Trend in use of health care services and long term care Results of AGIR - WP 2 and WP4A Dr. Erika Schulz

Erika Schulz Life expectancy, morbidity and use of health and long term care services

Erika Schulz Presentation of the results of –WP2, which deals with the current situation in the use of health care and long term care services, and the connection between long term care giving at home and employment of women, and –WP4 Part A, which deals with two different projection methods to estimate the development of the use of health and long term care services: Projection method A, which shows the influence of demographic development without changes in health status of the population on utilisation and Projection method B, which shows the influence of both – demographic development and changes in health status of the population on utilisation.

Erika Schulz WP 2 – proceeding (I) –The first step was to collect all available data about the current use of health and long term care services by age-groups and the trends in the past from our participants covering eight EU-countries: Belgium, Denmark, Finland, France, Germany, Netherlands, Spain and United Kingdom –With these data it was possible to show the connection between age and use of health care services and long term care in institutions and at home. –The advantage of the data is that they inlcude the whole population, the disadvantage is that they do not differentiate between the different health status of the population.

Erika Schulz WP 2 – proceeding (II) –Therefore, in a second step the European Community Household Panel (ECHP) was used to analyse the health care utilisation by age and health status, –and to show the connection between care giving at home and the labour force participation of women. –The disadvantage of the ECHP is, that this household panel covers only persons aged 16+ and provides no information about long term care giving in institutions and the need for long term care at home. –To get an idea of the amount of people in need for long term care the „severely hampered persons who have to cut down things they usually do due to disability“ were used as a soft proxy.

Erika Schulz WP 2 – data from participants –Hospital utilisation (admissions and length of stay) (8 countries) –Contact with doctors ( 7 countries) –Long term care giving in institutions (6) –Long term care giving at home (4) –Household/family composition as a determinant of long term care giving at home (up to 7) and –Labour force participation as a determinant of long term care giving at home (5).

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz Trends in hospital utilisation

Erika Schulz Hospital days per capita - Germany

Erika Schulz

Erika Schulz

Erika Schulz Trends in need for long-term care in institutions and at home

Erika Schulz WP 2 – data from ECHP –Hospital utilisation (admissions and length of stay) –Determinants of hospital utilisation (beside age, sex and health status also education, income and marital status) –Contact with doctors (GP, SP; DE) –Severely hampered persons who have to cut down things they usually do due to longstanding illness or disability –Characteristics of people looking after old and disabled persons in the same household or elsewhere, in particular the employment status of people looking after old persons –Determinants of long term care giving at home (beside age, sex and employment status also health status, family status and income)

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz WP 4A – proceeding (I) –The task of WP 4 Part A was to estimate the health care utilisation taking into account the results of WP 1 and WP 2. –To meet this task two projection methods were used: Method A: The country specific utilisation data collected from our participants were combined with two population scenarios. This projection method shows only the impact of demographic change and increasing life expectancy on health and long term care utilisation, but includes the whole population and long term care giving in institutions.

Erika Schulz WP 4A – proceeding (II) Method B: The ECHP data, which are differentiated by age- groups and health status, were combined with two population scenarios and two health scenarios. This projection method shows the impact of demographic change, increasing life expectancy and changes in the health status of the population on health care utilisation, but includes only the population aged 16+ in private households and provides no information about long term care giving in institutions. Additional the development of potential care givers was calculated.

Erika Schulz Demographic scenarios –As one scenario the EUROSTAT baseline scenario was used and CPB created three additonal scenarios with higher life expectancies: the living longer low scenario, the living longer middle scenario and the living longer high scenario. –In WP 4 Part A the baseline scenario and the living longer high scenario were used. Latter reduces the mortality rates of people aged 20 to 90 by 50 % in gradual steps until 2050 (additional to the reduction of mortality in the baseline scenario). The following table shows the assumptions.

Erika Schulz

Erika Schulz

Erika Schulz WP 4A – Results of projection method A Projection of hospital admissions and of the total number of hospital days Projection of the number of contacts with a doctor Projection of long term care recipients in institutions Projection of long term care recipients at home –All projection were made for two demographic scenarios, namely the baseline scenario and the living longer high scenario

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz WP 4 Part A projection method B

Erika Schulz

Erika Schulz

Erika Schulz WP 4A – Results of projection method B Projection of hospital admissions and of the total number of hospital days Projection of the number of contacts with a general practitioner Projection of severely hampered persons Projection of persons providing long term care at home –All projection were made for two demographic and two health scenarios, namely the baseline scenario with constant health, the baseline scenario with improving health, the living longer scenario with constant health and the living longer in better health scenario, and for the eight participating countries, for these countries altogether and for the EU.

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz

Erika Schulz Summary (1) –Empirical analyses in WP 2 showed that the use of inpatient and outpatient services are related to age and health status, but also to education and income. –The increasing life expectancy are in most countries connected with higher utilisation rates in the past. –The need for long-term care is closely related to age. The prevalence rates for long-term care increases sharply from age 70 onwards, and women have a higher probability to receive long-term care than men, because widowhood is more often among women than men. –Whereas life expectancy increased the prevalence rates for long-term care giving in institutions show no clear trend. Institutional care is influenced by other important factors, especially political decisions, than trends in life expectancy.

Erika Schulz Summary (2) –On average around 5 % (7 %) of all persons (of women) are informal care givers. Care giving at home is in most cases a hard burden for care givers. On average around 18 hours were spend for care giving at home (women spend 21 hours). –The share of care givers is higher among inactive people than employees. –Employment and care giving seems adversely related. If need for care giving occur within the household a great part of women leave their job, a lower part reduced their working time.

Erika Schulz Summary (3) –Based on the results and data of WP2 and WP1 (in particular the estimations of LEGH) in WP 4 Part A the development of health care and long term care utilisation until 2050 were shown at two levels: In projection method A the data from national sources were combined with two demograhic scenarios. The results show the effect of demographic changes and the impact of increasing life expectancy for the total population and provides estimations for long term care giving in institutions. In projection method B data from the ECHP were combined with four scenarios including changes in life expectancy and health status of the population. The results show the impact of demographic changes, increasing life expectancy and improvements in health on health care utilisation, but includes only people aged 16+ and provides no information about care giving in institutions.

Erika Schulz Summary (4) –The results of projection method A and projection method B are not full comparable, because they uses different sources and definitions of variables, but in general they show similar developments: The development of hospital days and long term care giving respectively severely hampered persons show a higher dynamic than the development of hospital admissions and contacts with a doctor The living-longer-high scenario lead to higher population in 2050, but the development of the utilisation show a still higher dynamic Countries with a decreasing population until 2050 show no general lower increases in utilisation development than countries with increasing population

Erika Schulz Summary (5) –The estimations with the projection method B show that improvements in health status lead to a more moderate increase in utilisation compared to the scenarios without improvements in health. But in general, under the underlying assumptions the improvements in health cannot completely compensate the effect of increasing life expectancy. In the EU are the utilisation data a little bit higher in the living-longer better health scenario as in the baseline scenario in 2050.

Erika Schulz Summary (6) The estimation of the development of the number of care- givers at home shows that a better health status does not lead to a markedly higher number of care-givers. The main driving factors are the demographic development and the additional increase in life expectancy in the living-longer scenario. The development of the relation of severely hampered persons to the number of care-givers shows that the pressure on informal care-giving will increase. If the higher development of long-term care recipients at home from the national sources are taken into account, this relation may have a much higher dynamic. The expected changes in household composition and increase in the labour force participation of women strengthen this development, too

Erika Schulz