The impact of ageing on hospital care and long-term care--the example of Germany

Abstract

Background: In the next few decades the population in all EU-countries will age rapidly. This could have a major impact on the health care sector. This study analyses the effect of population ageing on utilisation in two key sectors of the health care system, namely hospital care and long-term care in Germany, up to 2020 with an outlook to 2050.

Methods: Two population scenarios, one with constant, one with increasing life expectancy, were combined with constant age and gender specific utilisation rates of hospital and long-term care. In the case of hospital care two projection methods were used: Method A differentiates between age-groups, gender and main diagnosis. Method B differentiates between age-groups, survivors and decedents.

Results: Population ageing was found to cause a moderate increase in hospital days, but was associated with substantial changes in the disease and age structure. In the case of increasing life expectancy, method B lead to a lower growth in hospital days than method A. The number of persons receiving long-term care will increase strongly, associated with a shift to more severe disability and institutional care. Changes in the composition of private households and the increasing labour participation of women will lead to additional demand for professional caregivers at home and in institutions.

Conclusions: Changes in the number and disease structure of hospital days due to population ageing will require reorganisation and restructuring of hospital departments. In the case of long-term care a high increase in professional home care and institutional care will be required. Health policy has to take into account these developments in order to adequately deal with future demand for these services.