IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v88y2013icp39-47.html
   My bibliography  Save this article

Use of hospital and long-term institutional care services in relation to proximity to death among older people in Finland

Author

Listed:
  • Murphy, Michael
  • Martikainen, Pekka

Abstract

Using nationally-representative register data for older people in Finland in period 1998–2003 we study how the number of days in acute hospital and long term institutional care services varies by age and proximity to death and how these use patterns change as mortality improves. Acute health care use depends more on proximity to death than on age, a finding often interpreted as showing that the need for care services among older people will be substantially less than would be expected based on the likely increase in population numbers. We show that this assumption is too optimistic for three reasons: (1) the increase in population numbers will be concentrated mainly among the “old old” where use of services is substantial; (2) earlier findings of much lower use of acute care services by older than younger people who are close to death are not observed; and (3) any savings in acute care are more than offset by greater use of residential long-term care (LTC). The main consequences of improving mortality are: (1) to postpone rather than to reduce overall demand for health care; (2) to shift the balance of care from acute to long-term care services; and (3) to increase considerably the average age of time spent in care. We further construct a new indicator “care-free life expectancy” based on number of days in hospital and long-term care to summarise care use patterns for cohorts under a range of plausible mortality assumptions. As mortality improves, lifetime use of acute hospital and long-term care after age 65 and the proportion of life spent in LTC increases for later cohorts, but the proportion spent in acute care decreases slightly.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:socmed:v:88:y:2013:i:c:p:39-47
    DOI: 10.1016/j.socscimed.2013.03.042
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953613002116
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2013.03.042?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Oecd, 2006. "Projecting OECD Health and Long-Term Care Expenditures: What Are the Main Drivers?," OECD Economics Department Working Papers 477, OECD Publishing.
    2. Sally C. Stearns & Edward C. Norton, 2004. "Time to include time to death? The future of health care expenditure predictions," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 315-327, April.
    3. 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, October.
    4. Bartosz Przywara, 2010. "Projecting future health care expenditure at European level: drivers, methodology and main results," European Economy - Economic Papers 2008 - 2015 417, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    5. David M. Cutler & Louise Sheiner, 1998. "Demographics and Medical Care Spending: Standard and Non-Standard Effects," NBER Working Papers 6866, National Bureau of Economic Research, Inc.
    6. Peter Zweifel & Stefan Felder & Markus Meiers, 1999. "Ageing of population and health care expenditure: a red herring?," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 485-496, September.
    7. Schulz, Erika & Leidl, Reiner & Konig, Hans-Helmut, 2004. "The impact of ageing on hospital care and long-term care--the example of Germany," Health Policy, Elsevier, vol. 67(1), pages 57-74, January.
    8. Baoping Shang & Dana Goldman, 2008. "Does age or life expectancy better predict health care expenditures?," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 487-501, April.
    9. Batljan, Ilija & Lagergren, Mårten, 2004. "Inpatient/outpatient health care costs and remaining years of life--effect of decreasing mortality on future acute health care demand," Social Science & Medicine, Elsevier, vol. 59(12), pages 2459-2466, December.
    10. Victor R. Fuchs, 1984. ""Though Much is Taken" -- Reflections on Aging, Health, and Medical Care," NBER Working Papers 1269, National Bureau of Economic Research, Inc.
    11. France Weaver & Sally C. Stearns & Edward C. Norton & William Spector, 2009. "Proximity to death and participation in the long‐term care market," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 867-883, August.
    12. 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.
    13. 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.
    14. 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.
    15. Friedrich Breyer & Joan Costa-Font & Stefan Felder, 2010. "Ageing, health, and health care," Oxford Review of Economic Policy, Oxford University Press, vol. 26(4), pages 674-690, Winter.
    16. Wickstrom, Jannie & Serup-Hansen, Niels & Kristiansen, Ivar Sonbo, 2002. "Future health care costs--do health care costs during the last year of life matter?," Health Policy, Elsevier, vol. 62(2), pages 161-172, November.
    17. Hã„Kkinen, Unto & Martikainen, Pekka & Noro, Anja & Nihtilã„, Elina & Peltola, Mikko, 2008. "Aging, health expenditure, proximity to death, and income in Finland," Health Economics, Policy and Law, Cambridge University Press, vol. 3(2), pages 165-195, April.
    18. McGrail, K. & Green, B. & Barer, M.L. & Evans, R.G. & Hertzman, C., 2000. "Age, Costs of Acute and Long-term Care and Proximity to Death: Evidence for 1987-88 and 1994-94 in Btitish Columbia," Centre for Health Services and Policy Research 2000:8, University of British Columbia - Centre for Health Services and Policy Research..
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    2. Jutta Pulkki & Mari Aaltonen & Jani Raitanen & Pekka Rissanen & Marja Jylhä & Leena Forma, 2020. "Purchases of medicines among community-dwelling older people: comparing people in the last 2 years of life and those who lived at least 2 years longer," European Journal of Ageing, Springer, vol. 17(3), pages 361-369, September.
    3. Kaarina Korhonen & Elina Einiö & Taina Leinonen & Lasse Tarkiainen & Pekka Martikainen, 2018. "Time-varying effects of socio-demographic and economic factors on the use of institutional long-term care before dementia-related death: A Finnish register-based study," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-16, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Maciej Lis, 2015. "Red Herring in the Vistula River: Time-to-Death and Health Care Expenditure," IBS Working Papers 13/2015, Instytut Badan Strukturalnych.
    2. 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.
    3. Friedrich Breyer & Normann Lorenz, 2019. "The "Red Herring" after 20 Years: Ageing and Health Care Expenditures," CESifo Working Paper Series 7951, CESifo.
    4. 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.
    5. 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.
    6. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.
    7. Breyer Friedrich, 2015. "Demographischer Wandel und Gesundheitsausgaben: Theorie, Empirie und Politikimplikationen," Perspektiven der Wirtschaftspolitik, De Gruyter, vol. 16(3), pages 215-230, October.
    8. Karlsson, Martin & Klohn, Florian, 2011. "Some notes on how to catch a red herring: Ageing, time-to-death & care costs for older people in Sweden," Darmstadt Discussion Papers in Economics 207, Darmstadt University of Technology, Department of Law and Economics.
    9. Yu, Tiffany Hui-Kuang & Wang, David Han-Min & Wu, Kuo-Lun, 2015. "Reexamining the red herring effect on healthcare expenditures," Journal of Business Research, Elsevier, vol. 68(4), pages 783-787.
    10. Kildemoes, Helle Wallach & Christiansen, Terkel & Gyrd-Hansen, Dorte & Kristiansen, Ivar Sonbo & Andersen, Morten, 2006. "The impact of population ageing on future Danish drug expenditure," Health Policy, Elsevier, vol. 75(3), pages 298-311, February.
    11. Stefan Felder, 2013. "The Impact of Demographic Change on Healthcare Expenditure," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 11(1), pages 03-06, 04.
    12. Albert Wong & Pieter H. M. van Baal & Hendriek C. Boshuizen & Johan J. Polder, 2011. "Exploring the influence of proximity to death on disease‐specific hospital expenditures: a carpaccio of red herrings," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 379-400, April.
    13. Atella, Vincenzo & Conti, Valentina, 2014. "The effect of age and time to death on primary care costs: The Italian experience," Social Science & Medicine, Elsevier, vol. 114(C), pages 10-17.
    14. Friedrich Breyer & Normann Lorenz & Thomas Niebel, 2015. "Health care expenditures and longevity: is there a Eubie Blake effect?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 95-112, January.
    15. 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.
    16. Maciej Lis, 2015. "What Drives the Increase in Health Care Costs with Age," IBS Working Papers 5/2015, Instytut Badan Strukturalnych.
    17. Fredrik Gregersen, 2014. "The impact of ageing on health care expenditures: a study of steepening," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 979-989, December.
    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. 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.
    20. Breyer, Friedrich & Felder, Stefan, 2006. "Life expectancy and health care expenditures: A new calculation for Germany using the costs of dying," Health Policy, Elsevier, vol. 75(2), pages 178-186, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:88:y:2013:i:c:p:39-47. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.