1. Solidarity and the distribution of Health Expenditures
Johan Polder
Tilec-Tranzo Annual Conference
Tilburg, January 26th 2012
Solidarity and the distribution of health expenditures

2. Solidarity and the distribution of health expenditures

3.
Succes comes at the price of public health expenditure (billion euros, share in total public spending; source: CPB)
Solidarity and the distribution of health expenditures

4. Competition in Dutch health care
Harmful for solidarity?
no evidence
Harmful for tax payer?
Depends on the balance between costs and benefits
Solidarity and the distribution of health expenditures

5. 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
Solidarity and the distribution of health expenditures

6. 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
Solidarity and the distribution of health expenditures

7. Tranzo Health Economists’ Group
Solidarity and the distribution of health expenditures

8. What about health? Absence of illness Self perceived health
Physical and cognitive limitations
Solidarity and the distribution of health expenditures

9. Solidarity and the distribution of health expenditures

10. Cost of illness 2010 Average HCE per inhabitant (euro) Females Males
Solidarity and the distribution of health expenditures

11. Solidarity and the distribution of health expenditures

12.
“Red herring” in Dutch hospital expenditure Average expenditure for decedents and survivors
Decedents
Survivors
age
Solidarity and the distribution of health expenditures 12

13. Latent health States Based on the Longitudinal Ageing Study Amsterdam (LASA)
Bad health
Moderate health
Good health
Solidarity and the distribution of health expenditures

14. Life expectancy Health expenditure
Solidarity and the distribution of health expenditures

15. The 2 faces of healthy ageing
Life expectancy at age 65
Cumulative HCE at age 65
Solidarity and the distribution of health expenditures

16. Lorenzcurve for Acute Care expenditure Single year versus lifetime
Lorenzcurve for Acute Care expenditure Single year versus lifetime
Solidarity and the distribution of health expenditures

17. 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
Solidarity and the distribution of health expenditures

18. 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
Solidarity and the distribution of health expenditures

19.
“The increasing share of global income spent on healthcare expenditures is not a calamity; it is a sign of the remarkable economic and social progress of our age”
(The Escape from Hunger and Premature Death, 1700–2100; 2004, p. 107).
Solidarity and the distribution of health expenditures 19

20. Thank you…!
Solidarity and the distribution of health expenditures