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Solidarity and the distribution of Health Expenditures. Johan Polder Tilec-Tranzo Annual Conference Tilburg, January 26th 2012. Succes comes at the price of public health expenditure (billion euros, share in total public spending; source: CPB). Competition in Dutch health care.

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Solidarity and the distribution of health expenditures

Solidarity and the distribution of Health Expenditures

Johan Polder

Tilec-Tranzo Annual Conference

Tilburg, January 26th 2012


Succes comes at the price of public health expenditure(billion euros, share in total public spending; source: CPB)


Competition in dutch health care
Competition in Dutch health care

  • Harmful for solidarity?

    • no evidence

  • Harmful for tax payer?

    • Depends on the balance between costs and benefits


Policy debate anno 2012
Policy debate anno 2012

  • Affordability of health care in the (near) future

    • Given ageing

    • Given trends in epidemiology and technology

    • Given economic outlook

  • Sustainability of solidarity

    • Given that babyboom cohort gets older

    • Given age specific trends in health expenditure


This presentation
This presentation

  • Macroeconomic perspective

  • The role of health as a determinant of health expenditure (HCE)

  • Especially

    • The distribution of HCE over the course of life regarding healthy ageing



What about health

Absence of illness

Self perceived health

Physical and cognitive limitations

What about health?


Cost of illness 2010
Cost of illness 2010

Average HCE per inhabitant (euro)

Females

Males


Red herring in dutch hospital expenditure average expenditure for decedents and survivors
“Red herring” in Dutch hospital expenditureAverage expenditure for decedents and survivors

Decedents

Survivors

age


Latent health states based on the longitudinal ageing study amsterdam lasa
Latent health StatesBased on the Longitudinal Ageing Study Amsterdam (LASA)

Bad health

Moderate health

Good health



The 2 faces of healthy ageing
The 2 faces of healthy ageing

Life expectancy at age 65

Cumulative HCE at age 65


Lorenzcurve for acute care expenditure single year versus lifetime
Lorenzcurve for Acute Care expenditureSingle year versus lifetime


Conclusion
Conclusion

  • Despite / (due to?) competition

  • there’s a lot of solidarity in the Dutch health care system

    • (Between higher and lower incomes, not discussed)

    • Between healthy and unhealthy people

    • Between age cohorts

    • But also between people and their future selves


Competition and solidarity
Competition and solidarity

  • There’s a strong case for a longitudinal approach

    • Health Maintenance Organizations

    • Long term insurance contracts

    • Health Savings Accounts

  • Competition

    • fair balance between solidarity and a

    • Sustainable development of health care expenditure


  • The increasing share of global income spenton healthcare expenditures is not a calamity; itis a sign of the remarkable economic andsocial progress of our age”

  • (The Escape from Hunger and Premature Death, 1700–2100; 2004, p.107).



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