Bollettino epidemiologico nazionaleAging and Health Care Costs, Treviso (Veneto), 1999-2000
Giuseppe Battistella and Antonio Carlini
Epidemiologic Observatory of Local Health Agency 9, Treviso
The increasing number of older persons in the populations is resulting in an increased demand for health services and increasing costs (1). In Treviso, where 16.9% of the population is over the age of 65, the elements contributing to increased consumption of health services has been examined.
The analysis was based on computerized data of the Local Health Agency 9 of Treviso (population 362,000). Data from a variety of data sets on health care utilization were linked using each individual’s health identification number.
The sources used included data for 1999-2000 from public and from private health facilities under contract with the Local Health Agencies and from other Local Health Agencies in the Veneto Region and elsewhere in Italy where local residents may have sought care. Data obtained from these sources included hospitalizations, including day hospital use (99% of records successfully linked with the health agency population list in 2000); prescription records (93.8% successful linkage), outpatient specialty services (92.6% successful linkage). A series of checks were carried out to verify data quality.
The hospitalization and day hospital costs were calculated based on individual discharge records and services of specialists received during the hospitalization; for pharmacy costs, the reimbursement paid by the health agency for each prescription that was filled was used. The cost for drugs and for specialty services include those paid by the health unit and by the patient (in Italy, patients pay a minimal sum for each prescription and specialty visit).
During 1999-2000, the per capita costs were equal to 405 Euros in those under 65 years and 1, 681 for those 65 years and over. Trends in pro-capita costs are shown in the Figure.
After the first year of life, costs remain low during infancy and adolescence. For males, the costs remain relatively low until the age of 50, after which they begin to increase rapidly. For women between the ages of 20 and 50 years, the costs are higher than for men, but after 50 years, they are generally lower.
The mean per capita costs by type of service received and age are seen in Table 1. Among those 65 and over, the group with the highest costs, 60% of total costs are for hospitalization.
The increase in costs associated with age may be due to the increasing frequency of various diseases/conditions and/or to increasing costs of treat a specific disease or condition (2). Table 2 shows the prevalence of two important diseases (diabetes and neoplasms) and the costs related to the two. The prevalence of both increases with age, as does the percent of total expenditures accounted for by the two diseases. However, while the per capita costs for diabetes increase with age, those for neoplastic disease remain essentially unchanged among adults. Although these two diseases are relatively infrequent, they represent an important proportion of overall costs.
The reduction of costs will require major efforts directed toward primary and secondary prevention. For example, for diabetes, recent studies have suggested that screening for glucose intolerance and the promotion of physical activity can have major effects on the incidence of Type 2 diabetes, the most commonly observed form in adults (3) and that secondary prevention, with periodic clinical evaluations, can prevent the development of costly complications (4).
Comment
Roberto Zanola
University of Western Piedmont “A Avogadro”
Centre for Health Economics, Department of Public Policy and Collective Choice
For some time, attempts have been made to estimate the effects of aging on health care costs. There are two main schools of thought, and this article brings to mind both of the two. At the moment, the debate remains open. On the one hand, there is a rich body of scientific literature that confirms that aging of the population results in increased health care costs (5,6). Others, however, feel that the effects of aging are less than might be predicted (7,8). This article, using the computerized records of the Local Health Agency 9 of Treviso, contributes to this debate, providing evidence justifying both theories. The increase in the number of elderly is resulting an in increased demand for health services and an accompanying increase in public sector costs. Further examination of the data, however, shows that the increase in cost is largely limited to increase in the numbers and rates of hospitalization.
Caution is required in generalizing the findings of a local study presented here to the rest of Italy. It would be useful to compare results for a national sample to determine the extent to which these findings are specific to the Treviso setting or whether they are indeed more generalizable. Alternatively, it would be interesting and useful to reproduce this study in other parts of the country. Finally, it may be useful to apply econometric analyses (6) to further refine the methodologic content presented here.