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Demographics and Medical Care Spending: Standard and Non-Standard Effects

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David M. Cutler
Louise Sheiner

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Abstract

In this paper, we examine the effects of likely demographic changes on medical spending for the elderly. Standard forecasts highlight the potential for greater life expectancy to increase costs: medical costs generally increase with age, and greater life expectancy means that more of the elderly will be in the older age groups. Two factors work in the other direction, however. First, increases in life expectancy mean that a smaller share of the elderly will be in the last year of life, when medical costs generally are very high. Furthermore, more of the elderly will be dying at older ages, and end-of-life costs typically decline with age at death. Second, disability rates among the surviving population have been declining in recent years by 0.5 to 1.5 percent annually. Reductions in disability, if sustained, will also reduce medical spending. Thus, changes in disability and mortality should, on net, reduce average medical spending on the elderly. However, these effects are not as large as the projected increase in medical spending stemming from increases in overall medical costs. Technological change in medicine at anywhere near its historic rate would still result in a substantial public sector burden for medical costs.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 6866.

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Date of creation: Dec 1998
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Handle: RePEc:nbr:nberwo:6866

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  1. Robert W. Fogel, 1994. "Economic Growth, Population Theory, and Physiology: The Bearing of Long-Term Processes on the Making of Economic Policy," NBER Working Papers 4638, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  2. Timothy Waidmann & John Bound & Michael Schoenbaum, 1995. "The Illusion of Failure: Trends in the Self-Reported Health of the U.S. Elderly," NBER Working Papers 5017, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  3. James M. Poterba & Lawrence H. Summers, 1987. "Public Policy Implications of Declining Old-Age Mortality," NBER Reprints 0934, National Bureau of Economic Research, Inc.
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  4. Darius Lakdawalla & Tomas Philipson, 1998. "The Rise in Old Age Longevity and the Market for Long-Term Care," NBER Working Papers 6547, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  5. Victor R. Fuchs, 1998. "Health Care for the Elderly: How Much? Who Will Pay for It?," NBER Working Papers 6755, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  6. Samuel H. Preston, 1996. "American Longevity: Past, Present, and Future," Center for Policy Research Policy Briefs 7, Center for Policy Research, Maxwell School, Syracuse University. [Downloadable!]
  7. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February. [Downloadable!] (restricted)
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