Time to include time to death? The future of health care expenditure predictions
Time to include time to death? The future of health care expenditure predictions
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DOI：
10.1002/hec.831
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发表时间：
2004-04-01
期刊：
影响因子：
2.1
通讯作者：
Norton, EC
中科院分区：
文献类型：
--
作者：
Stearns, SC;Norton, EC
政府对未来医疗保健支出的预测——鉴于婴儿潮一代的老龄化，这是一个非常令人担忧的问题——是基于明确控制年龄但不控制临终支出的计量经济学回归。由于生命末期的支出平均急剧增加，如果技术或其他社会因素继续延长寿命，基于省略死亡时间作为解释变量的回归的未来成本分布预测将出现向上偏差（或者更明确地说，年龄系数将出现向上偏差）。尽管对当前样本的医疗保健支出预测不会有偏差，但对未来寿命更长的人群的预测将出现向上偏差，并且偏差的程度将随着预期寿命的增加而增加。我们探讨了将死亡时间纳入卫生支出纵向模型的实证意义，以预测未来支出。排除死亡时间并使用当前生命表的简单模型的预测比控制死亡时间的扩展模型高 9%。当使用 2020 年预计寿命表时，偏差增加到 15%。模型之间的预测差异足以证明重新评估将死亡时间纳入预测医疗保健支出的模型的价值是合理的。版权所有 (C) 2003 John Wiley Sons, Ltd.
Government projections of future health care expenditures - a great concern given the aging baby-boom generation - are based on econometric regressions that control explicitly for age but do not control for end-of-life expenditures. Because expenditures increase dramatically on average at the end of life, predictions of future cost distributions based on regressions that omit time to death as an explanatory variable will be biased upward (or, more explicitly, the coefficients on age will be biased upward) if technology or other social factors continue to prolong life. Although health care expenditure predictions for a current sample will not be biased, predictions for future cohorts with greater longevity will be biased upwards, and the magnitude of the bias will increase as the expected longevity increases. We explore the empirical implications of incorporating time to death in longitudinal models of health expenditures for the purpose of predicting future expenditures. Predictions from a simple model that excludes time to death and uses current life tables are 9% higher than from an expanded model controlling for time to death. The bias increases to 15% when using projected life tables for 2020. The predicted differences between the models are sufficient to justify reassessment of the value of inclusion of time to death in models for predicting health care expenditures. Copyright (C) 2003 John Wiley Sons, Ltd.