Impact of longevity and ageing Compression or extension of - - PowerPoint PPT Presentation

Impact of longevity and ageing

Compression or extension

• f morbidity and costs?
• Dr. Jürgen Becher

IAAHS Colloquium 2004 April 28 – 29, 2004, Dresden

Münchener Rück Munich Re Group CENTRE OF COMPETENCE BIOSCIENCES

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Longevity Effects of volume

"Baby boomers"

Low birth rates Aging of population

Theory: compression or extension of morbidity?

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55 70 75 80

Age

Current situation

The impact of longevity on morbidity

Morbidity

Source: Schwartz 1997, Fries 1989

Today Scenario I Compression Tomorrow Scenario II Extension/medicalisation

What kind of evidence is available?

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How the information is presented to the public Süddeutsche Zeitung, 21 January 2003, „Price of ageing“ „Increasing life expectancy could even disburden health insurance funds because only the last months before death are expensive“

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Existing publications are often limited to a specific detail such as – subjective health (Doblhammer 2001) – severe disability (Jacobzone 2000) – death-associated cost (Yang 2003). Our aim: A survey providing an overview from several perspectives Available evidence

Munich Re survey

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– Medication – Out-patient benefits – In-patient benefits – Need for long-term care – State of health – Specific diseases – Total health expenditure Aspects considered in the Munich Re survey

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– MEDLINE and internet research (Google and websites of specific institutions) – Combined search terms from the categories

• Age (e.g. ageing, old age)
• Healthcare factors

(State of health, in-patient/outpatient services, medication, long-term care)

• Use/prevalence (e.g. costs, use, visits, prevalence)

– 54 publications were included (1990 – 2003) Methods used in the Munich Re survey

Results (in extracts)

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– Increasing number of prescriptions – Seniors' per-capita expenditure shows highest rate of increase – Disproportionate increase of high-cost cases – Expensive newly approved drugs mainly for seniors Results – Medication

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Per-capita drug expenditure (Belgium)

2000 BEF 4000 BEF 6000 BEF 8000BEF 10000 BEF 12000 BEF 14000 BEF 0-4 5-11 12-19 20-29 30-39 40-54 55-64 65-79 80+

1986 1990 1993 1996

Per-capita drug expenditure

Source: Van Tielen 1998

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Seniors (over 65) show a considerable increase in all areas (data from the USA) – Visits to the doctor (+30%, 1990-98) – Home visits (+300%, 1990-98) – Outpatient surgery (+100%, 1980-89) – Lab tests (+57%, 1980-89) Results – Outpatient benefits

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– Increase of per-capita hospital admissions – Longer duration of stay (+65% compared to younger ages) – Seniors' per-capita costs

• Much higher than for younger age groups,
• Showing a disproportionately high increase
• 40% to 64% readmissions (“revolving door” effect)

– Possible attenuating effects

• In-patient treatment costs in the year of death

decrease with increasing patient age (over 70-75y.)

• Old seniors cause lower costs for the same disease

Results – In-patient treatment

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Frequency of hospital admissions (Spain)

300 400 500 600 700 800

25-34 35-44 45-54 55-64 65-74 75+ Age

1994 1985 (population adj. to 1994)

Frequency x1000

Source: Gornemann 2002

+26% +49%

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1000 2000 3000 4000 65 70 75 80 85 90 95 100

In the year preceding death More than one year prior to death

Monthly in-patient treatment costs (USA, Medicare)

Age Source: Yang 2003

Monthly costs (in 1998 $)

Costs for patients close to death : development over time

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Age distribution of heart surgery 1990-2001 (D)

2.6 3.6 1.3 1.4 2.5 9.4 28.7 37 12.4 1 1.9 1.5 0.6 0.6 1.4 5.2 15.1 35.4 32.9 5.4

5 10 15 20 25 30 35 40 <1 1 > 10 10 > 20 20 > 30 30 > 40 40 > 50 50 > 60 60 > 70 70 > 80 80 >

Age groups Per cent

1990 2001

Source: Bruckenberger 2002

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Per-capita in-patient costs by survival status (DKV, full-coverage plan, age group 75-79 years in 1999)

5000 10000 15000 20000 25000 30000 1993 1994 1995 1996 1997 1998 1999

Year Dead Survivors Per-capita costs (DM/year)

Source: Ziegenhagen 2002

Conclusions

More chronic disease Feeling better Reduced disability Increasingly eleborate and costly medical care Longevity

Missing links

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– Only with regard to some single aspects

• Subjective health
• Disability in younger seniors
• Near death costs (but long term effect doubtful)

– Higher impact on quality of life – Limited influence on costs Is there compression?

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55 70 75 80

Age

The impact of longevity on morbidity/costs

Morbidity

Current situation

Today

Scenario III Attenuated extension

Tomorrow

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Medicine and quality of life in old age Studs Terkel (*May 16, 1912) Famous American journalist and author (Pulitzer Prize 1985) 1996 5x coronary bypass at age 84 saved his life Today still busy (Last book appeared in 2001)

Münchener Rück Munich Re Group

Thank you for your interest

Münchener Rück Munich Re Group

• Dr. Jürgen Becher

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Visits to the doctor by age (USA)

100 200 300 400 500 600 700 1985 1989-1990 1995-1996 1997-1998 1999 under 15 15-24 25-44 45-64 65 and over Visits to the doctor per 100 persons

Source: Cherry 2001

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In-patient costs for male patients (Germany, private health insurance)

Gesamtausgaben Medizinische Versorgung Heimpflege Kosten pro Person ($)

1979 1982 1985 1988 1991 1994 1000 2000 3000 4000 5000 6000 7000 8000

Costs (DM) per capita per year Age group Year

Source: Buchner 2002

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Age distribution of health expenditure over time (USA 1953-1987)

1 2 3 4 5 6

<1Yr 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 1953 1963 1970 1977 1987

Relative costs (age 35-44=1) Source: Cutler 1999

Age