The effect of population aging on future hospital demand

Health Affairs

Volumn 25, Issue 3, 2006, Pages

  Strunk, Bradley C ^a   Ginsburg, Paul B ^b   Banker, Michelle I ^c  

^a Center for Studying Health System Change (HSC)   (United States)

^b HSC   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; ELDERLY CARE; HEALTH SERVICE; HOSPITALIZATION; HUMAN; LONGEVITY; MEDICAL TECHNOLOGY; POPULATION DYNAMICS; UNITED STATES; UTILIZATION REVIEW;

AGED; BIOMEDICAL TECHNOLOGY; HEALTH SERVICES FOR THE AGED; HEALTH SERVICES NEEDS AND DEMAND; HOSPITALIZATION; HUMANS; LONGEVITY; POPULATION DYNAMICS; UNITED STATES;

EID: 33744766458     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.w141     Document Type: Article

References (20)

1. Calculated by authors from U.S. Census Bureau, "U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin," 26 August 2004, http://www.census.gov/ipc/www/usinterimproj (accessed 13 March 2006).
2. B.C. Strunk and P.B. Ginsburg, "Aging Plays Limited Role in Health Care Cost Trends," Data Bulletin no. 23 (Washington: Center for Studying Health System Change, September 2002);
3. U.E. Reinhardt, "Does the Aging of the Population Really Drive the Demand for Health Care?" Health Affairs 22, no. 6 (2003): 27-39;
4. B. Alemayehu and K.E. Warner, "The Lifetime Distribution of Health Care Costs," Health Services Research 39, no. 3 (2004): 627-642;
5. and S.P. Keehan et al., "Age Estimates in the National Health Accounts," Health Care Financing Review, 2 December 2004, http://www.cms.hhs.gov/apps/review/web_exclusives/keehan.pdf (accessed 14 March 2006).
6. For a complete description of the NHAMCS, see L.F. McCaif and T. McLemore, Plan and Operation of the National Hospital Ambulatory Medical Care Survey, Vital and Health Statistics Series 1, no. 34 (Hyattsville, Md.: National Center for Health Statistics, July 1994).
7. For a complete description of the NHDS, see C. Dennison and R. Pokras, Design and Operation of the National Hospital Discharge Survey: 1988 Redesign, Vital and Health Statistics Series 1, no. 39 (Hyattsville, Md.: NCHS, December 2000).
8. We compared the age pattern of hospital visits for outpatient hospitalizations, emergency department (ED) services, and ambulatory surgery with that of inpatient discharges using the 1996 NHAMCS, 1996 NHDS, and 1996 NSAS. For a complete description of the NSAS, see T. McLemore and L. Lawrence, Plan and Operation of the National Survey of Ambulatory Surgery, Vital and Health Statistics Series 1, no. 37 (Hyattsville, Md.: NCHS, October 1997). All three surveys are conducted by the NCHS as components of its National Health Care Survey and therefore use the same hospital universe and a similar survey design. A simple comparison of outpatient and ED hospitalization, ambulatory surgery in a hospital setting, and inpatient hospitalization suggests that variation in use of outpatient and ED hospitalizations by age is much smaller than age variation in use of inpatient hospitalization. Outpatient and ED visits varied only by a factor of 2 between the lowest-using age group (children ages 6-12) and the highest-using age group (elderly adults over age eighty-five). In stark contrast, inpatient hospitalizations varied by more than a factor of 30 across age groups. The number of ambulatory surgery visits per person varied by a factor of 10 between the lowest-using group (children ages 6-12) and the highest-using group (adults ages 75-84).
9. For more information about the 2003 NIS, see Healthcare Cost and Utilization Project, "Overview of the National Inpatient Sample," 6 January 2006, http://www.hcup-us.ahrq.gov/nisoverview.jsp (accessed 6 March 2006).
10. HSS Inc., All Payer Severity-Adjusted DRGs (APS-DRGs): Normalized Charge, LOS, and Mortality Weights Version 0402H (for APS-DRGs Version 21), 2004, http://www.hcup-us.ahrq.gov/db/nation/nis/APS-DRGs%20V21%20Weights%20Manual.pdf (accessed 17 February 2006).
11. Our analysis at the MDC level excludes those DRGs that are assigned to multiple MDCs, with the exception of those that fall predominantly in one MDC. The DRGs excluded constitute only 0.75 percent of total discharges in 2003. Also, individual charge weight and discharge data for each age in Texas have been interpolated from data on five-year age intervals.
12. See U.S. Census Bureau, "U.S. Interim Projections";
13. see also U.S. Census Bureau, "Methodology and Assumptions for the Population Projections of the United States: 1999 to 2100," Population Division Working Paper no. 38 (Washington: Census Bureau, January 2000), for detailed information about these assumptions.
14. This procedure replicates that of previous analyses; for example, see Strunk and Ginsburg, "Aging Plays Limited Role";
15. and Reinhardt, "Does the Aging of the Population?"
16. The Centers for Medicare and Medicaid Services provide projections for total hospital spending through 2014 based on data from the 2003 National Health Expenditure Accounts. We extended the projection to 2015 by assuming the same annual increase as projected for the 2010-2014 period. We used past trend differences between inpatient and total hospital spending to predict inpatient revenue from 2005 to 2015.
17. Authors' calculations based on data from the NIS. Data obtained through AHRQ, HCUPNet, http://hcup.ahrq.gov/HCUPnet.asp (accessed 6 March 2006).
18. E. Meara, C. White, and D.M. Cutler, "Trends in Medical Spending by Age, 1963-2000," Health Affairs 23, no. 4 (2004): 176-183.
19. D. Shactman et al, "The Outlook for Hospital Spending," Health Affairs 22, no. 6 (2003): 12-26.
20. C. Lesser, P. Ginsburg, and L. Felland, "Initial Findings from HSC's 2005 Site Visits: Stage Set for Growing Health Care Cost and Access Problems," Issue Brief no. 97 (Washington: HSC, August 2005).