2012年-CEPS欧洲政策研究中心_Objective_Trends_and_Perceptions_of_Health_Status_in_Germany_18页_190kb

Summary of "Objective Trends and Perceptions of Health Status in Germany"

Core Content

This research report, authored by Christina Felfe and published by ENEPRI in August 2006, examines the objective trends and subjective perceptions of health status in Germany using data from the German Socio-Economic Panel (GSOEP) from 1984 to 2003. The study focuses on how changes in health status and healthcare utilisation have influenced healthcare expenditures, and explores the determinants of health status, including demographic, socioeconomic, and lifestyle factors.

Main Trends in Health Status

Health Satisfaction

• Overall Decline: Health satisfaction has generally declined over the past two decades, with a notable improvement in recent years.
• Age-related Decline: Satisfaction with health worsens as people age, with a peak in early adulthood and a steady decline thereafter.
• Cohort Differences: Younger cohorts (born in the 1970s and 1960s) show higher satisfaction with their health compared to older cohorts, indicating a shift in expectations or improved health conditions.
• East-West Disparity: East Germans have historically reported lower satisfaction with their health than West Germans, but this gap has narrowed over time.

Disability

• Age-related Increase: The degree of disability increases with age, with a sharp rise among the elderly.
• Retirement Impact: There is a noticeable peak in disability around retirement age for men, but not for women, suggesting a possible work-related component.
• Improvement Over Time: Despite the general increase in disability, there has been some improvement in recent years, particularly among younger age groups.

Hindered by Health Status

• Age-related Increase: The likelihood of being hindered by health in daily life increases with age.
• Steady Improvement: From age 40 to around 70, the percentage of people hindered by health has decreased, primarily due to a reduction in those severely hindered.
• Gender Differences: Men are more likely to be hindered by health than women, though the gap is not as pronounced as in the case of disability.

Chronic Illness

• Rising Prevalence: The prevalence of chronic illnesses increases with age.
• Upward Trend in 1990s: There was a notable increase in chronic illness prevalence in the 1990s compared to the 1980s.
• Elderly Impact: The increase in chronic illnesses was particularly pronounced for individuals over 65.
• Limited Data: No data is available for the period after 2003, limiting the ability to draw long-term conclusions.

Trends in Healthcare Utilisation

Hospital Stays

• Rising Frequency: The number of hospital stays increased significantly from 1984 to 2000, especially among individuals over 45.
• Recent Decline: After 2000, the average number of hospital stays per year has declined.
• East-West Difference: In the early 1990s, East Germans had fewer hospital stays than West Germans, but this difference has disappeared in recent years.
• Age and Gender Patterns: Women in their 20s-30s are more likely to be hospitalized due to childbirth, while men are more likely to be hospitalized at older ages.

Duration of Hospital Stays

• Shorter Stays: While the number of hospital stays has increased, the average duration per stay has decreased, except for elderly individuals in the early 1990s.
• Overall Decline: The overall rate of hospital usage has decreased since 2000.

Doctor Visits

• Declining Frequency: The percentage of people visiting the doctor has decreased over the past two decades, with a slight increase in the early 1990s.
• Age and Gender Patterns: The decline in doctor visits is more pronounced among younger individuals, possibly due to improved health or reduced preventative care.
• East-West Disparity: East Germans have lower rates of doctor visits compared to West Germans, which may be linked to differences in healthcare access or use patterns.

Determinants of Health Status

Multivariate Analysis

• Sample Size: A sample of about 21,000 individuals aged 16 and older was used.
• Variables Considered: The analysis included age, gender, education, marital status, origin (East or West Germany), job prestige, income, and type of health insurance.
• Health Satisfaction:
  • Age: A negative effect on health satisfaction.
  • Age Squared: A positive effect, indicating a U-shaped relationship with age.
  • Gender: Women report lower satisfaction than men.
  • Origin: West Germans report higher satisfaction.
  • Education: Higher education is associated with greater health satisfaction.
  • Marital Status: Separated and widowed individuals report higher satisfaction than married individuals.
  • Job Prestige and Income: Both are positively correlated with health satisfaction.
  • Private Insurance: Has a positive effect on health satisfaction.
• Hindered by Health Status:
  • Age: A negative effect, indicating greater hindrance with age.
  • Age Squared: A positive effect, suggesting a more pronounced impact as people age.
  • Gender: Being female increases the likelihood of being hindered.
  • Origin: West Germans are less hindered than East Germans.
  • Education: Higher education is associated with lower hindrance.
  • Marital Status: Separated and widowed individuals are more likely to be hindered.
  • Job Prestige and Income: Better job and income are associated with lower hindrance.
  • Private Insurance: Has a positive effect on the degree of hindrance.

Key Findings

• Health Expenditure Drivers: Rising healthcare expenditures in Germany are attributed to population aging, medical technology advances, and increased public expectations.
• Subjective vs. Objective Measures: While objective health status (e.g., disability, hindrance) has improved, subjective health satisfaction has declined, suggesting that expectations may be rising.
• Cohort Effects: Younger cohorts have higher expectations and perceive their health to be worse, even if objective health status has not significantly deteriorated.
• Private Insurance Influence: Private insurance is associated with better access to healthcare services but does not necessarily correlate with better health outcomes or satisfaction.

Conclusion

The report highlights the complex relationship between health status, healthcare utilisation, and healthcare expenditures in Germany. It underscores the importance of considering both objective and subjective indicators of health when designing healthcare policies. The findings suggest that while the objective health status of the population has improved, the perception of health has worsened, possibly due to rising expectations. Understanding these trends and determinants can help policymakers address the challenges of healthcare financing and service delivery in an aging society.