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Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals


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  • Brockmann, Hilke
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    The consequences of population ageing for the public health care system and health care costs may be less severe than is commonly assumed. Hospital discharge data from Germany's largest health insurer (AOK) show that the cost of caring for patients during their last year of life makes up a large part of total health expenditures. And this last year of life is less costly if patients die at an advanced age. As a multivariate analysis reveals, oldest old patients as a rule receive less costly treatment than younger patients for the same illness. Moreover, this pattern is more pronounced for elderly women than for elderly men. These findings suggest that health care is informally rationed according to the age and sex of the patient. The data also indicate that there may be more age-related rationing going on in Germany than in the United States. Future research should investigate the national, institutional, and individual factors behind health care rationing. In this paper, I discuss the physician's professional decision as one plausible determinant.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 55 (2002)
    Issue (Month): 4 (August)
    Pages: 593-608

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    Handle: RePEc:eee:socmed:v:55:y:2002:i:4:p:593-608

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    Keywords: Elderly Health care expenditures Health care rationing Germany;


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    Cited by:
    1. Dieter Cassel & Andreas Postler, 2007. "Alternde Bevoelkerung und Gesundheitsausgaben, Eine theoretische Analyse demographischer Ausgabeneffekte auf den Beitragssatz der GKV," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), Justus-Liebig University Giessen, Department of Statistics and Economics, vol. 227(5+6), pages 578-602, December.
    2. Gielen, Birgit & Remacle, Anne & Mertens, Raf, 2010. "Patterns of health care use and expenditure during the last 6 months of life in Belgium: Differences between age categories in cancer and non-cancer patients," Health Policy, Elsevier, vol. 97(1), pages 53-61, September.
    3. Murphy, Michael & Martikainen, Pekka, 2013. "Use of hospital and long-term institutional care services in relation to proximity to death among older people in Finland," Social Science & Medicine, Elsevier, vol. 88(C), pages 39-47.
    4. Gandjour, Afschin & Lauterbach, Karl Wilhelm, 2005. "Does prevention save costs?: Considering deferral of the expensive last year of life," Journal of Health Economics, Elsevier, vol. 24(4), pages 715-724, July.
    5. Emi Sato & Kiyohide Fushimi, 2009. "What has influenced patient health-care expenditures in Japan?: variables of age, death, length of stay, and medical care," Health Economics, John Wiley & Sons, Ltd., vol. 18(7), pages 843-853.
    6. Melberg, Hans Olav & Sørensen, Jan, 2013. "How does end of life costs and increases in life expectancy affect projections of future hospital spending?," HERO On line Working Paper Series 2013:9, Oslo University, Health Economics Research Programme.
    7. Louise Sheiner, 2004. "The effects of technology on the age distribution of health spending: a cross-country perspective," Finance and Economics Discussion Series 2004-14, Board of Governors of the Federal Reserve System (U.S.).
    8. Ishizaki, Tatsuro & Imanaka, Yuichi & Oh, Eun-Hwan & Sekimoto, Miho & Hayashida, Kenshi & Kobuse, Hiroe, 2008. "Association between patient age and hospitalization resource use in a teaching hospital in Japan," Health Policy, Elsevier, vol. 87(1), pages 20-30, July.
    9. Wörz, Markus, 2011. "Financial consequences of falling ill: Changes in the German health insurance system since the 1980s," Discussion Papers, Research Unit: Inequality and Social Integration SP I 2011-209, Social Science Research Center Berlin (WZB).


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