2012年-CEPS欧洲政策研究中心_Incidence_of_Poor_Health_and_Long_117页_550kb

Summary of "Incidence of Poor Health and Long-Term Care Health Transitions in Europe – Results from the European Community Household Panel Survey and Institutional Data"

Core Content

This report is the final output of Work Package 3 of the AHEAD project, which aimed to estimate annual probabilities of health state transitions, including mortality and permanent institutionalisation, using the European Community Household Panel (ECHP) data. The results are intended to support the estimation of healthy life expectancy and forecasting of future health expenditure needs. The study also explores the use of alternative data sources for countries where ECHP data is insufficient.

Main Purpose

The main goal of this work package is to provide a methodological basis for estimating health transitions in Europe. These transitions are essential for understanding the dynamics of health and long-term care needs, which is more informative than relying solely on prevalence data.

Key Definitions and Measures

Two primary measures of health state are used in the analysis:

• Self-assessed health (SAH): A subjective measure that captures individuals' general perception of their health, typically reported as "Very good, good, fair, bad, very bad".
• Chronic, hampering health condition: A more objective measure that combines the presence of a chronic condition with the degree of its impact on daily activities.

These measures are used to estimate transition probabilities between different health states for adults in private households and for those over 65, specifically focusing on first-time admission to long-term care institutions.

Methodological Challenges

The study faced several challenges:

• Sample attrition: The ECHP data suffers from attrition, particularly in health status reporting, which affects the reliability of the results.
• Mortality and institutionalisation reporting issues: Inconsistent and incomplete data on mortality and institutionalisation led to the need for post-stratification and alternative data sources.
• Data comparability: Differences in national reporting practices and data collection methods across countries made cross-national comparisons difficult.

Data Coverage

• Full results are available for: Belgium, the UK, Ireland, and Italy.
• Partial results are available for: Germany, Denmark, the Netherlands, Greece, Portugal, and Finland.
• No results are available for Sweden and Luxembourg due to limited or non-existent ECHP participation in health transition analysis.

Estimation Method

• The transition probabilities are presented in the form of probit equations, allowing for estimation by age and gender.
• Post-stratification was used to adjust for mortality underreporting.
• Alternative data sources were employed to obtain institutionalisation rates for countries where ECHP data was insufficient.

Consequences of Data Gaps

• The lack of reliable institutionalisation data in some countries (e.g., Sweden and Luxembourg) limits the completeness of the analysis.
• The report highlights the importance of addressing these gaps to improve the accuracy of health transition models.

Implications and Recommendations

• The use of self-assessed health as a measure has been widely accepted due to its predictive power for mortality, despite concerns about international comparability.
• There is a need for more objective measures of disability and health status to validate self-assessed health and improve the accuracy of health transition estimates.
• The EU Statistics on Income and Living Conditions (SILC), the successor to ECHP, offers more focused data but lacks the full longitudinal depth of ECHP.

Conclusion

This report represents a significant contribution to understanding health transitions in Europe. It underscores the importance of longitudinal data for forecasting health and care needs, while also highlighting the methodological and data limitations that must be addressed to improve the reliability of such estimates.

Main Points

• Objective: Estimate health state transitions for populations over 65, including mortality and institutionalisation.
• Data Source: European Community Household Panel (ECHP), with some data supplemented from alternative sources.
• Health Measures: Self-assessed health (SAH) and chronic, hampering health condition.
• Methodology: Probit models, post-stratification, and use of alternative data sources.
• Challenges: Sample attrition, underreporting of mortality and institutionalisation, and differences in national data collection practices.
• Findings: Full results for four countries, partial for six, and no results for two. SAH is a robust predictor of mortality but has issues with international comparability.
• Recommendations: More research is needed to validate SAH against objective measures and to improve data collection for institutionalisation.

Key Information

• Project: AHEAD (Ageing, Health Status and the Determinants of Health Expenditure).
• Institution: Personal Social Services Research Unit (PSSRU), University of Kent.
• Funding: European Commission, 6th Research Framework Programme.
• Report Number: ENEPRI Research Report No. 34.
• Publication Date: December 2006.
• ISBN: 92-9079-649-9.
• Data Period: 1994–2001.
• Data Sources: ECHP and national surveys, with some data from SILC.

Comparative Insights

• The ECHP provides a unique opportunity for comparative analysis across EU countries.
• However, its data is not without limitations, especially regarding institutionalisation and mortality.
• The report emphasizes the importance of considering health dynamics rather than static prevalence data for accurate forecasting.