Aging, health expenditure, proximity to death, and income in Finland

AbstractThis study revisits the debate on the ‘red herring’, i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity to death with the predictions of a naïve model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a naïve model is used in health expenditure projections. Among individuals not in long-term care, we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasize that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone, as often claimed in public discussion. We do not find any strong positive associations between income and expenditure for most non-LTC categories of health care utilization. Income was positively related to expenditure on prescribed medicines, in which cost-sharing between the state and the individual is relatively high. Overall, our results indicate that the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.

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The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China

Health Policy and Planning ◽

10.1093/heapol/czac003 ◽

2022 ◽

Author(s):

He Chen ◽

Jing Ning

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Treatment Effect ◽

Health Expenditure ◽

Long Term Care ◽

Care Utilization ◽

Ageing Population ◽

Term Care ◽

Long Term Care Insurance

Abstract Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.

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Hip Fractures in Long-Term Care: Is the Excess Explained by the Age and Gender Distribution of the Residents?

Journal of Aging Research ◽

10.4061/2010/291258 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Richard G. Crilly ◽

David A. Tanner ◽

Marita Kloseck ◽

Bert M. Chesworth

Keyword(s):

Hip Fracture ◽

Long Term Care ◽

High Rate ◽

Fracture Rate ◽

Term Care ◽

Age And Gender ◽

Discharge Data ◽

Predominantly Female ◽

And Gender

Introduction. This study compares hip fracture rates in Long Term Care (LTC) residents with those in the community to determine if their high rate of fracturing reflects the extreme age and predominantly female nature of that population.Methods. Hospital discharge data in London Ontario (population 350,000) and Statistics Canada data were used to correct the hip fracture rate in the LTC setting for age and gender.Results. The risk of hip fracture is 1.8 times greater in LTC than in the community for people of similar age and gender. The rate in women is 1.5 times higher whereas in men it is 4.3 times higher. In the oldest residents, the risk in men exceeds that of women in LTC.Conclusion. The high hip fracture rate in LTC is not just a reflection of the age and predominantly female nature of this population. The oldest men in LTC are a particularly high risk group, deserving more attention.

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Health care and long-term care costs by age and proximity to death in a publicly funded universal system: A descriptive study of population data

Nordic Journal of Health Economics ◽

10.5617/njhe.7070 ◽

2020 ◽

Author(s):

Jorid Kalseth ◽

Kjartan Sarheim Anthun ◽

Leena Forma

Keyword(s):

Health Care ◽

Long Term Care ◽

Health Care Expenditures ◽

Population Ageing ◽

Relative Importance ◽

Term Care ◽

Universal System ◽

Proximity To Death ◽

Care Costs

Trends in population ageing parallel concerns with escalating health care expenditures. The purposes of this study are to (1) estimate the distribution of health care and long-term care costs to ascertain the relative importance of age vs. proximity to death as the main driver of costs; (2) explore the relative importance of user rates and costs per user as the primary driver of per capita costs of selected services for survivors and decedents, respectively; and (3) provide projections of future costs. We use data on service use for the entire Norwegian population from four national registers linked with the Cause of Death Registry to calculate costs per decedent in the last 365 days of life and the average one-year costs of people surviving at least two years. Future costs were calculated using projections on population and probability of death from Statistics Norway. We find that the substantial increase in costs at older ages among both decedents and survivors relates to higher long-term care costs. Health care costs peak in the late 50s among decedents and in the early 80s among survivors and then decrease with age. While costs in the last year of life for each decedent are 19 times the average costs of survivors, the decedent/survivor cost ratio decreases with age to less than double among those aged ³95 years. Expenditure projections indicate an increase in spending due to population ageing, especially in long-term care expenditures. For somatic hospital costs, proximity to death has a greater impact on costs than age; the age effect is more important for long-term care, implying that the “red herring” effect is larger for acute health care than for long-term care. Adjusting for costs during the last year of life reduces the projected increase in expenditures, but only to a limited extent.

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Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research

Innovation in Aging ◽

10.1093/geroni/igaa057.127 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 39-39

Author(s):

Katie Aubrecht ◽

Ivy Bourgeault ◽

Tamara Daly

Keyword(s):

Long Term Care ◽

Term Care ◽

Social Divisions ◽

Care Workers ◽

Power Differentials ◽

Care Relationships ◽

And Gender ◽

Relations Of Power ◽

Status Of Care

Abstract Intersectionality is a useful method (Lutz, 2015) for interdisciplinary long-term care (LTC) research to advance a more critical understanding of how experiences of quality are shaped by mutually reproducing social divisions, identities and relations of power that shape LTC. This paper discusses insights from the “Mapping Care Relationships” stream of the Seniors – Adding Life to Years (SALTY) project, a pan-Canadian program of research examining clinical, social and policy perspectives on quality in LTC. “Mapping Care Relationships” mapped how promising approaches to care relationships are organized and experienced in LTC. From January 2018-August 2019 our team of nine researchers conducted rapid ethnographies in eight nursing homes, two in each of four provinces across Canada. We purposively observed and interviewed workers from a wide variety of positions and backgrounds, informed by an intersectionality approach. We traced how promising approaches in person-centred dementia care (PCDC) in particular may reify the subordinated status of care workers (some more than others) and reinforce inequities within LTC systems. In multiple LTC homes, front-line care workers described experiencing physical and emotional harm in care relationships with residents which caused them distress. However, consistent with a PCDC approach, the harm was attributed to ‘behaviours’ clinically symptomatic of dementia. In framing power differentials from a medical perspective, PCDC makes it possible to interpret harmful experiences as 'part of the job’ and something workers should know to expect, prevent, avoid, redirect, or ignore. Lutz, H. (2015). Intersectionality as method. DiGeSt. Journal of diversity and gender studies, 2(1-2), 39-44.

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Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2474 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 704-704

Author(s):

Yuchi Young ◽

Barbara Resnick

Keyword(s):

Older Adults ◽

Health Care ◽

Health Systems ◽

Long Term Care ◽

The United States ◽

World Population ◽

Term Care ◽

The Usa ◽

Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

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Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

Innovation in Aging ◽

10.1093/geroni/igaa057.569 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 176-176

Author(s):

Hiroto Yoshida ◽

Yuriko Kihara

Keyword(s):

Long Term Care ◽

The Elderly ◽

Elderly Age ◽

Term Care ◽

Intentional Weight Loss ◽

Long Term Care Insurance ◽

And Gender ◽

The Impact

Abstract This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

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The Influence of Race and Gender on Staff-Resident Interactions in Nursing Homes

Innovation in Aging ◽

10.1093/geroni/igaa057.599 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 185-185

Author(s):

Rachel McPherson ◽

Barbara Resnick ◽

Elizabeth Galik

Keyword(s):

Racial Differences ◽

Long Term Care ◽

Analysis Of Covariance ◽

Positive Interactions ◽

Term Care ◽

Race And Gender ◽

Significant Difference ◽

And Gender

Abstract Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.

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Human-Engaged Health Care Services Recommendation for Aging and Long-term Care

2019 IEEE 23rd International Conference on Computer Supported Cooperative Work in Design (CSCWD) ◽

10.1109/cscwd.2019.8791885 ◽

2019 ◽

Author(s):

Liuqian Ni ◽

Yuling Sun ◽

Yanqin Yang ◽

Liang He

Keyword(s):

Health Care ◽

Health Care Services ◽

Long Term Care ◽

Term Care ◽

Care Services

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Future Costs of Long-term Care in Japan and Sweden

International Journal of Health Services ◽

10.1177/0020731417727450 ◽

2017 ◽

Vol 48 (1) ◽

pp. 128-147 ◽

Cited By ~ 3

Author(s):

Mårten Lagergren ◽

Noriko Kurube ◽

Yasuhiko Saito

Keyword(s):

Long Term Care ◽

Population Change ◽

Population Aging ◽

Population Data ◽

Epidemiological Data ◽

The Other ◽

Age Group ◽

Term Care ◽

And Gender

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.

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