Shortpaper - Proefschrift: Studies of health and long-term care expenditure growth in aging populations.

Summary
The number of elderly in de Dutch population has increased and will continue to increase. Population aging will have profound implications for the financial sustainability of the health care system. The objective of this thesis is to improve understanding of the relative contribution of population aging to growth in acute and long-term care expenditures. The thesis consists of a literature overview and four empirical studies. The main conclusions were as follows. First, given that the relationship between age and health care expenditure is largely due to health, the full contribution of population aging to growth in health care expenditure could only be considered when accounting for changing health patterns. Findings show that estimating the effect of (healthy) aging on health care expenditures cannot be fully captured when approximating health by age or time to death. These models grossly overestimate the impact of population aging on long-term care expenditures. Second, the impact of changes in the age composition of the population on health care expenditure growth is limited: it could explain 0.5-1.0% of a total annual real growth of 4-5%. However, the full effect of population aging could be substantial as the impact of population aging is strongly related to that of other important determinants like medical technological progress, developments in wages/prices and government policies. Third, the contribution of several factors to growth in acute and long-term care expenditures differed. While long-term care spending growth depends most on population aging and trends in disability, acute care expenditure growth is mainly subject to changes in medical practices, largely due to medical technological progress and health policies. Therefore, policymakers should be aware that forecasts of health care expenditures solely based on trends in population characteristics are likely to considerably underestimate the actual growth, in particularly for acute care. For instance, only a 6% growth of median acute care expenditures over the period 1998-2004 would have been predicted in 1998, while the actual growth amounted to 29%.