2012年-CEPS欧洲政策研究中心_A_Survey_of_the_Impact_of_Death_13页_161kb

Summary of the Impact of Death-Related Costs on Health-Care Expenditure and Demographics in Italy

Core Content

This document presents a policy brief based on research conducted under the AHEAD project, which examines the impact of death-related costs on health-care expenditure in Italy. The study explores how demographic changes, particularly aging, influence health spending, with a focus on distinguishing between "old age costs" (spending due to aging) and "death costs" (spending due to the event of dying). It also reviews the empirical literature on the relationship between age, proximity to death, and health expenditure, and provides detailed regional data from four Italian regions: Lombardy, Tuscany, Abruzzi, and Apulia.

Main Findings

1. Age and Health Expenditure

• Health-care expenditure increases with age, following a J-shaped curve.
• The ratio of per capita healthcare expenditure between deceased and survivors is significantly higher for deceased individuals, especially at older ages.
• In the last year of life, healthcare costs for the deceased are much higher than for survivors.

2. Death-Related Costs

• Death-related costs are not solely a function of age but are more closely related to the proximity to death.
• These costs are concentrated in the final months of life, with the highest per capita expenditure in the last month before death.
• The ratio between deceased and survivor healthcare costs by age varies, with higher ratios for older age groups and lower ones for younger ages.

3. Regional Analysis in Italy

• The study uses data from four Italian regions, which together account for more than 19 million people (one-third of the population).
• The ratio of per capita expenditure for deceased to survivors ranges from 10 to 14 for all ages, and drops to 1 or 2 for those over 90 years old.
• The results show that, for men and women over 55-59 years old, the deceased spend 26% and 18%, respectively, of what survivors spend.

4. Methodology

• The study uses a two-step method: first, assembling individual-level healthcare consumption databases; second, computing health expenditure by age and gender, and by proximity to death.
• Data linkage methods differ by region: Lombardy and Tuscany use fiscal numbers, while Abruzzi and Apulia use a statistical method with an estimated 5% error rate.
• The data covers hospital care and, in some regions, outpatient specialist care and pharmaceutical costs.

5. Comparative Analysis with OECD Countries

• The results are comparable to other OECD countries, with similar trends in the ratio of deceased to survivor healthcare costs.
• For example, in the Netherlands, the ratio is 11.5 for all ages, while in the USA it is around 9 for 70-74 years and 5 for 80-84 years.

Key Implications

• Policy Relevance: The study highlights the importance of considering death-related costs in health expenditure projections, as they significantly affect the perceived impact of aging on healthcare spending.
• Efficiency and Accountability: Including death costs in projections reduces concerns about excessive future healthcare spending, suggesting that age alone is not a reliable predictor.
• Regional Variability: Despite geographical and institutional differences, the four Italian regions show similar patterns in health expenditure related to aging and death.
• Need for Further Research: While the study focuses on hospital costs, it suggests the need for extending the analysis to other healthcare expenditure categories, such as long-term care, to gain a more comprehensive understanding.
• Macro-Level Projections: The distinction between old age costs and death costs can inform long-term healthcare expenditure forecasts at the national and EU levels.

Conclusion

The findings indicate that aging does not necessarily lead to a dramatic increase in healthcare costs when death-related costs are accounted for. This has important implications for policy-making, as it challenges the conventional assumption that aging is the primary driver of health expenditure growth. The study supports a more nuanced approach to health expenditure projections, emphasizing the need to incorporate proximity to death as a key variable.

References

• The research is part of the AHEAD project, funded by the European Commission.
• The methodology is based on the work of Bartolacci et al. (2001).
• The results have been used by the Italian government (Ragioneria Generale dello Stato) and the EU Working Group on Ageing Populations (AWG) in health expenditure projections.