Health care rationing in Germany

In the years to come demographers expect the elderly population in Germany to grow due to both low birth rates and rising longevity. It has generally been assumed that population aging leads to increasing health expenditures. Data usually exhibit a linear increase in health care expenditures with age. But studies from scientists in the U.S.A question this assumption. For example, Lubitz and colleagues from the American Health Care Financing Administration show that older patients in hospitals induce lower costs than younger patients. In 1988, Medicare costs for deceased patients 65 to 69 years of age averaged $15.436, whereas costs for deceased patients 90 years of age or older averaged only $8.888. "Unfortunately there were hardly any comparable studies in other countries," says Dr. Hilke Brockmann from the Max Planck Institute for Demographic Research in Rostock. Thus, it was impossible to say whether these decreasing medical expenditures at higher ages are an American pattern due to the specific feature of a private health insurance regime. "In addition, it was completely unknown whether sex plays also a role in discriminating against older people in hospitals", says Brockmann. That is why she started a research project based on data obtained from Germany's largest health insurer (AOK) in two different regions; Westphalia-Lippe (Western Germany) and Thuringia (Eastern Germany). The data include the costs of hospital stays of AOK members between 1996 and 1997 who were at least 20 years old. The descriptive analyses reveal the total annual expenses for deceased and non-deceased patients and the age-specific distribution of diseases among the deceased patients. The influence of age discrimination was tested with multivariate regression models. The study examines the severity of the illness and multi-morbidity, as well as the length of stay, the kind of treatment and the place of treatment.

Patients that died in 1997 and survivors were analyzed separately. It

Contact: Dr. Hilke Brockmann

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