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The effect of age and time to death on health care expenditures: the Italian experience

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Abstract

A large body of literature, mainly based on hospital costs, shows that time to death (TTD) is by far a better predictor of health spending than age. In this paper, we investigate if this finding holds true also in presence of outpatient costs (drugs, diagnostic tests and specialist visits). Our analysis is based on data obtained from the Health Search-SiSSI database, which contains patient-level data collected routinely by General Practitioners in Italy since 2002. We study individuals aged 19 and older, during years 2006-2009. By means of a two-part model, which accounts for the presence of zero expenditure, we find that TTD is a good predictor of outpatient costs in Italy, but age remains a strong driver. These results suggest that age and TTD can have different role in shaping health care costs according to the component of health expenditure examined. Therefore, our advice to policy makers is to use disaggregated models to better disentangle these contributions in order to produce more reliable health spending forecasts.

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Bibliographic Info

Paper provided by Tor Vergata University, CEIS in its series CEIS Research Paper with number 267.

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Length: 26 pages
Date of creation: 08 Mar 2013
Date of revision: 12 Nov 2013
Handle: RePEc:rtv:ceisrp:267

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Postal: CEIS - Centre for Economic and International Studies - Faculty of Economics - University of Rome "Tor Vergata" - Via Columbia, 2 00133 Roma
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Keywords: ageing; time to death; outpatient health care expenditure; cost of dying;

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  1. Peter Zweifel & Stefan Felder & Andreas Werblow, 2004. "Population Ageing and Health Care Expenditure: New Evidence on the “Red Herring”," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan, vol. 29(4), pages 652-666, October.
  2. Huber, Hélène & Dormont, Brigitte, 2006. "Causes of health expenditure growth : the predominance of changes in medical practices over population ageing," Economics Papers from University Paris Dauphine 123456789/1630, Paris Dauphine University.
  3. Felder, Stefan & Werblow, Andreas & Zweifel, Peter, 2010. "Do red herrings swim in circles? Controlling for the endogeneity of time to death," Journal of Health Economics, Elsevier, vol. 29(2), pages 205-212, March.
  4. Colombier, Carsten & Weber, Werner, 2009. "Projecting health-care expenditure for Switzerland: further evidence against the 'red-herring' hypothesis," MPRA Paper 26747, University Library of Munich, Germany, revised Nov 2009.
  5. Federico Belotti & Partha Deb, 2012. "TPM: Stata module to estimate two-part cross-sectional models," Statistical Software Components S457538, Boston College Department of Economics, revised 10 Aug 2013.
  6. Seshamani, Meena & Gray, Alastair M., 2004. "A longitudinal study of the effects of age and time to death on hospital costs," Journal of Health Economics, Elsevier, vol. 23(2), pages 217-235, March.
  7. Andreas Werblow & Stefan Felder & Peter Zweifel, 2007. "Population ageing and health care expenditure: a school of 'red herrings'?," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1109-1126.
  8. Meena Seshamani & Alastair Gray, 2004. "Ageing and health-care expenditure: the red herring argument revisited," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 303-314.
  9. de Meijer, Claudine & Koopmanschap, Marc & d' Uva, Teresa Bago & van Doorslaer, Eddy, 2011. "Determinants of long-term care spending: Age, time to death or disability?," Journal of Health Economics, Elsevier, vol. 30(2), pages 425-438, March.
  10. Sergi Jiménez-Mart�n & José M. Labeaga & Maite Mart�nez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321.
  11. Zhou Yang & Edward C. Norton & Sally C. Stearns, 2003. "Longevity and Health Care Expenditures," Journals of Gerontology: Series B, Gerontological Society of America, vol. 58(1), pages S2-S10.
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