although the consequences of population aging for growth in health expenditures have been widely investigated, research on this topic is rather fragmented. Therefore, these consequences are not fully understood. This paper reviews the consequences of population aging for health expenditure growth in Western countries by combining insights from epidemiological and health economics research. Based on a conceptual model of health care use, we first review evidence on the relationship between age and health expenditures to provide insight into the direct effect of aging on health expenditure growth. Second, we discuss the interaction between aging and the main societal drivers of health expenditures. Aging most likely influences growth in health expenditures indirectly, through its influence on these societal factors. The literature shows that the direct effect of aging depends strongly on underlying health and disability. Commonly used approximations of health, like age or mortality, insufficiently capture complex dynamics in health. Population aging moderately increases expenditures on acute care and strongly increases expenditures on long-term care. The evidence further shows that the most important driver of health expenditure growth, medical technology, interacts strongly with age and health, i.e., population aging reinforces the influence of medical technology on health expenditure growth and vice versa. We therefore conclude that population aging will remain in the centre of policy debate. Further research should focus on the changes in health that explain the effect of longevity gains on health expenditures, and on the interactions between aging and other societal factors driving expenditure growth.
尽管人口老龄化对医疗支出增长的影响已得到广泛研究，但该主题的研究较为零散。因此，人们尚未完全理解这些影响。本文结合流行病学和卫生经济学研究的见解，综述了西方国家人口老龄化对医疗支出增长的影响。基于医疗保健使用的概念模型，我们首先回顾年龄与医疗支出之间关系的证据，以深入了解老龄化对医疗支出增长的直接影响。其次，我们讨论老龄化与医疗支出的主要社会驱动因素之间的相互作用。老龄化很可能通过对这些社会因素的影响间接影响医疗支出的增长。文献表明，老龄化的直接影响在很大程度上取决于潜在的健康状况和残疾情况。常用的健康近似指标，如年龄或死亡率，不足以捕捉健康方面的复杂动态。人口老龄化适度增加了急性护理支出，并大幅增加了长期护理支出。证据还表明，医疗支出增长的最重要驱动因素——医疗技术，与年龄和健康状况密切相关，即人口老龄化强化了医疗技术对医疗支出增长的影响，反之亦然。因此，我们得出结论，人口老龄化仍将是政策辩论的核心。进一步的研究应聚焦于解释寿命延长对医疗支出影响的健康变化，以及老龄化与其他推动支出增长的社会因素之间的相互作用。
