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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


  • Brockmann, Hilke


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.

Suggested Citation

  • 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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    References listed on IDEAS

    1. Miller, Douglas L. & Paxson, Christina, 2006. "Relative income, race, and mortality," Journal of Health Economics, Elsevier, vol. 25(5), pages 979-1003, September.
    2. Angus Deaton, 2001. "Relative Deprivation, Inequality, and Mortality," NBER Working Papers 8099, National Bureau of Economic Research, Inc.
    3. Victor R. Fuchs & Mark B. McClellan & Jonathan S. Skinner, 2004. "Area Differences in Utilization of Medical Care and Mortality among U.S. Elderly," NBER Chapters,in: Perspectives on the Economics of Aging, pages 367-414 National Bureau of Economic Research, Inc.
    4. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, Oxford University Press, vol. 115(2), pages 617-650.
    5. Alberto Alesina & Reza Baqir & William Easterly, 1999. "Public Goods and Ethnic Divisions," The Quarterly Journal of Economics, Oxford University Press, vol. 114(4), pages 1243-1284.
    6. Michael Grossman, 1976. "The Correlation between Health and Schooling," NBER Chapters,in: Household Production and Consumption, pages 147-224 National Bureau of Economic Research, Inc.
    7. Jennifer M. Mellor & Jeffrey Milyo, 1999. "Re-Examining the Evidence of an Ecological Association between Income Inequality and Health," Discussion Papers Series, Department of Economics, Tufts University 9922, Department of Economics, Tufts University.
    8. repec:aph:ajpbhl:1998:88:7:1074-1080_3 is not listed on IDEAS
    9. repec:aph:ajpbhl:2001:91:3:385-391_5 is not listed on IDEAS
    10. David A. Jaeger & Susanna Loeb & Sarah E. Turner & John Bound, 1998. "Coding Geographic Areas Across Census Years: Creating Consistent Definitions of Metropolitan Areas," NBER Working Papers 6772, National Bureau of Economic Research, Inc.
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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. 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.).
    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. 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, Social Science Research Center Berlin (WZB).
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. Xesfingi, Sofia & Vozikis, Athanassios, 2014. "Citizens’ Preferences on Health Care Expenditure Allocation: Evidence from Greece," MPRA Paper 63419, University Library of Munich, Germany.
    11. repec:jns:jbstat:v:227:y:2007:i:5-6:p:578-602 is not listed on IDEAS
    12. 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.


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