CENTRE OF COMPETENCE BIOSCIENCES Impact of longevity and ageing Compression or extension of morbidity and costs? Dr. Jürgen Becher IAAHS Colloquium 2004 April 28 – 29, 2004, Dresden Münchener Rück Munich Re Group
Compression or extension Munich Re Longevity Aging of population Low birth Effects of volume "Baby boomers" rates 2
Theory: compression or extension of morbidity?
Compression or extension Munich Re The impact of longevity on morbidity � Today Current situation Morbidity � Tomorrow Scenario I Compression Scenario II Extension/medicalisation 0 Age 55 70 75 80 4 Source: Schwartz 1997, Fries 1989
What kind of evidence is available?
Compression or extension Munich Re 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“ 6
Compression or extension Munich Re Available evidence 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 7
Munich Re survey
Compression or extension Munich Re Aspects considered in the Munich Re survey – Medication – Out-patient benefits – In-patient benefits – Need for long-term care – State of health – Specific diseases – Total health expenditure 9
Compression or extension Munich Re Methods used in the Munich Re survey – 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) 10
Results (in extracts)
Compression or extension Munich Re Results – Medication – 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 12
Compression or extension Munich Re Per-capita drug expenditure (Belgium) 14000 BEF 1986 1990 1993 1996 12000 BEF Per-capita drug expenditure 10000 BEF 8000BEF 6000 BEF 4000 BEF 2000 BEF 0 0-4 5-11 12-19 20-29 30-39 40-54 55-64 65-79 80+ Source: Van Tielen 1998 13
Compression or extension Munich Re Results – Outpatient benefits 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) 14
Compression or extension Munich Re Results – In-patient treatment – 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 15
Compression or extension Munich Re Frequency of hospital admissions (Spain) 800 1994 700 1985 (population adj. to 1994) Frequency x1000 600 +26% +49% 500 400 300 25-34 35-44 45-54 55-64 65-74 75+ Age Source: Gornemann 2002 16
Compression or extension Munich Re Monthly in-patient treatment costs (USA, Medicare) 4000 In the year preceding death More than one year prior to death Monthly costs (in 1998 $) 3000 2000 1000 0 65 70 75 80 85 90 95 100 Age Source: Yang 2003 17
Costs for patients close to death : development over time
Compression or extension Munich Re Age distribution of heart surgery 1990-2001 (D) 40 37 35.4 35 32.9 30 28.7 1990 2001 25 20 Per cent 15.1 15 12.4 9.4 10 5.4 5.2 5 3.6 2.6 1.9 2.5 1.5 1.3 1.4 1.4 1 0.6 0.6 0 <1 1 > 10 10 > 20 20 > 30 30 > 40 40 > 50 50 > 60 60 > 70 70 > 80 80 > Age groups Source: Bruckenberger 2002 19
Compression or extension Munich Re Per-capita in-patient costs by survival status (DKV, full-coverage plan, age group 75-79 years in 1999) 30000 25000 Per-capita costs (DM/year) Dead 20000 Survivors 15000 10000 5000 0 1993 1994 1995 1996 1997 1998 1999 Year Source: Ziegenhagen 2002 20
Conclusions
Missing links Longevity Feeling better Reduced disability More chronic disease Increasingly eleborate and costly medical care
Compression or extension Munich Re Is there compression? – 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 23
Compression or extension Munich Re The impact of longevity on morbidity/costs � Today Current situation Morbidity � Tomorrow Scenario III Attenuated extension 0 Age 55 70 75 80 24
Compression or extension Munich Re 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) 25
Thank you for your interest Dr. Jürgen Becher Münchener Rück Munich Re Group Münchener Rück Munich Re Group
Compression or extension Munich Re Visits to the doctor by age (USA) 700 under 15 15-24 25-44 45-64 65 and over 600 Visits to the doctor per 100 persons 500 400 300 200 100 0 1985 1989-1990 1995-1996 1997-1998 1999 Source: Cherry 2001 27
Compression or extension Munich Re In-patient costs for male patients (Germany, private health insurance) Gesamtausgaben 8000 7000 Costs (DM) per capita Medizinische Versorgung 6000 Kosten pro Person ($) per year 5000 4000 3000 Heimpflege 2000 1000 1994 1991 1988 0 1985 1982 1979 Year Age group Source: Buchner 2002 28
Compression or extension Munich Re Age distribution of health expenditure over time (USA 1953-1987) 6 1953 1963 1970 1977 1987 5 4 Relative costs (age 35-44=1) 3 2 1 0 <1Yr 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 Age Source: Cutler 1999 29
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