The effect of population aging on health expenditure growth: a critical review.
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ABSTRACT:
SUBMITTER: de Meijer C
PROVIDER: S-EPMC5549212 | biostudies-other | 2013 Dec
REPOSITORIES: biostudies-other
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Project description:BackgroundThe existing evidence shows that the pattern of health expenditure differs considerably between people at the end-of-life and people in other periods of their lives. The awareness of these differences, combined with a detailed analysis of future mortality rates is one of the key pieces of information needed for health spending prognoses. The general objective of this review was to identify and map the existing empirical evidence on end-of-life expenditure related to health care for the older population.MethodsTo achieve the objective of the study a systematic scoping review was performed. There were 61 studies included in the analysis. The project has been registered through the Open Science Framework.ResultsThe included studies cover different kinds of expenditure in terms of payers, providers and types of services, although most of them include analyses of hospital spending and nearly 60% of analyses were conducted for insurance expenditure. The studies provide very different results, which are difficult to compare. However, all of the studies analyzing expenditure by survivorship status indicate that expenditure on decedents is higher than on survivors. Many studies indicate a strong relationship between health expenditure and proximity to death and indicate that proximity to death is a more important determinant of health expenditure than age per se. Drawing conclusions on the relationship between end-of-life expenditure and socio-economic status would be possible only by placing the analysis in a broader context, including the rules of a health system's organization and financing. This review showed that a lot of studies are focused on limited types of care, settings, and payers, showing only a partial picture of health and social care systems in the context of end-of-life expenditure for the older population.ConclusionThe results of studies on end-of-life expenditure for the older population conducted so far are largely inconsistent. The review showed a great variety of problems appearing in the area of end-of-life expenditure analysis, related to methodology, data availability, and the comparability of results. Further research is needed to improve the methods of analyses, as well as to develop some analysis standards to enhance research quality and comparability.
| S-EPMC10905877 | biostudies-literature
Project description:Little study has yet been made of the effect of different beverages on oral health outcomes in the aging population. The purpose of this systematic review is to evaluate the association between different beverages, including alcohol intake, coffee, milk, tea, and sugary drinks, and a cluster of oral health outcomes, including periodontal disease, oral dysbiosis, and tooth loss in older adults. The literature was screened from the inception up to May 2021 using six different electronic databases. Two independent researchers assessed the eligibility of 1308 retrieved articles regarding inclusion criteria; only 12 fitted the eligibility requirements, representing 16 beverage entries. A minimum age of 60 was the inclusion criterion. No exclusion criteria were applied to outcomes assessment tools, recruiting facilities (hospital or community), general health status, country, and study type (longitudinal or cross-sectional). The consumption of alcoholic beverages was expressed as alcohol intake in all eligible studies, thereby replacing alcoholic beverages in the analysis. The quality of evidence was judged as moderate for alcohol and low or very low for beverages. In regard to oral health in the elderly, the review identified information on alcohol (56.25%), followed by coffee (18.75%), milk (12.50%), tea (6.25%), and sugary drinks (6.25%). Alcohol, sugary drinks, and coffee were found to be related to tooth loss. Periodontal disease was inversely related to coffee and milk, but fostered by alcohol consumption. In one article, tea but not coffee seemed to improve oral microbiota. In summary, alcohol seems to be a driver for tooth loss and periodontal disease in the aging population. However, more research is needed to gain a more solid knowledge in this research area. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO, Identifier: CRD42021256386.
| S-EPMC8579113 | biostudies-literature
Project description:We investigate the consequences of population aging for long-run economic growth perspectives. Our framework incorporates endogenous growth models and semi-endogenous growth models as special cases. We show that (1) increases in longevity have a positive impact on per capita output growth, (2) decreases in fertility have a negative impact on per capita output growth, (3) the positive longevity effect dominates the negative fertility effect in case of the endogenous growth framework, and (4) population aging fosters long-run growth in the endogenous growth framework, while its effect depends on the relative change between fertility and mortality in the semi-endogenous growth framework.Electronic supplementary material The online version of this article (doi:10.1007/s00148-012-0441-9) contains supplementary material, which is available to authorized users.
| S-EPMC3617593 | biostudies-literature
Project description:BackgroundIn 2002, the Chinese government launched a new rural health financing policy to provide health insurance (New Cooperative Medical Scheme, NCMS) for its rural population. NCMS, jointly financed by governments and individual households, aims to protect households from impoverishment due to catastrophic health expenditure. In 2011, NCMS covered more than 96% of the rural population. We have systematically searched and reviewed available evidence to estimate the effects of NCMS on health outcomes and on alleviating catastrophic health expenditure.MethodsPubMed, Web of Science with Conference Proceedings, ProQuest Digital Dissertations, CMCI, CNKI, and VIP were searched. We also obtained literature from colleague communications. Quasi-experimental studies regarding the effect of NCMS on health outcomes and catastrophic health expenditure were included. Two independent reviewers screened the literature, extracted the data, and assessed the study quality.ResultsFifteen studies out of the 6123 studies in the literature fulfilled criteria and were included in this review. Twelve studies identified the relationship between NCMS and health outcomes, among which six studies measured sickness or injury in the past four weeks, four measured sickness or injury in the past two weeks, and five measured self-reported health status. Four studies focused on the relationship between NCMS and alleviating catastrophic health expenditure. However, the results from these studies were in conflict: individual studies indicated that NCMS had positive, negative, or no effect on health outcomes and/or the incidence of catastrophic health payments, respectively.ConclusionsWe still have no clear evidence that NCMS improves the health outcomes and decreases the alleviating catastrophic health expenditure of the China's rural population. In addition, the heterogeneity among individual studies reminds us that provider payment method reforms, benefit package and information systems around NCMS should be improved in the future.
| S-EPMC3423411 | biostudies-literature
Project description:The evolution of the aging process has long been a biological riddle, because it is difficult to explain the evolution of a trait that has apparently no benefit to the individual. Over 60 years ago, Medawar realized that the force of natural selection declines with chronological age because of unavoidable environmental risks. This forms the basis of the mainstream view that aging arises as a consequence of a declining selection pressure to maintain the physiological functioning of living beings forever. Over recent years, however, a number of articles have appeared that nevertheless propose the existence of specific aging genes; that is, that the aging process is genetically programmed. If this view were correct, it would have serious implications for experiments to understand and postpone aging. Therefore, we studied in detail various specific proposals why aging should be programmed. We find that not a single one withstands close scrutiny of its assumptions or simulation results. Nonprogrammed aging theories based on the insight of Medawar (as further developed by Hamilton and Charlesworth) are still the best explanation for the evolution of the aging process. We hope that this analysis helps to clarify the problems associated with the idea of programmed aging.
| S-EPMC6398523 | biostudies-literature
Project description:IntroductionOut-of-pocket medical expenses are a crucial source of health care financing in a number of countries. With the ongoing population aging, health care costs are likely to increase. Therefore, disentangling the relationship between health care spending and monetary poverty is becoming increasingly important. Although there is extensive literature on the impoverishment effect of out-of-pocket medical payments, it lacks empirical studies on a causal relationship between catastrophic health expenditure and poverty. In our paper, we try to fill this gap.MethodsWe estimate recursive bivariate probit models using Polish Household Budget Survey data covering years from 2010 to 2013 and from 2016 to 2018. The model controls for a wide range of factors and endogeneity between poverty and catastrophic health expenditure.ResultsWe show that the causal relationship between catastrophic health expenditure and relative poverty is significant and positive across different methodological approaches. We find no empirical evidence that a one-time incidence of catastrophic health expenditure creates a poverty trap. We also show that using a poverty measure which treats out-of-pocket medical payments and luxury consumption as perfect substitutes can lead to an underestimation of poverty among the elderly.ConclusionOut-of-pocket medical payments should probably receive more attention from policymakers than the official statistics suggest. A current challenge is to correctly identify and appropriately support those who are most affected by catastrophic health expenditure. More prospectively, a complex modernization of the Polish public health system is needed.
| S-EPMC9999341 | biostudies-literature
Project description:Older incarcerated individuals comprise the fastest growing demographic in the US prison system. Unhealthy lifestyles among incarcerated individuals and inadequate health care lead to earlier onset and more rapid progression of many chronic conditions that are prevalent among community-living older adults. There are limited peer-reviewed epidemiologic data in this area; however, there is growing interest in identifying strategies for housing aging incarcerated individuals, delivering appropriate health care in prisons, and coordinating after-release health care. In this systematic review, we summarize the epidemiologic evidence of the health challenges facing the aging US prison population. Our comprehensive literature search focused on health outcomes, including diseases, comorbid conditions, mental health, cognition, and mobility. From 12,486 articles identified from the literature search, we reviewed 21 studies published between 2007 and 2017. All the studies were observational and cross-sectional, and most (n = 17) were based on regional samples. Sample sizes varied widely, ranging from 25 to 14,499 incarcerated people (median, 258). In general, compared with their younger counterparts, older incarcerated individuals reported high rates of diabetes mellitus, cardiovascular conditions, and liver disease. Mental health problems were common, especially anxiety, fear of desire for death or suicide, and depression. Activities of daily living were challenging for up to one-fifth of the population. We found no empirical data on cognition among older incarcerated individuals. The findings of this review reveal few empirical data in this area and highlight the need for new data to drive policy and practice patterns that address critical health issues related to the aging prison population.
| S-EPMC5982810 | biostudies-literature
Project description:BackgroundThe effect of number of health items on out-of-pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions.ObjectivesThis study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household's information.MethodsA generic questionnaire to collect data on household's OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement.FindingsWe found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items.ConclusionOur findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting.
| S-EPMC8098927 | biostudies-literature
Project description:Background and Aims: The determination of energy requirements is necessary to promote adequate growth and nutritional status in pediatric populations. Currently, several predictive equations have been designed and modified to estimate energy expenditure at rest. Our objectives were (1) to identify the equations designed for energy expenditure prediction and (2) to identify the anthropometric and demographic variables used in the design of the equations for pediatric patients who are healthy and have illness. Methods: A systematic search in the Medline/PubMed, EMBASE and LILACS databases for observational studies published up to January 2021 that reported the design of predictive equations to estimate basal or resting energy expenditure in pediatric populations was carried out. Studies were excluded if the study population included athletes, adult patients, or any patients taking medications that altered energy expenditure. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Of the 769 studies identified in the search, 39 met the inclusion criteria and were analyzed. Predictive equations were established for three pediatric populations: those who were healthy (n = 8), those who had overweight or obesity (n = 17), and those with a specific clinical situation (n = 14). In the healthy pediatric population, the FAO/WHO and Schofield equations had the highest R 2 values, while in the population with obesity, the Molnár and Dietz equations had the highest R 2 values for both boys and girls. Conclusions: Many different predictive equations for energy expenditure in pediatric patients have been published. This review is a compendium of most of these equations; this information will enable clinicians to critically evaluate their use in clinical practice. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=226270, PROSPERO [CRD42021226270].
| S-EPMC8685418 | biostudies-literature
Project description:ObjectivesCatastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the relationships between CHE and people's mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether the association differs between those with and without social health insurance (SHI).MethodsThe data came from 3 waves of the China Health and Retirement Longitudinal Study (2011, 2013, and 2015, N = 13,166). We focused on older people aged 60 and older. We built panel data regression and quantile regression models to analyze the data.ResultsIncurring CHE is significantly associated with poor mental health. The association is weakened among older people receiving SHI, which indicates that SHI has a protective effect. Moreover, the association between CHE and mental health and the protective effect of SHI are stronger among those with mild or moderate mental health problems.DiscussionOur findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for older people with greater health care needs.
| S-EPMC8755894 | biostudies-literature