The effect of longevity on spending for acute and long-term care.
The effect of longevity on spending for acute and long-term care.
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DOI：
10.1056/nejm200005113421906
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发表时间：
2000-05-11
影响因子：
158.5
通讯作者：
Lubitz, J
中科院分区：
文献类型：
--
作者：
Spillman, BC;Lubitz, J
背景资料：美国老年人占总人口的比例预计将从2000年的13%上升到2030年的20%。对保健开支的影响可能是深远的，因为老年人使用保健服务的比率高于年轻人。我们估计急性和长期护理的总支出从65岁到死亡，并在过去两年的life.Methods：我们结合数据从医疗保险，全国死亡率随访调查，全国医疗支出调查，估计全国总支出的医疗保健根据死亡年龄。我们还使用两个队列的预测人口统计学特征来模拟支出：2000年年满65岁的人和2015年年满65岁的人。总支出（按1996年美元计算）从65岁至死亡的退休金随着寿命的延长而大幅增加，从65岁死亡者的31 181美元增加到200美元以上，90岁时死亡的人的养老金为10000美元，部分原因是为非常老的人提供的养老院支出急剧增加。生命最后两年的支出也随着寿命的延长而增加，但医疗保险支出的减少（75岁时死亡的人为37，000美元，95岁时死亡的人为21，000美元）缓和了疗养院支出增加的影响（75岁死亡者6，000美元，95岁死亡者32，000美元）。在对妇女寿命延长进行调整后，妇女的保健支出始终高于男子。模拟结果显示，65岁以后寿命的延长对2000年至2015年预期支出增加的影响相对较小，特别是对医疗保险所涵盖的服务。在1950年出生的人比在1935年和更多的人存活到65岁的人数更多的影响是更重要的。结论：在美国，长寿对急性护理支出的影响不同于其对长期护理支出的影响。急性护理支出，主要是医院护理和医生服务的支出，随着死亡年龄的增加而以较低的速度增加，而长期护理支出则以较快的速度增加。65岁以后寿命的延长可能会导致长期护理支出的增加，但老年人人数的增加对总支出的影响更为重要。（N Engl J Med 2000;342：1409-15.）（C）2000年，马萨诸塞州医学会。
Background: The proportion of the population made up of elderly persons in the United States is projected to increase from 13 percent of the population in 2000 to 20 percent by 2030. The implications for health care expenditures may be profound, because elderly persons use health care services at a greater rate than younger persons. We estimated total expenditures for acute and long-term care from the age of 65 years until death and in the last two years of life.Methods: We combined data from Medicare, the National Mortality Followback Survey, and the National Medical Expenditure Survey to estimate total national expenditures for health care according to the age at death. We also simulated expenditures with the use of projected demographic characteristics of two cohorts: people turning 65 in 2000 and those turning 65 in 2015.Results: Total expenditures (in 1996 dollars) from the age of 65 years until death increase substantially with longevity, from $31,181 for persons who die at the age of 65 years to more than $200,000 for those who die at the age of 90, in part because of steep increases in nursing home expenditures for very old persons. Spending in the last two years of life also increases with longevity, but a reduction in Medicare expenditures ($37,000 for persons who die at the age of 75 years and $21,000 for those who die at the age of 95) moderates the effect of the increase in nursing home expenditures ($6,000 for those who die at the age of 75 years and $32,000 for those who die at the age of 95). Health care spending for women is consistently higher than that for men, after adjustment for the increased longevity of women. Simulations show that increased longevity after the age of 65 years has a relatively small effect on the anticipated increase in spending, especially for services covered by Medicare, from 2000 to 2015. The effects of the larger number of people born in 1950 than in 1935 and the larger number of people surviving to the age of 65 years are much more important.Conclusions: In the United States, the effect of longevity on expenditures for acute care differs from its effect on expenditures for long-term care. Acute care expenditures, principally for hospital care and physicians' services, increase at a reduced rate as the age at death increases, whereas expenditures for long-term care increase at an accelerated rate. Increases in longevity after the age of 65 years may result in greater spending for long-term care, but the increase in the number of elderly persons has a more important effect on total spending. (N Engl J Med 2000;342:1409-15.) (C)2000, Massachusetts Medical Society.