人口老化與全民健保支出：死亡距離取向的分析

10.6191/jps.2011.5

李大正(Tai-Cheng Lee)；楊靜利(Ching-Li Yang)；王德睦(Te-Mu Wang)

人口老化 ； 死亡距離 ； 醫療費用 ； population aging ； time to death ； health care expenditures

人口學刊

43期（2011 / 12 / 01）

1 - 35

繁體中文

一般認為醫療費用隨著年齡增加而增加，因此人口老化將加重醫療費用上漲壓力。然而，部分研究指出老年人的平均醫療費用比年輕人高的關鍵不只是年齡較大，還有老年人較年輕人更接近死亡，因此主張討論人口老化與醫療費用的關聯時，必須納入「死亡距離」的考量。本文從死亡距離角度分析臺灣不同年齡人口之死亡距離別醫療費用的分佈，以檢視年齡、死亡距離與醫療費用三者的關聯。最後結合人口推計結果，比較年齡與死亡距離兩種取向下未來全民健保整體支出的趨勢。研究結果顯示，個人醫療費用的高峰集中於死亡前一段時間，而死亡年齡越高，死亡距離別平均醫療費用越低，隱含壽命延長一方面因增加高齡人數而對整體醫療費用帶來壓力，另一方面也對整體費用的上漲有遞延作用。此外，從歷年資料來看，平均每人醫療支出開始快速增加的時間與死亡時間的距離逐漸擴大，顯示罹患疾病的時間拉長，又加大醫療支出。綜合而言，總體醫療費用將隨著人口老化而逐漸成長，但是費用推計的結果顯示年齡模型的估計值明顯較死亡距離模型估計值來得高，顯然單從年齡取向探討人口老化與醫療費用的關聯，容易高估人口老化對醫療費用的影響。

The effects of ageing on health care spending are uncertain. Some argue that health care expenditures increase substantially with age primarily because mortality rates increase with age, and expenditures increase with closeness to death. The main reason why healthcare costs increase with age is that older people are closer to death than younger people. The pattern of health expenditure by age is considerably influenced by the concentration of expenditure in the final years of life. The greater expenditure on the elderly is a consequence of the heavy weight of so-called death costs. In addition, increases in longevity may be expected to lead to postponement of these costs of the final years of life, and declines in age-specific mortality may be expected to lead to declines in age-specific costs because declining mortality reduces the proportion of those near death. If we overlook this aspect, we envisage a misleading scenario of health expenditure increase.Incorporating the concept of time to death, this paper reexamines the relationship of population aging and healthcare expenditure in Taiwan. Results indicate that different death age groups have similar average expenditures patterns against time to death, but expenditures are higher for younger people than for older people. These imply that increases in longevity delay the high costs associated with the final stage of life. Projections failing to take time to death into account might result in upward biased simulations, while total expenditures will still be raised by the absolute number of elderly people.

1. 陳世能、邱雅苓(2003)。醫療保健支出成長因素之探討—時間序列分析與門檻模型的應用。經濟研究，39(2)，197-240。
   連結：
2. 行政院經濟建設委員會人力規劃處（2008）中華民國臺灣97 年至145年人口推計。臺北。
3. Felder, S.,Meier, M.,Schmitt, H.(2000).Health Care Expenditure in the Last Months of Life.Journal of Health Economics,19(5),679-695.
4. Fuchs, V. R.(1984).Though Much Is Taken: Reflections on Aging, Health, andMedical Care.MilbankMemorial Fund Quarterly,62(2),143-166.
5. Garber, A. M.,MaCurdy, T. E.,McClellan, M. C.(1998).Medical Care at the End of Life: Diseases, Treatment Patterns and Costs.NBER Working Paper,6748
6. Getzen, T. E.(1992).Population Aging and the Growth of Health Expenditures.Journal of Gerontology: Social Sciences,47(3),S98-S104.
7. Hoover, D. R.,Crystal, S.,Kumar, R.,Sambamoorthi, U.,Cantor, J. C.(2002).Medical Expenditures During the Last Year of Life: Findings from the 1992-1996 Medicare Current Beneficiary Survey.Health Service Research,37(6),1625-1642.
8. Lien, H. M.,Chou, S. Y.,Liu, J. T.(2008).Hospital Ownership and Performance: Evidence from Stroke and Cardiac Treatment in Taiwan.Journal of Health Economics,27(5),1208-1223.
9. Liu, C. N.,Yang, M. C.(2002).National Health Insurance Expenditure for Adult Beneficiaries in Taiwan in Their Last Year of Life.Journal of the FormosanMedical Association,101(8),552-559.
10. Lubitz, J. D.,Riley, G. F.(1993).Trends in Medicare Payments in the Last Year of Life.The New England Journal of Medicine,328(15),1092-1096.
11. Lubitz, J.,Beebe, J.,Baker, C.(1995).Longevity and Medicare Expenditures.TheNew England Journal ofMedicine,332(15),999-1003.
12. Madsen, J.,Serup-Hansen, N.,Kristiansen, I. S.(2002).Future Health Care Costs-Do Health Care Costs During the Last Year of Life Matter?.Health Policy,62(2),161-172.
13. Mendelson, D. N.,Schwartz, W. B.(1993).The Effects of Aging and Population Growth on Health Care Costs.Health Affairs,12(1),119-125.
14. Miller, T.(2001).Increasing Longevity and Medicare Expenditures.Demography,38(2),215-226.
15. Payne, G.,Laporte, A.,Foot, D. K.,Coyte, P. C.(2009).Temporal Trends in the Relative Cost of Dying: Evidence from Canada.Health Policy,90(2-3),270-276.
16. Polder, J. J.,Barendregt, J. J.,van Oers, H.(2006).Health Care Costs in the Last Year of Life-The Dutch Experience.Social Science and Medicine,63(7),1720-1731.
17. Schneider, E. L.,Guralnik, J. M.(1990).The Aging of America: Impact on Health Care Costs.The Journal of the AmericanMedical Association,263(17),2335-2340.
18. Scitovsky, A. A.(2005).The High Cost of Dying:What Do the Data Show?.TheMilbank Quarterly,83(4),825-841.
19. Seshamani, M.,Gray, A.(2004).Ageing and Health-Care Expenditure: TheRedHerringArgument Revisited.Health Economics,13(4),303-314.
20. Shang, B.,Goldman, D.(2007).Does Age or Life Expectancy Better Predict Health Care Expenditures?.Health Economics,17(4),487-501.
21. Stearns, S. C.,Norton, E. C.(2004).Time to Include Time to Death? The Future of Health Care Expenditure Predictions.Health Economics,13(4),315-327.
22. Van Weel, C.,Michels, J.(1997).Dying, Not Old Age, to Blame for Costs of Health Care.The Lancet,350(9085),1159-1160.
23. Werblow, A.,Felder, S.,Zweifel, P.(2007).Population Ageing and Health Care Expenditure: A School of 'Red Herrings'?.Health Economics,16(10),1109-1127.
24. Yang, Z.,Norton, E. C.,Stearns, S. C.(2003).Longevity and Health Care Expenditures: The Real Reasons Older People Spend More.Journal of Gerontology: Social Sciences,58B(1),S2-S10.
25. Zweifel, P.,Felder, S.,Meiers, M.(1999).Ageing of Population and Health Care Expenditure: A Red Herring?.Health Economics,8(6),485-496.
26. Zweifel, P.,Felder, S.,Werblow, A.(2004).Population Ageing and Health Care Expenditure: New Evidence on the 'Red Herring'.Geneva Papers on Risk and Insurance: Issues and Practice,29(4),652-666.
27. 行政院衛生署中央健康保險局(2009)。,臺北:。
28. 行政院衛生署中央健康保險局(2008)。,臺北:。
29. 陳寬政、劉正、涂肇慶(1999)。出生時平均餘命的長期趨勢：臺灣與日本。臺灣社會學研究，3，87-114。
30. 楊銘欽(2001)。行政院衛生署委託研究計畫行政院衛生署委託研究計畫,行政院衛生署。
31. 劉嘉年、楊銘欽、楊志良(2001)。臺灣成年民眾於死亡前三個月健保醫療費用支出之影響因素分析。臺灣公共衛生雜誌，20(6)，451-462。
32. 謝啟瑞、林建甫、游慧光(1998)。臺灣醫療保健支出成長原因的探討。人文及社會科學集刊，10(1)，1-32。

1. 蔡偉德、陳芝嘉、余清祥(2015)。921震災對中老年人死亡風險的影響。人口學刊，50，61-99。
2. 高興桂(2012)。老年人身體活動與醫療看診次數之關係研究。中原體育學報，1，214-224。
3. 許筱翎,余清祥,王信忠(2019)。從全民健保研究資料庫評估高齡人口的醫療利用。人口學刊，58，89-120。
4. 張宏達、吳鴻文(2018)。複合型運動對老人功能性體適能的效益。體育學系系刊，17，111-118。
5. 鄭惠萍、高興桂(2012)。老人運動行為與看診次數及生活品質之關係。運動研究，21(2)，1-15。
6. 莊正中(2015)。告別悲觀主義預言？試論臺灣人口老化危機的迷思與挑戰。東吳社會工作學報，28，75-108。