Ageing and health-care expenditure: the red herring argument revisited
Ageing and health-care expenditure: the red herring argument revisited
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DOI：
10.1002/hec.826
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发表时间：
2004-04-01
期刊：
影响因子：
2.1
通讯作者：
Gray, A
中科院分区：
文献类型：
--
作者：
Seshamani, M;Gray, A
Zweifel及其同事此前曾提出，与年龄相比，接近死亡对医疗成本的影响更重要，这表明人口结构变化本身不会对未来的总医疗支出产生重大影响。然而，计量经济学方法的问题导致了这些研究结果的稳健性的挑战。本文重新分析。使用来自英国牛津郡的纵向医院数据集，Zweifel研究的两步Heckman模型首先被复制，发现年龄和死亡的临近程度对医院成本都没有显着影响。模型的计量经济学问题的证明，而不是一个两部分的模型显示，年龄和接近死亡有显着的影响，季度医院费用。成本预测，计算自举95%的置信区间，进一步表明，虽然年龄可能会显着影响季度成本。与生命最后一年临近死亡时季度成本增加三倍相比，这些成本变化很小。分析表明，模型选择的重要性，以正确评估的决定因素的医疗保健支出。版权所有（C）2003约翰威利父子有限公司。
Zweifel and colleagues have previously proposed that proximity to death is a more important influence on healthcare costs than age, suggesting that demographic change per se will not have a large impact on future aggregate health expenditure. However, issues of econometric methodology have led to challenges of the robustness of these findings. This paper revisits the analysis. Using a longitudinal hospital data set from Oxfordshire, England, the two-step Heckman model from the Zweifel study is first replicated, to find that neither age nor proximity to death have a significant effect on hospital costs. Econometric problems with the model are demonstrated, and instead a two-part model shows both age and proximity to death to have significant effects on quarterly hospital costs. Cost predictions, calculated with bootstrapped 95% confidence intervals, further demonstrate that while age may significantly affect quarterly costs. these cost changes are small compared to the tripling of quarterly costs that occurs with approaching death in the last year of life. The analyses show the importance of model selection to properly assess the determinants of health-care expenditures. Copyright (C) 2003 John Wiley Sons, Ltd.