2012年-CEPS欧洲政策研究中心_Health_and_Morbidity_by_Age_and_Socio_124页_857kb

Summary of "Health and Morbidity by Age and Socio-Economic Characteristics"

Core Content

This research report, published by ENEPRI in November 2005, examines the relationship between health status and health services utilisation across the EU-15 member states, focusing on how these are influenced by age and socio-economic characteristics. It is part of the AHEAD project, which investigates the determinants of health expenditure in the context of an ageing population.

The report uses longitudinal micro-data from the European Community Household Panel (ECHP) to estimate multivariate models of health status and health services utilisation. It analyses both cross-sectional and panel data to distinguish between the effects of ageing and cohort differences.

Main Views and Key Findings

1. Health Expenditure Trends

• Medical treatment expenditure has been increasing as a proportion of national income in the EU.
• An ageing population is expected to further increase pressure on health expenditure.
• While many studies highlight that time to mortality, not age, is a key determinant of health care costs, this report focuses on the direct effect of age due to the nature of its data.

2. Data and Methodology

• The ECHP provides harmonised longitudinal data on individuals in private households across most EU-15 countries, covering the period from 1994 to 2001.
• Data availability varies across countries and waves, with some countries (e.g., Luxembourg) excluded due to lack of health-related data.
• Two indicators of health status are used: self-assessed health (SAH) and chronic illness.
• Two indicators of health services utilisation are used: general practitioner (GP) visits and hospital in-patient nights.
• Socio-economic variables such as age, gender, employment status, marital status, education, and income are controlled for in the analysis.
• The report also includes a panel analysis to separate the effects of age and cohort.

3. Key Results

• Health Status and Age: As age increases, health status tends to worsen. However, much of this variation is explained by socio-economic characteristics.
• Health Services Utilisation and Age: The use of health services increases with age, but this relationship is also influenced by socio-economic factors.
• Gender Differences: Women generally report worse health status and higher use of GP services compared to men, though there is no significant difference in hospital nights.
• Country Differences: The age-health and age-utilisation relationships vary by country, influenced by cultural and institutional factors such as the gate-keeping role of GPs and access to free care.
• Panel vs. Cross-sectional Data: Panel models (which follow the same individuals over time) show greater variation in health services utilisation at older ages and suggest a stronger age effect than cross-sectional models.

4. Limitations and Considerations

• The panel data is relatively short (seven years), which limits the ability to fully distinguish between age and cohort effects.
• The cross-sectional models use count data methods, while panel models use simple OLS, which may affect comparability.
• There is potential for bias due to attrition, and data from the UK and Germany are adjusted using national sources (GSOEP and BHPS) after 1997.
• The report uses a fixed set of boundaries for SAH categories without adjusting for reporting heterogeneity, which may affect the interpretation of age effects.

Conclusion

The research concludes that while age has a significant impact on health status and health services utilisation, much of the variation is explained by socio-economic characteristics. This supports the argument that the key driver of health care costs is not age per se, but the time to mortality associated with ageing. The findings also highlight that cultural and institutional differences across EU countries play a role in shaping these relationships. The study provides a foundation for future work that will explore the links between ageing, health service utilisation, and health expenditures in more depth.

Key Information

• Data Source: European Community Household Panel (ECHP), 1994–2001.
• Countries Analyzed: EU-15, with some data from national sources (GSOEP, BHPS, PSELL).
• Health Indicators: Self-assessed health (SAH), chronic illness.
• Utilisation Indicators: GP visits, hospital in-patient nights.
• Socio-Economic Variables: Age, gender, employment status, marital status, education, income, and household composition.
• Methodology: Cross-sectional and panel models; ordered response models and interval regression used for SAH.
• Main Outcomes:
  • Ageing is associated with worse health and higher health service use, but socio-economic factors explain much of the variation.
  • Women report worse health and use more GP services than men.
  • Institutional and cultural factors influence health service utilisation patterns.
  • Panel models show more variability in health service use at older ages.

Structure

• Abstract: Summarises the purpose and key findings of the study.
• Summary: Provides an overview of the research, its aim, and main conclusions.
• Data and Research Methods: Describes the data sources, variables, and analytical approaches.
• Results: Includes cross-sectional and panel analyses, highlighting differences in health status and utilisation by age, gender, and country.
• Conclusion: Summarises the implications of the findings for health policy and future research.

References and Appendices

• The report includes references to supporting literature (e.g., Seshamani & Gray, 2004; van Doorslaer & Jones, 2003; Lindeboom & van Doorslaer, 2004).
• Appendices A, B, and C provide detailed variable definitions, data availability, and additional results.