Age and Ageing, Vol 29, 249-253, Copyright © 2000 by British Geriatrics Society
K McGrail, B Green, M Barer, R Evans, C Hertzman and C Normand
Background. The consequences of ageing populations for
health care costs have become a concern for governments and health care
funders in most countries. However, there is increasing evidence that costs
are more closely related to proximity to death than to age. This means that
projections using age-specific costs will exaggerate the impact of ageing.
Previous studies of the relationship of age, proximity to death and costs
have been restricted to acute medical care.Objective.
To assess the effects of age and proximity to death on costs of
both acute medical care and nursing and social care, and to assess if this
relationship was stable in a time of rapid change in health care
expenditure.Design and methods. We compared all
decedents in the chosen age categories for the years 1987-8 and 1994-95
with all survivors in the same age groups. We measured use of health and
social care for each individual using the British Columbia linked data, and
costs of care assessed by multiplying the number of services by the unit
cost of each service.Setting. The Province of British
Columbia.Subjects. All decedents in 1987-88 and
1994-95 in British Columbia in the chosen age groups, and all survivors in
the same age groups.Results. Costs of acute care rise
with age, but the proximity to death is a more important factor in
determining costs. The additional costs of dying fall with age. In
contrast, costs of nursing and social care rise with age, but additional
costs for those who are dying increase with age. Similar patters were found
for the two cohorts.Conclusion. Age is less important
than proximity to death as a predictor of costs. However, the pattern of
social and nursing care costs is different from that for acute medical
care. In planning services it is important to take into account the
relatively larger impact of ageing on social and nursing care than on acute
care.Keywords: ageing, health care costs
ARTICLES
Age, costs of acute and long-term care and proximity to death: evidence for 1987-88 and 1994-95 in British Columbia
Centre for Health Services and Policy Research, University of British Columbia, Canada; Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Health Services Research Unit, Keppel Street, London, WC1E 7HT, UK; Corresponding author; Fax: (+44) 171 580 8183; E-mail: c.normand@lshtm.ac.uk
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