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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

Abstract

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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  • Brockmann, Hilke, 2002. "Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals," Social Science & Medicine, Elsevier, vol. 55(4), pages 593-608, August.
    • Handle: RePEc:eee:socmed:v:55:y:2002:i:4:p:593-608
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    Cited by:

    1. 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.
    2. Anne Vinkel Hansen & Laust Hvas Mortensen & Stella Trompet & Rudi Westendorp, 2020. "Health care expenditure in the last five years of life is driven by morbidity, not age: A national study of spending trajectories in Danish decedents over age 65," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-11, December.
    3. Jeannette Winkelhage & Adele Diederich, 2012. "The Relevance of Personal Characteristics in Allocating Health Care Resources—Controversial Preferences of Laypersons with Different Educational Backgrounds," IJERPH, MDPI, vol. 9(1), pages 1-21, January.
    4. 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, WZB Berlin Social Science Center.
    5. Peggy Voss & Julia K. Wolff & Klaus Rothermund, 2017. "Relations between views on ageing and perceived age discrimination: a domain-specific perspective," European Journal of Ageing, Springer, vol. 14(1), pages 5-15, March.
    6. 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, July.
    7. Friedrich Breyer & Normann Lorenz, 2021. "The “red herring” after 20 years: ageing and health care expenditures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 661-667, July.
    8. Xesfingi, Sofia & Vozikis, Athanassios, 2014. "Citizens’ Preferences on Health Care Expenditure Allocation: Evidence from Greece," MPRA Paper 63419, University Library of Munich, Germany.
    9. repec:jns:jbstat:v:227:y:2007:i:5-6:p:578-602 is not listed on IDEAS
    10. Postler Andreas, 2010. "Gesundheitspolitik – Grundrisse einer nachhaltigen und gerechten Finanzierung der Gesetzlichen Krankenversicherung / Health policy – outline for a sustainable and fair financing of Germany’s statutory," ORDO. Jahrbuch für die Ordnung von Wirtschaft und Gesellschaft, De Gruyter, vol. 61(1), pages 267-286, January.
    11. 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.
    12. 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.).
    13. 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.
    14. Chandoevwit, Worawan & Phatchana, Phasith, 2018. "Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life," Social Science & Medicine, Elsevier, vol. 207(C), pages 64-70.
    15. Maurizio Bussolo & Johannes Koettl & Emily Sinnott, 2015. "Golden Aging," World Bank Publications - Books, The World Bank Group, number 22018, December.
    16. Rolden, Herbert J.A. & van Bodegom, David & Westendorp, Rudi G.J., 2014. "Variation in the costs of dying and the role of different health services, socio-demographic characteristics, and preceding health care expenses," Social Science & Medicine, Elsevier, vol. 120(C), pages 110-117.
    17. Polder, Johan J. & Barendregt, Jan J. & van Oers, Hans, 2006. "Health care costs in the last year of life--The Dutch experience," Social Science & Medicine, Elsevier, vol. 63(7), pages 1720-1731, October.
    18. 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.
    19. Melberg, Hans Olav & Sørensen, Jan, 2013. "How does end of life costs and increases in life expectancy affect projections of future hospital spending?," HERO Online Working Paper Series 2013:9, University of Oslo, Health Economics Research Programme.
    20. Constantina Safiliou-Rothschild, 2009. "Are Older People Responsible for High Healthcare Costs?," CESifo Forum, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 10(01), pages 57-64, April.
    21. Adele Diederich & Jeannette Winkelhage & Norman Wirsik, 2011. "Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.

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