Counting backward to health care's future: using time-to-death modeling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures

Abstract

In most developed countries, as the largest population cohorts approach the age of sixty-five, the impact of population aging on health care expenditures has become a topic of growing interest. This articles examines trends in elderly disability and end-of-life morbidity, estimations of the cost of dying, and models of expenditures as a function of both age and time-to-death and finds broad improvement in mortality and morbidity among the elderly in the developed world. Reduced mortality and low growth in the costs associated with dying could reduce forecasted expenditures, but high growth in expenditures for those not close to death and for nonhospital services could create new economic pressures on health care systems.

FIGURE 1

U.S. Per Capita Health Expenditures and Death Rates by Age Group, 1999–2000.

FIGURE 2

Illustration of Expansion, Postponement, and Compression of Morbidity Theories. Legend: O = beginning of life; M = onset of end-of-life morbidity; D = death. The shift from the upper to the lower bar in each pair (i.e., from OD to O′D′) represents a change in the population's health and life expectancies for a period of calendar time.