The effect of trends in health and longevity on health services use by older adults

Abstract

Background: The effect of population aging on future health services use depends on the relationship between longevity gains and health. Whether further gains in life expectancy will be paired by improvements in health is uncertain. We therefore analyze the effect of population ageing on health services use under different health scenarios. We focus on the possibly diverging trends between different dimensions of health and their effect on health services use.

Methods: Using longitudinal data on health and health services use, a latent Markov model has been estimated that includes different dimensions of health. We use this model to perform a simulation study and analyze the health dynamics that drive the effect of population aging. We simulate three health scenarios on the relationship between longevity and health (expansion of morbidity, compression of morbidity, and the dynamic equilibrium scenario). We use the scenarios to predict costs of health services use in the Netherlands between 2010 and 2050.

Results: Hospital use is predicted to decline after 2040, whereas long-term care will continue to rise up to 2050. Considerable differences in expenditure growth rates between scenarios with the same life expectancy but different trends in health are found. Compression of morbidity generally leads to the lowest growth. The effect of additional life expectancy gains within the same health scenario is relatively small for hospital care, but considerable for long-term care.

Conclusions: By comparing different health scenarios resulting in the same life expectancy, we show that health improvements do contain costs when they decrease morbidity but not mortality. This suggests that investing in healthy aging can contribute to containing health expenditure growth.

Fig. 1

The relationship between the latent health variable and the observed health indicators. Expected values of the observed health indicators for each latent health state. Values have been standardized to lie between 0 (best outcome) and 1 (worst outcome)

Fig. 2

The relationship between the latent health variable and costs of health services use. The age curve of expected costs of health services use (hospital care, home care, long term care) for men (with baseline characteristics) for each latent health state

Fig. 3

The expected remaining lifeyears and health expenditures spent in each health state for 65-years old for men under different scenarios. 1 expansion of morbidity, 2 compression of morbidity, 3 dynamic equilibrium. o indicates the scenarios without changes in the health of new cohorts of 65-years old, + the scenarios including health changes at 65, and ++ scenarios with additional gains in life expectancy

Fig. 4

Health composition of the population in 2010 and projection for 2050 under different scenarios. The number of people in each health state per age group (women left, men right)

Fig. 5

Predictions of expenditures between 2010 and 2050, for hospital care, home care, and long-term care, for each scenario