German Elder Care Costs
May Not Doom Health System
Excerpt By Ned Stafford, Reuter's Health

FRANKFURT (Reuters Health) - The cost of treating elderly patients in German hospitals with life-threatening diseases is far less than treatment costs for people younger than retirement age, which could mean that Germany's rapidly aging population is not the ticking healthcare-spending time bomb that some believe, according to a German researcher.

Dr. Hilke Brockmann of the Max Planck Institute for Demographic Research said that treatment costs for older patients may be lower because of healthcare "rationing," where doctors weigh cost versus chances of successful outcome, rather than simply striving for an optimal medical outcome.

Studies in the US already have questioned the assumption that an aging population leads to increasing healthcare expenditures, Brockmann said in a statement. But she noted that Germany's publicly financed system is very different from the US system. Because a major study of elderly healthcare costs in Germany had not yet been done, it was not clear whether results of the US studies would hold true in Germany.

For the study, Brockmann analyzed data on 430,000 patients at least 20 years old who had been hospitalized during 1996 and 1997 in the western German region of Westphalia-Lippe and the former East German state of Thuringia. The patients were covered by AOK, Germany's largest public health insurance provider.

She analyzed total annual expenses for both surviving and non-surviving patients, as well as the severity of illness and multi-morbidity, length of stay, kind of treatment and location of treatment.

In general, patients older than 60 received less costly treatment than younger patients suffering from the same diseases, with expenses for life-threatening illness declining even more sharply as people aged, she said.

Based on disease type, Brockman found that hospital costs for patients 80 and older were about half that of patients who had not reached retirement age or were only a few years past.

A large portion of health expenses for women aged 20 to 60 are for treatment of breast cancer or other tumors, while older women suffer more from cardiovascular disease. Men's cancer rates increase after age 65, but both older men and women usually die from cardiovascular or respiratory diseases, she said.

The study also found that, in general, hospitals provided more expensive treatment for non-surviving women than for non-surviving men of the same age group through very old ages. In contrast, treatment for surviving male patients was more expensive than for surviving woman, with the only exception being women 85 and older in Thuringia.

Brockmann said she does not agree with one explanation for healthcare rationing, which is that elderly patients simply do not want aggressive medical treatment. She believes that "age-specific cost patterns are caused by clinical decision making."

It is an open question whether the survival rate of elderly patients could be improved if age rationing were discontinued and maximum medical treatment applied, she said.

Brockmann is planning a follow-up study using data from other health insurers in Germany and from other nations.

SOURCE: Social Science & Medicine 2002;55:593-608.

Reference Source 89

For more information on how to prevent other diseases, use
PreventDisease.com's "Quick Prevention Resources".