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Comments on health and morbidity

Comments on health and morbidity. Marc Koopmanschap iMTA/BMG, Erasmus Medical Centre/University Rotterdam, Netherlands m.koopmanschap@erasmusmc.nl. Questions AHEAD WPI. Describe and model health status and health services use by age and socio-economic status (SES)

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Comments on health and morbidity

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  1. Comments on health and morbidity Marc Koopmanschap iMTA/BMG, Erasmus Medical Centre/University Rotterdam, Netherlands m.koopmanschap@erasmusmc.nl

  2. Questions AHEAD WPI • Describe and model health status and health services use by age and socio-economic status (SES) • Inform policy makers on implications of ageing • Focus on age “effect” on health when controlled for SES

  3. Conclusions AHEAD • Health status & health care costs vs age: strong link, but controlled for SES, modest age effect remains • Evidence concurs with red herring statement that time to mortality is more important than age for health care expenditures

  4. The data (1) • Data on health status and SES look fine (comparability across countries questionable, page 6) • Data on medical consumption ok? • GP visits • LOS for in hospital care -> NOT: long term care, medication, hospital outpatient care, fysical therapy etc. Together: 60 % of health care costs (Heijink 2007)

  5. The data (2) • Age (and SES) pattern of health care costs in several missing parts of health care, may be quite different from GP and in hospital. Especially long term care (community care, home care, nursing home care, psychiatric care) • (see Polder; Heijnk etc,)

  6. Concurs with red herring? • This analysis did not seem to include health care costs during the last year of life • Why then concluding that the results concur with conclusions Zweifel etc?

  7. (A school of) red herrings • Health care costs in last year of life more important thanage • This holds especially for cure sectors, in long term care age also seems an important determinant of health care costs. • (Zweifel HE 99), Polder SSM 2006, Werblow 2007)

  8. My suggestion (1) • Try to repeat this analysis with better individual data (probably from health insurers) on health care expenditure • Data for many more health care services, including long term care; • Include health care costs in last (1 or 2) years before death;

  9. My suggestion (2) • Try to make a longitudinal analysis • Also try to include information on change in health care practice/technology; • Dormont (HE 2006) concluded for France that impact of practice change on costs was much larger than impact of ageing • (pay also attention on differential impact on different age groups)

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