Demographic influence on health care and long-term care ......Demographic Ageing • Changes in age composition of the population will affect needs and demand for health and social

Demographic influence on health care and long-term care demand - Different methods?

Ilija Batljan and Mårten Lagergren*

Sweden

* Copyright remains with the authors

Demographic AgeingDemographic Ageing

• Changes in age composition of the population will affect needs and demand for health and social care.

• Care needs are not evenly divided among age groups in the population. Cost per capita tends to rise sharply with age.

• Usual approach: simple demographic extrapolation of care costs based on the expected size trends of various age groups and the cost per capita in each group.

M i n i s t r y o f H e a l t h a n d S o c i a l A f f a i r s S t o c k h o l m , S w e d e n

Ageing Population and Health Care Expenditure, OECD 2000

Australia

Canada

Denmark

Finland

France

Germany

Ireland

JapanSpain

Sweden

Switzerland

United States

5

6

7

8

9

10

11

12

13

14

10 11 12 13 14 15 16 17 18 19

% Population Over 65

% G

DP o

n He

alth

Extrapolations• Demographic projections• Mortality projections• Mortality - Morbidity• Projections of health status

Population forecast per agePopulation forecast per age--group 2000 group 2000 –– 20302030

0

200000

400000

600000

800000

1000000

1200000

2000 2005 2010 2015 2020 2025 2030

65 - 74 years75 - 84 years85- years

Impact of declining mortality. Changes in SCB's forecasts of the number of people aged 80 and

over

300350400450500550600650700

2010 2015 2020 2025

1978198319861989199119941997

'000

Mortality - Morbidity• Expansion of morbidity• Compression of morbidity• Postponement of morbidity

Cost per inhabitant and age group (SEK per capita) for the population of Skåne in 1997

02 0004 0006 0008 000

10 00012 00014 00016 00018 00020 000

0-64 65+ 65-69 70-74 75-79 80-84 85-89 90+

SEK

Inpatient care Outpatient care

Per capita costs of Per capita costs of LTCaSLTCaS for the for the people older than 65 years, 2001 people older than 65 years, 2001

0

50 000

100 000

150 000

200 000

250 000

300 000

65-74 75-79 80-84 85-89 90+

Age group

SEK Women

Men

The connection between the time The connection between the time remaining before death and the costs remaining before death and the costs

of careof care

Empirical evidence: the last years of life, Empirical evidence: the last years of life, irrespective of how long people live, are irrespective of how long people live, are associated with high care costs.associated with high care costs.Changes in the age structure of the population Changes in the age structure of the population are partially a function of decreasing ageare partially a function of decreasing age--specific mortality. If mortality declines, it specific mortality. If mortality declines, it means a smaller number of people in age means a smaller number of people in age group who are in their last years of life. group who are in their last years of life.

The connection between the time The connection between the time remaining before death and the costs remaining before death and the costs

of care of care -- ConclusionConclusion

The proportion of people close to death rises The proportion of people close to death rises with age:::> the number of years left until with age:::> the number of years left until death is a more relevant definition of age for death is a more relevant definition of age for use in demographic projections on future use in demographic projections on future health care expenditures, than the number of health care expenditures, than the number of years since birth. years since birth.

M i n i s t r y o f H e a l t h a n d S o c i a l A f f a i r s S t o c k h o l m , S w e d e n

Average cost (in SEK '000) of inpatient health care per capita in the population, depending on remaining years of life. Men, women and total, all age groups, Skåne region (formerly Malmöhus County Council), 1997

0

10

20

30

40

50

60

0 1 2 3 4 5 6 >6 AllNo. of remaining years of life

Per c

apita

, SEK

'000

MenWomenAll

Volume-index trends for health care derived from simple and revised extrapolation

90

95

100

105

110

115

120

2000 2005 2010 2015 2020 2025 2030

Index 2000=100

Simple extrapolation

Extra polation usingremaining years' life

The older people’s functional ability The older people’s functional ability and demand for careand demand for care

Health status Health status Functional ability Functional ability –– limitations limitations ––disabilitydisabilityLast years of lifeLast years of life

Trend of proportion of elderly people with severe ill-health according to SCB's Swedish National Survey

of Living Conditions, 1975-97

0

5

10

15

20

25

30

1975/80 1981/85 1986/90 1991/95 1996/97Percentages of elderly people in different age groups

Men

65-6970-7475-7980-84

0

5

10

15

20

25

30

35

40

1975/80 1981/85 1986/90 1991/95 1996/97

Percentages of elderly people in different age groups

Wom

en 65-6970-7475-7980-84

The ASIM III modelThe ASIM III modelA simulation model A simulation model

concerning needs of longconcerning needs of long--term care of elderly persons term care of elderly persons

in Sweden in Sweden

The ASIM III The ASIM III modelmodelaimsaims at at estimatingestimating

the the amountamount of LTC services of LTC services providedprovided-- given given degreedegree of of dependencydependency per per

ageage--groupgroup, , gendergender and civil status. and civil status. RetrospectivelyRetrospectively 1985 1985 ––20002000ProspectivelyProspectively 2000 2000 ––20302030

ImplementationImplementation in EXCELin EXCEL

The The resultsresults are are achievedachieved by by combiningcombiningdifferent data different data basesbases::

National National statisticsstatistics concconc. LTC . LTC National National surveyssurveys of of livingliving conditionsconditions(ULF) (ULF) The ASIMThe ASIM--studies in Solna studies in Solna municipalitymunicipality1984 1984 ––19941994The SNAC The SNAC studystudy at Kungsholmen 2001at Kungsholmen 2001The ”The ”fieldfield municipalitiesmunicipalities” ” surveysurvey 2002 2002

LevelLevel of of providedprovided LTC servicesLTC servicesHome Home helphelp in in ordinaryordinary housinghousing or service or service

housinghousing< 1 hour/< 1 hour/dayday1 1 ––2 2 hourshours//dayday> 2 > 2 hourshours //dayday

InstitutionalInstitutional care (care (residentialresidential homehome, , nursingnursing homehome etc.) etc.)

DegreeDegree of of illill--healthhealth accordingaccording to ULFto ULFFull Full healthhealthSlightSlight illill--healthhealthModerate Moderate illill--healthhealthSevereSevere illill--healthhealth

SevereSevere illill--healthhealth is is subdividedsubdivided usingusing the ASIMthe ASIM--index index intointo: : RelativelyRelatively severesevereSevereSevereVeryVery severesevere

Age Age groupsgroups and civil statusand civil status65 65 –– 74 74 yearsyears75 75 –– 84 84 yearsyears85 + 85 + yearsyears

MarriedMarriedNot Not marriedmarried ((widowwidow, , divorceddivorced, , unmarriedunmarried))

Development of the probability of severe illDevelopment of the probability of severe ill--health in the period health in the period 2000 2000 -- 2030, non2030, non--married men and women, aged 75 married men and women, aged 75 ––79 years 79 years

and 85 and 85 ––89 years respectively89 years respectively

0

0,1

0,2

0,3

0,4

0,5

0,6

2000 2005 2010 2015 2020 2025 2030

Women - 75 -79 yearsMen - 75 -79 yearsWomen - 85 -89 yearsMen - 85 -89 years

Projected development of the total yearly costs for the longProjected development of the total yearly costs for the long--term care services for the elderly per age group assuming term care services for the elderly per age group assuming

unchanged healthunchanged health after the year 2000 (millions SEK).after the year 2000 (millions SEK).

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

65 - 74 75 - 84 85 - All

1985200020152030

Projected development of the total yearly costs for the longProjected development of the total yearly costs for the long--term term care services for the elderly per age group assuming care services for the elderly per age group assuming unchanged unchanged

health trendshealth trends after the year 2000 (millions SEK)after the year 2000 (millions SEK)

0

10000

20000

30000

40000

50000

60000

70000

65 - 74 years 75 - 84 years 85 - years All age groups

2000201020202030

The projected LTC-cost increase in fixed prices during the period 2000-30

020406080

100120140160180

2000 2005 2010 2015 2020 2025 2030

Scenario 0Scenario A Scenario BScenario CScenario D

Other factors affecting care costsOther factors affecting care costsHelp, support and care needs given Help, support and care needs given morbidity and social conditionsmorbidity and social conditionsAccess to help and support from the Access to help and support from the family and social networkfamily and social networkPropensity to seek public health and Propensity to seek public health and social care: expectations, charges, social care: expectations, charges, private alternativesprivate alternativesCare structure: domiciliary or Care structure: domiciliary or institutional health and social careinstitutional health and social care

Other factors affecting care Other factors affecting care costs…costs…

Impact of care on health and functional Impact of care on health and functional ability: preventive inputs, rehabilitation, ability: preventive inputs, rehabilitation, iatrogenic care needs (generated by iatrogenic care needs (generated by care itself)care itself)Staff requirements for given care inputsStaff requirements for given care inputsStaff costs and other costs (pay, Staff costs and other costs (pay, accommodation standard, medicines, accommodation standard, medicines, technical aids).technical aids).

21 CENTURY21 CENTURY

We will also in the We will also in the 21century live longer? 21century live longer? and in good health?and in good health?

????