Health

Wealth and Disability in Later Life: The English Longitudinal Study of Ageing (ELSA)

This is the introduction to a special issue of Fiscal Studies, looking at medical spending around the developed world.

This paper examines health status differences between England and the United States, with an emphasis on the implications of any health disparities for health care cost differences between the two countries.

This paper reviews what is known about socio-economic inequalities in health care in England, with particular attention to inequalities relative to need that may be considered unfair (‘inequities’).

This paper presents a summary of the trends in medical expenditure in England together with, using detailed administrative data, an analysis of the growth over 15 years of expenditure and activity in hospital inpatient health care, which represents around 20–25 per cent of all NHS expenditure.

Using full population longitudinal data from merged administrative registers for Denmark, we document that medical spending is highly concentrated in the population and is persistent through time at the individual level.

This paper uses administrative National Health Service hospital records to examine key features of public hospital spending in England.

This paper studies medical spending in France from three perspectives: concentration, persistence, and evolution before death.

We use claims panel data from a big German private health insurer to provide detailed individual-level evidence on medical spending between 2005 and 2011. This includes evidence on the distribution of medical spending, the dependence of medical spending on age and other demographic characteristics, its persistence, and how medical spending evolves in the years before death.

Health care spending growth in Japan has accelerated in recent years, unlike in most OECD countries. It is thus important to characterise the structure of recent medical spending using individual-level data.

The Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population.

In this paper, we present evidence on the concentration of hospital-based medical spending in Canada.

Since the creation of National Health Insurance (NHI) in 1995, Taiwan's medical spending has been increasing rapidly, as has been the case in most countries worldwide. This paper follows international standards in documenting recent trends in Taiwan's medical spending by category, relying on official statistics, Surveys of Family Income and Expenditure (SFIE) data and administrative reimbursement panel data from the NHI Universal Database (NHIUD).

We document facts about the US population's medical spending using the Medical Expenditure Panel Survey data set.

We use data from the Medicare Current Beneficiary Survey (MCBS) to document the medical spending of Americans aged 65 and older.

There is little current information regarding the long-term persistence of health spending in the United States, in particular among the population aged under 65 (pre-Medicare eligibility). We describe and model the extent of persistence over a six-year period (2003–08) using medical and pharmacy claims for over 3 million employees, retirees and dependants derived from the Truven Health MarketScan database.

We use data from the Health and Retirement Study (HRS) to document the distribution of out-of-pocket medical spending among individuals aged 55 and over in the US. The HRS data permit us to examine out-of-pocket spending close to the end of life and to analyse the components of spending in more detail than has been done in previous studies.

In 2012/2013 the English Longitudinal Study of Ageing (ELSA) included a comprehensive Sexual Relationships and Activities Questionnaire (SRA-Q). A total of 7,079 men and women mainly aged 50 to >90, primarily heterosexual and in a coupled relationship, completed the SRA-Q, answering a series of questions about their attitudes to sexual relationships, their own sexual activities, problems and concerns with sexual functioning, and quality of intimate relationships. The questions aimed to gain insights into the ways in which sexual relations and activities related to health, wellbeing and other lifestyle factors change as people grow older. The primary mode of data collection was a tick box response to a series of questions. However, at the end of the questionnaire an open comment box was provided, which asked respondents whether there was anything else that they would like to say; 1,084 respondents provided additional information and these comments created a unique qualitative data-set. The analysis of the data then illustrated how people's health, relationships, experiences and perceptions of ageing, along with sexual satisfaction, impact on sexual relationships and activities.

The old age provisions of the Medicaid program were designed to insure retirees against medical expenses. We estimate a structural model of savings and medical spending and use it to compute the distribution of lifetime Medicaid transfers and Medicaid valuations across currently single retirees.