1. Alternative scenarios for health, life expectancy and social expenditure - AGIR WP4 Dr. Erika Schulz

2. Erika Schulz 14.02.2003 Aims of WP4 –WP4 focuses on the implications of „living longer and in better health“ on health consumption, health and pension expenditure and sustainability of public finance. –WP4 uses the data of WP1, WP2 and WP3 to make projections. –The sensitivity of demographic projections for health consumption and expenditure as well as retirement benefits will be demonstrated using a scenario approach with alternative assumptions concerning life expectancy and health.

3. Erika Schulz 14.02.2003 Two parts of WP4 –WP4 can be separated into two parts: Part A focuses on the impact of alternative assumptions of life expectancy on the demographic develop- ment and the use of health and long-term care services. –Part B focuses on the development of health expenditure and public finances under alternativ scenarios. –Both parts uses different models and methods and will be therefore presented separatly.

4. Erika Schulz 14.02.2003 Life expectancy, morbidity and health expenditure

5. Erika Schulz 14.02.2003 WP4 Part A deals with following questions:  What impact have further improvements of life expectancy on the demographic development?  What impact has an increasing life expectancy on health care utilisation?  What impact has the ”near to death” on health care utilisation?  What impact has an increasing life expectancy on long-term care recipients in institutions and at home?  What impact have the increasing female labour force participation on the further potential of long- term care giving at home?

6. Erika Schulz 14.02.2003 Tasks of WP 4 Part A –Building scenarios about further improvements in life expectancy and computing the demographic development until 2050. –Building scenarios about improvements in health and the impact on the use of health and long-term care services. –Forecast the number of inpatients and people with LTC for selected EU countries. –If data available forecasts of utilisation will be done consider the „near to death“. –Estimation of the potential of informal care givers of long-term care at home.

7. Erika Schulz 14.02.2003 Demographic scenarios –Most studies for EU countries uses the EUROSTAT baseline scenario. –In this scenario an increase of the average EU fertility rate from 1.5 (2000) to 1.7 in 2050 is projected. –The average life expectancy at birth for men is projected to rise five years from 75 in 2000 to 80 by 2050; for women, it is also projected to rise from 81 years in 2000 to 85 by 2050. –The migration will be nearly constant (660 to 630 million).

8. Erika Schulz 14.02.2003 Demographic development in the EU Source: Eurostat baseline scenario

9. Erika Schulz 14.02.2003 Changes in the number of persons aged 60+ between 1998 and 2050 in % Source: Eurostat baseline scenario

10. Erika Schulz 14.02.2003 Advantage and disadvantage of EUROSTAT –The advantage of using the baseline scenario is, that this forecast is widely spread and that the assumptions are harmonised. –The disadvantage is that the assumptions seems to be not realistic for several EU countries and were criticised at our Madrid meeting the results are not separated by survivors and decedents no scenario without further improvements in life expectancy, but the same assumptions for the other variables as the baseline scenario exists. –Mostly the further increase of life expectancy is underestimated.

11. Erika Schulz 14.02.2003 Assumptions of the EU baseline scenario

12. Erika Schulz 14.02.2003 Development of life expectancy

13. Erika Schulz 14.02.2003... for the Elderly

14. Erika Schulz 14.02.2003 Life expectancy and health status –Life expectancy is only a rough indicator for the global health status of a population. –For the analysis of the impact of an increasing life expectancy on the use of health care services it will be better to distinguish between the number of years lived in full health and the number of years lived in bad health or the share of people with/without disability in each age-group.

15. Erika Schulz 14.02.2003 WHO - Healthy life expectancy

16. Erika Schulz 14.02.2003 Scenarios of improvements in health –Scenario with constant prevalence rates –Scenario with overall improvements in health - decreasing share of sick or disabled people within all age-groups –Scenario which uses the past trends or another scenario (to be discussed)

17. Erika Schulz 14.02.2003 Three hypotheses Medical and technological progress Socio- demographic and economic factors Framework conditions: economic development, policies, assets

18. Erika Schulz 14.02.2003 Men

19. Erika Schulz 14.02.2003 Life expectancy and hospital utilisation in Germany

20. Erika Schulz 14.02.2003 Life expectancy and hospital utilisation in the Netherlands

21. Erika Schulz 14.02.2003 Life expectancy and hospital utilisation in Belgium

22. Erika Schulz 14.02.2003 Use of health care services

23. Erika Schulz 14.02.2003 Hospital days per capita - Germany

24. Erika Schulz 14.02.2003 Results for Germany - four scenarios

25. Erika Schulz 14.02.2003 Development of days spent in a hospital in Germany (in Mill.) - constant LE

26. Erika Schulz 14.02.2003 Development of days spent in a hospital in Germany (in Mill.) - increasing LE

27. Erika Schulz 14.02.2003 Development of days spent in a hospital in Germany (changes in %) - constant LE

28. Erika Schulz 14.02.2003 Development of days spent in a hospital in Germany (changes in %) - increasing LE

29. Erika Schulz 14.02.2003 Number of persons with contact to a doctor in Germany

30. Erika Schulz 14.02.2003 People receiving LTC in Germany

31. Erika Schulz 14.02.2003 People in LTC - structure in %

32. Erika Schulz 14.02.2003 Informal home care - care giving by groups of family caregivers in Germany

33. Erika Schulz 14.02.2003

34. Erika Schulz 14.02.2003 Assumptions about life expectancy

35. Erika Schulz 14.02.2003 Assumptions about fertility

36. Erika Schulz 14.02.2003 Assumptions about migration (1)

37. Erika Schulz 14.02.2003 Assumptions about migration (2)

38. Erika Schulz 14.02.2003 Utilisation rates separated for survivors and decedents

39. Erika Schulz 14.02.2003 Source: Mandeep Bains: Projection future needs. Presentation at the OECD workshop: Ageing related diseases, Paris 20/21 June 2002.

40. Erika Schulz 14.02.2003 Health care expenditure separated for survivors and decedents