Carreras Marc, Ibern Pere, Inoriza José María
Research Group on Health Services and Health Outcomes (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Spain.
Universitat de Girona, Barcelona, Spain.
Health Econ. 2018 May;27(5):865-876. doi: 10.1002/hec.3635. Epub 2018 Feb 9.
In 1999, Zweifel, Felder, and Meiers questioned conventional wisdom on ageing and healthcare expenditure (HCE). According to these authors, the positive association between age and HCE is due to an increasing age-specific mortality and the high cost of dying. After a weighty academic debate, a new consensus was reached on the importance of proximity to death when analysing HCE. Nevertheless, the influence of individual health status remains unknown. The objective of our study is to analyse the influence individual health status has on HCE, when compared to proximity to death and demographic effects and considering a comprehensive view of healthcare services and costs. We examined data concerning different HCE components of N = 61,473 persons aged 30 to 95 years old. Using 2-part models, we analysed the probability of use and positive HCE. Regardless of the specific group of healthcare services, HCE at the end of life depends mainly on the individual health status. Proximity to death approximates individual morbidity when it is excluded from the model. The inclusion of morbidity generally improves the goodness of fit. These results provide implications for the analysis of ageing population and its impact on HCE that should be taken into account.
1999年，茨魏费尔、费尔德和迈尔斯对有关老龄化与医疗保健支出（HCE）的传统观念提出了质疑。据这些作者称，年龄与医疗保健支出之间的正相关关系是由于特定年龄死亡率的上升以及死亡成本高昂。经过一场激烈的学术辩论，在分析医疗保健支出时，人们就接近死亡的重要性达成了新的共识。然而，个人健康状况的影响仍然未知。我们研究的目的是分析与接近死亡和人口统计学效应相比，个人健康状况对医疗保健支出的影响，并综合考虑医疗服务和成本。我们研究了N = 61473名年龄在30至95岁之间人群的不同医疗保健支出组成部分的数据。使用两部分模型，我们分析了使用概率和正向医疗保健支出。无论医疗服务的具体类别如何，临终时的医疗保健支出主要取决于个人健康状况。当接近死亡因素从模型中排除时，它近似于个人发病率。纳入发病率通常会提高拟合优度。这些结果为分析老龄化人口及其对医疗保健支出的影响提供了启示，应予以考虑。
