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Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population


  • Howdon, Daniel
  • Rice, Nigel


This paper uses Hospital Episode Statistics, English administrative data, to investigate the growth in admitted patient health care expenditures and the implications of an ageing population. We use two samples of around 40,000 individuals who (a) used inpatient health care in the financial year 2005/06 and died by the end of 2011/12 and (b) died in 2011/12 and had some hospital utilisation since 2005/06. We use a panel structure to follow individuals over seven years of this administrative data, containing estimates of inpatient health care expenditures (HCE), information regarding individuals’ age, time-to-death (TTD), morbidities at the time of an admission, as well as the hospital provider, year and season of admission. We show that HCE is principally determined by proximity to death rather than age, and that proximity to death is itself a proxy for morbidity.

Suggested Citation

  • Howdon, Daniel & Rice, Nigel, 2018. "Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population," Journal of Health Economics, Elsevier, vol. 57(C), pages 60-74.
  • Handle: RePEc:eee:jhecon:v:57:y:2018:i:c:p:60-74
    DOI: 10.1016/j.jhealeco.2017.11.001

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    References listed on IDEAS

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    Cited by:

    1. Nisha C. Hazra & Caroline Rudisill & Martin C. Gulliford, 2018. "Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 831-842, July.
    2. George Stoye & Tom Lee, 2019. "Variation in end-of-life hospital spending in England: Evidence from linked survey and administrative data," IFS Working Papers W19/22, Institute for Fiscal Studies.
    3. Costa-Font, Joan & Vilaplana-Prieto, Cristina, 2020. "More than one red herring? Heterogeneous effects of ageing on healthcare utilisation," LSE Research Online Documents on Economics 104243, London School of Economics and Political Science, LSE Library.
    4. Wittenberg, Raphael & Sharpin, Luke & McCormick, Barry & Hurst, Jeremy, 2017. "The ageing society and emergency hospital admissions," Health Policy, Elsevier, vol. 121(8), pages 923-928.
    5. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond, revised 04 Dec 2018.
    6. Viktor von Wyl, 2019. "Proximity to death and health care expenditure increase revisited: A 15-year panel analysis of elderly persons," Health Economics Review, Springer, vol. 9(1), pages 1-16, December.
    7. Friedrich Breyer & Normann Lorenz, 0. "The “red herring” after 20 years: ageing and health care expenditures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 0, pages 1-7.
    8. Marc Carreras & Pere Ibern & José María Inoriza, 2018. "Ageing and healthcare expenditures: Exploring the role of individual health status," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 865-876, May.
    9. Chang, Shun-Chiao & Lin, Chi-Feng & Yeh, Ta-Chun & Chang, Chun-Wei, 2019. "Determinants of the performance of traditional Chinese medicine clinics in Taiwan," Health Policy, Elsevier, vol. 123(4), pages 379-387.
    10. Niek Stadhouders & Xander Koolman & Christel van Dijk & Patrick Jeurissen & Eddy Adang, 2019. "The marginal benefits of healthcare spending in the Netherlands: Estimating cost‐effectiveness thresholds using a translog production function," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1331-1344, November.
    11. Giuseppe Liotta & Francesco Gilardi & Stefano Orlando & Gennaro Rocco & Maria Grazia Proietti & Federica Asta & Manuela De Sario & Paola Michelozzi & Sandro Mancinelli & Leonardo Palombi & Maria Crist, 2019. "Cost of hospital care for the older adults according to their level of frailty. A cohort study in the Lazio region, Italy," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-13, June.
    12. Cristina Canova & Paola Anello & Claudio Barbiellini Amidei & Vito Parolin & Loris Zanier & Lorenzo Simonato, 2019. "Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
    13. Longden, Thomas & Wong, Chun Yee & Haywood, Philip & Hall, Jane & van Gool, Kees, 2018. "The prevalence of persistence and related health status: An analysis of persistently high healthcare costs in the short term and medium term," Social Science & Medicine, Elsevier, vol. 211(C), pages 147-156.
    14. Christophe Kolodziejczyk, 2020. "The effect of time to death on health care expenditures: taking into account the endogeneity and right censoring of time to death," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(6), pages 945-962, August.
    15. James Lomas & Miqdad Asaria & Laura Bojke & Chris P. Gale & Gerry Richardson & Simon Walker, 2018. "Which Costs Matter? Costs Included in Economic Evaluation and their Impact on Decision Uncertainty for Stable Coronary Artery Disease," PharmacoEconomics - Open, Springer, vol. 2(4), pages 403-413, December.
    16. Lassila, Jukka & Valkonen, Tarmo, 2019. "Alternative Demography-based Projection Approaches for Public Health and Long-term Care Expenditure," ETLA Working Papers 74, The Research Institute of the Finnish Economy.
    17. Jonas Krämer & Jonas Schreyögg, 2019. "Demand-side determinants of rising hospital admissions in Germany: the role of ageing," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 715-728, July.
    18. Moore, Patrick V. & Bennett, Kathleen & Normand, Charles, 2017. "Counting the time lived, the time left or illness? Age, proximity to death, morbidity and prescribing expenditures," Social Science & Medicine, Elsevier, vol. 184(C), pages 1-14.
    19. Nigel Rice & Maria Jose Aragon, 2018. "The determinants of health care expenditure growth," Working Papers 156cherp, Centre for Health Economics, University of York.
    20. Anne Mason & Idaira Rodriguez Santana & María José Aragón & Nigel Rice & Martin Chalkley & Raphael Wittenberg & Jose-Luis Fernandez, 2019. "Drivers of health care expenditure: Final report," Working Papers 169cherp, Centre for Health Economics, University of York.
    21. Idaira Rodriguez Santana & María José Aragón & Nigel Rice & Anne Rosemary Mason, 2020. "Trends in and drivers of healthcare expenditure in the English NHS: a retrospective analysis," Health Economics Review, Springer, vol. 10(1), pages 1-11, December.

    More about this item


    H51; J11; I19; Health care expenditures; Ageing; Time-to-death; Morbidity;

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • J11 - Labor and Demographic Economics - - Demographic Economics - - - Demographic Trends, Macroeconomic Effects, and Forecasts
    • I19 - Health, Education, and Welfare - - Health - - - Other


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