Hazra Nisha C, Gulliford Martin C, Rudisill Caroline
1School of Population Health Sciences, Faculty of Life Sciences and Medicine,King's College London,London,UK.
3Department of Social Policy,London School of Economics and Political Science,London,UK.
Health Econ Policy Law. 2018 Apr;13(2):209-217. doi: 10.1017/S1744133117000329. Epub 2017 Dec 26.
There are now 125 million people aged 80 years and over worldwide, projected by the United Nations to grow threefold by 2050. While increases in life expectancy and rapid increases in the older-age population are considered positive developments, the consequential future health care burden represents a leading concern for health services. We revisit Williams' 'fair innings' argument from 1997, in light of technological and demographic changes, and challenge the notion that greater longevity may impose an unfair burden on younger generations. We discuss perspectives on the equity-efficiency trade-off in terms of their implications for the growing over-80 population, as well as society in general. This includes questioning the comparison of treatment cost-effectiveness in younger vs. older populations when using quality-adjusted life years and the transience of life expectancies over generations. While recognising that there will never be a clear consensus regarding societal value judgements, we present empirical evidence on the very elderly that lends support to a stronger anti-ageist stance given current increases in longevity.
目前，全球80岁及以上的人口有1.25亿，据联合国预测，到2050年这一数字将增长两倍。虽然预期寿命的延长和老年人口的迅速增加被视为积极的发展趋势，但随之而来的未来医疗负担却是卫生服务领域的一个主要担忧。鉴于技术和人口结构的变化，我们重新审视了威廉姆斯1997年提出的“公平 innings”论点，并对长寿可能给年轻一代带来不公平负担这一观点提出质疑。我们从公平与效率权衡的角度，探讨其对80岁以上不断增长的人口以及整个社会的影响。这包括质疑在使用质量调整生命年时对年轻人群体与老年人群体治疗成本效益的比较，以及代际预期寿命的短暂性。虽然认识到在社会价值判断方面永远不会有明确的共识，但鉴于当前寿命的延长，我们提供了关于高龄老人的实证证据，以支持更强有力的反年龄歧视立场。
