Erika Schulz

The impact of ageing on hospital care and long-term care—the example of Germany

BACKGROUND In the next few decades the population in all EU-countries will age rapidly. This could have a major impact on the health care sector. This study analyses the effect of population ageing on utilisation in two key sectors of the health care system, namely hospital care and long-term care in Germany, up to 2020 with an outlook to 2050. METHODS Two population scenarios, one with constant, one with increasing life expectancy, were combined with constant age and gender specific utilisation rates of hospital and long-term care. In the case of hospital care two projection methods were used: Method A differentiates between age-groups, gender and main diagnosis. Method B differentiates between age-groups, survivors and decedents. RESULTS Population ageing was found to cause a moderate increase in hospital days, but was associated with substantial changes in the disease and age structure. In the case of increasing life expectancy, method B lead to a lower growth in hospital days than method A. The number of persons receiving long-term care will increase strongly, associated with a shift to more severe disability and institutional care. Changes in the composition of private households and the increasing labour participation of women will lead to additional demand for professional caregivers at home and in institutions. CONCLUSIONS Changes in the number and disease structure of hospital days due to population ageing will require reorganisation and restructuring of hospital departments. In the case of long-term care a high increase in professional home care and institutional care will be required. Health policy has to take into account these developments in order to adequately deal with future demand for these services.

The Influence of Supply and Demand Factors on Aggregate Health Care Expenditure with a Specific Focus on Age Composition

Expenditure on medical treatment has tended to increase as a proportion of national income throughout the European Union. Overall there has been a rising trend in the mean as low-spending countries such as the UK have faced political pressure to spend at least the average EU proportion of their national income on the provision of health services, medical treatment and long-term care. A particular concern is that with an ageing population and therefore the prospect of more old people around, the pressures on health care expenditure will increase further.The aim of this 6th work package (WP6) of the AHEAD project is to explain how demand and supply factors influence aggregate health care expenditure with a specific focus on age composition. Several studies in the past have shown that health care expenditure is not only influenced by demand factors, but also by those on the supply side, particularly technological progress, political decisions and economic framework conditions.In contrast with other studies (and aside from the focus on age), WP6 emphasizes variables describing health care and financing systems. The idea is that the inclusion of these variables affords a better explanation of health care expenditure. This report collects data on demand, supply and utilization of health care from official statistics and creates additional variables describing the health care and financing systems based on a literature review. In total, 63 variables are included in a basic data set for 28 countries, mostly covering the period 1980-2003. A brief statistical overview shows the development of some of the variables in the countries covered. The expected strong connection between health care expenditure and GDP can be seen in a cross-section analysis for 2003. The relation between health care expenditure and the share of the elderly in the population was also positive, but not as strong as in the case of GDP.

Andere Länder, andere Wege: Pflege im internationalen Vergleich

Dr. Erika Schulz ist wissenschaftliche Mitarbeiterin der Abteilung Staat am DIW Berlin Ob man Zugang zum System staatlicher Unterstützung bei Pflegebedarf erhält, hängt davon ab, dass die spezifischen Pflegebedarfe auch durch das Sozialrecht anerkannt werden. Dass dies keine starre Grenze ist zeigt unser internationaler Vergleich aber auch die Neuerungen des PSG II. Im Vergleich zum sehr umfangreichen dänischen System bleiben die formalen Schwellen für den Leistungsbezug in Deutschland auch in Zukunft relativ hoch. Gleichzeitig zeigen unsere Analysen, dass sich Struktur und Anteil der Leistungsempfänger Dänemark annähern werden, wenn der neue Pflegebedürftigkeitsbegriff eingeführt wird.

Projection of Care Need and Family Resources in Germany

In 2006, some 5.1 million people were in need of care in Germany. Of this number, 2.1 million were long-term care insurance (LTCI) beneficiaries. The need for care is strongly related to age. Half of the beneficiaries were aged 80 and older. The prevalences of the need for care increase sharply from the age of 70 onwards (see Pfaff, Chapter 1 in this proceedings). Thus, it is expected that the ageing of the population, particularly the sharp increase in the number of the oldest old, will lead to a marked rise in the number of people in need of care in coming years.

Wirtschaftliche Aspekte der Märkte für Gesundheitsdienstleistungen

Märkte für Gesundheitsdienstleistungen zeichnen sich nicht nur dadurch aus, dass auf ihnen sehr heterogene und komplexe Humandienstleistungen und andere Güter gehandelt werden, sondern auch dadurch, dass sie in ihrer Finanzierung zweigeteilt sind und sich letztlich aus vielen Teilmärkten zusammensetzen. In einem Gutachten des DIW Berlin (Deutschen Instituts für Wirtschaftsforschung) unter Mitarbeit von IGES Berlin für das Bundesministerium für Wirtschaft und Technologie war es ein zentrales Anliegen, die vielfältigen Märkte des Gesundheitsbereichs zu identifizieren, ihre Entwicklung und Veränderung in der Vergangenheit zu beleuchten und entsprechende Entwicklungen in der Zukunft zu prognostizieren. Dies galt es im Besonderen unter sich verändernden demographischen und wettbewerblichen Bedingungen in der EU zu tun. Das Augenmerk war dabei vor allem auf der Frage der Finanzierung in der Vergangenheit und den Potenzialen in der Zukunft gerichtet.