Aging, Dependency, and Healthcare Expenditures: Recent Evolution in Spain

Background: There is known to be a statistically positive relationship between age, dependency, and per capita healthcare expenditure, although its impact on healthcare and long term care expenditure growth is not clear. Theories of compression and expansion of morbidity offer opposite approaches to this subject.

Objectives: To quantify individual healthcare expenditure by age, to study the evolution of both health status and dependency among the elderly, and finally to estimate the relationships among them.

Methodology: The scope of this study is the Spanish national territory during the years 1997 to 2003. The analyzed variables are age, sex, health status, healthcare consumption, healthcare expenditure, and degree of dependency. Relationships among variables were analyzed by means of a logistic regression analysis.

Results: Healthcare expenditure of individuals 65 and over is three times the expenditure of those of 5-14 years. Future projections suggest that healthcare expenditures will grow proportionally more than the population. Dependency prevalence among the elderly has increased during the analyzed period from 26% in 1997 to 31% in 2003. Individuals with mild or moderate degrees of dependency consume primary care and drugs more intensively than those who are not dependent, although people with high dependency degrees do not.

Conclusions: While some published analyses predict a “morbidity compression” for the year 2010, both the known association between dependency and certain increasingly prevalent diseases and the obtained results lead us to support the “morbidity expansion” theory in Spain for the period 1997-2003.