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"Though Much is Taken" -- Reflections on Aging, Health, and Medical Care


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  • Victor R. Fuchs


The Medicare trust funds face huge prospective deficits by the end of this decade.This paper discusses trends in six areas that bear on the Medicare problem: the number of the elderly, their health status, use of medical care, labor force participation, income, and living arrangements. Among the most important findings are: 1) a very large increase since 1965 in life expectancy at age 65; 2) a very large increase since 1976 in real per capita health care expenditures on the elderly relative to expenditures on persons under age 65; 3) a cross-sectional increase with age in per capita health care expenditures that is primarily attributable to very large expenditures in the last year of life; 4) a sharp decrease in labor force participation and a sharp increase in relative income of the elderly since 1965.The paper concludes by raising questions about the need to reconsider the definition of the elderly, the need for more flexible labor market arrangements for older workers, and a need for a social consensus concerning appropriate care of dying patients.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 1269.

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Date of creation: Jan 1984
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Publication status: published as Fuchs, Victor R. "'Though Much Is Taken': Reflections on Aging, Health, and Medical Care." Milbank Memorial Fund Quarterly/Health and Society, Vol. 62, No. 2, (Spring 1984), pp. 143-166.
Handle: RePEc:nbr:nberwo:1269

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  1. Alan M. Garber & Victor R. Fuchs & James F. Silverman, 1983. "Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital," NBER Working Papers 1159, National Bureau of Economic Research, Inc.
  2. Victor R. Fuchs, 1982. "Self-Employment and Labor Force Participation of Older Males," Journal of Human Resources, University of Wisconsin Press, vol. 17(3), pages 339-357.
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Cited by:
  1. Thomas Barnay & Sophie Thiébaut & Bruno Ventelou, 2010. "Health and Early Retirement: Ageing, chronic conditions and the evolution of future drugs expenditures," TEPP Working Paper 2010-08, TEPP.
  2. Afschin Gandjour, 2009. "Aging diseases - do they prevent preventive health care from saving costs?," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 355-362.
  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. Michael J. Boskin & John B. Shoven, 1987. "Concepts and Measures of Earnings Replacement During Retirement," NBER Working Papers 1360, National Bureau of Economic Research, Inc.
  5. John B. Shoven, 2007. "New Age Thinking: Alternative Ways of Measuring Age, Their Relationship to Labor Force Participation, Goverment Policies and GDP," NBER Working Papers 13476, National Bureau of Economic Research, Inc.
  6. Firl, Daniel J., 2011. "Modeling healthcare quality: life expectancy SURS in the G7 countries and Korea," MPRA Paper 33900, University Library of Munich, Germany.
  7. Tetsuji Yamada & Tadashi Yamada, 1987. "Social Security and Earlier Retirement in Japan: Cross-Sectional Evidence," NBER Working Papers 2442, National Bureau of Economic Research, Inc.
  8. Breyer, Friedrich & Felder, Stefan, 2006. "Life expectancy and health care expenditures: A new calculation for Germany using the costs of dying," Health Policy, Elsevier, vol. 75(2), pages 178-186, January.
  9. Stefan Felder, 2013. "The Impact of Demographic Change on Healthcare Expenditure," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, vol. 11(1), pages 03-06, 04.
  10. 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.
  11. Kildemoes, Helle Wallach & Christiansen, Terkel & Gyrd-Hansen, Dorte & Kristiansen, Ivar Sonbo & Andersen, Morten, 2006. "The impact of population ageing on future Danish drug expenditure," Health Policy, Elsevier, vol. 75(3), pages 298-311, February.
  12. Hilke Brockmann, 2000. "Why is health treatment for the elderly less expensive than for the rest of the population? Health care rationing in Germany," MPIDR Working Papers WP-2000-001, Max Planck Institute for Demographic Research, Rostock, Germany.
  13. Wolfgang Lutz, 2010. "Education will be at the heart of 21st century demography," Vienna Yearbook of Population Research, Vienna Institute of Demography (VID) of the Austrian Academy of Sciences in Vienna, vol. 8(1), pages 9-16.
  14. Ried, Walter, 2007. "On the relationship between aging, edical progress and age-specific health care expenditures," Wirtschaftswissenschaftliche Diskussionspapiere 08/2007, Ernst Moritz Arndt University of Greifswald, Faculty of Law and Economics.
  15. Thomas Barnay & Sophie Thiebault & Bruno Ventelou, 2010. "Ageing, chronic conditions and the evolution of future drugs expenditures," Working Papers halshs-00809736, HAL.
  16. 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.


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