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Modeling the relationship between health and health care expenditures using a latent Markov model

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  • Wouterse, Bram
  • Huisman, Martijn
  • Meijboom, Bert R.
  • Deeg, Dorly J.H.
  • Polder, Johan J.

Abstract

We investigate the dynamic relationship between several dimensions of health and health care expenditures for older individuals. Health data from the Longitudinal Aging Survey Amsterdam is combined with data on hospital and long term care use. We estimate a latent variable based jointly on observed health indicators and expenditures. Annual transition probabilities between states of the latent variable are estimated using a Markov model. States associated with good current health and low annual health care expenditures are not associated with lower cumulative health care expenditures over remaining lifetime. We conclude that, although the direct health care cost saving effect is limited, the considerable gain in healthy lifeyears can make investing in the improvement of health of the older population worthwhile.

Suggested Citation

  • Wouterse, Bram & Huisman, Martijn & Meijboom, Bert R. & Deeg, Dorly J.H. & Polder, Johan J., 2013. "Modeling the relationship between health and health care expenditures using a latent Markov model," Journal of Health Economics, Elsevier, vol. 32(2), pages 423-439.
    • Handle: RePEc:eee:jhecon:v:32:y:2013:i:2:p:423-439
    DOI: 10.1016/j.jhealeco.2012.11.005
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    as
    1. Frijters, Paul & Ulker, Aydogan, 2008. "Robustness in health research: Do differences in health measures, techniques, and time frame matter?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1626-1644, December.
    2. Wouterse, B. & Meijboom, B.R. & Polder, J.J., 2011. "The relationship between baseline health and longitudinal costs of hospital use," Other publications TiSEM bdedc33c-9737-4bfc-beee-0, Tilburg University, School of Economics and Management.
    3. Deb, Partha & Trivedi, Pravin K., 2002. "The structure of demand for health care: latent class versus two-part models," Journal of Health Economics, Elsevier, vol. 21(4), pages 601-625, July.
    4. Bruce A. Craig & Peter P. Sendi, 2002. "Estimation of the transition matrix of a discrete‐time Markov chain," Health Economics, John Wiley & Sons, Ltd., vol. 11(1), pages 33-42, January.
    5. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    6. France Weaver & Sally C. Stearns & Edward C. Norton & William Spector, 2009. "Proximity to death and participation in the long‐term care market," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 867-883, August.
    7. Beth A. Reboussin & Kung-Yee Liang & David M. Reboussin, 1999. "Estimating Equations for a Latent Transit ion Model with Multiple Discrete Indicators," Biometrics, The International Biometric Society, vol. 55(3), pages 839-845, September.
    8. Teresa Bago d'Uva, 2005. "Latent class models for use of primary care: evidence from a British panel," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 873-892, September.
    9. repec:dau:papers:123456789/3881 is not listed on IDEAS
    10. Michael Molla & James Lubitz, 2008. "Retrospective information on health status and its application for population health measures," Demography, Springer;Population Association of America (PAA), vol. 45(1), pages 115-128, February.
    11. de Meijer, Claudine & Koopmanschap, Marc & d' Uva, Teresa Bago & van Doorslaer, Eddy, 2011. "Determinants of long-term care spending: Age, time to death or disability?," Journal of Health Economics, Elsevier, vol. 30(2), pages 425-438, March.
    12. Duan, Naihua, et al, 1983. "A Comparison of Alternative Models for the Demand for Medical Care," Journal of Business & Economic Statistics, American Statistical Association, vol. 1(2), pages 115-126, April.
    13. Bram Wouterse & Bert R. Meijboom & Johan J. Polder, 2011. "The relationship between baseline health and longitudinal costs of hospital use," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 985-1008, August.
    14. Brigitte Dormont & Michel Grignon & Hélène Huber, 2006. "Health expenditure growth: reassessing the threat of ageing," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 947-963, September.
    15. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    16. Peter Zweifel & Stefan Felder & Markus Meiers, 1999. "Ageing of population and health care expenditure: a red herring?," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 485-496, September.
    17. Paul Fearnhead & Loukia Meligkotsidou, 2004. "Exact filtering for partially observed continuous time models," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 66(3), pages 771-789, August.
    18. France Portrait & Maarten Lindeboom & Dorly Deeg, 2000. "The use of long‐term care services by the Dutch elderly," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 513-531, September.
    19. Teresa Bago d'Uva, 2006. "Latent class models for utilisation of health care," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 329-343, April.
    20. Gaétan Lafortune & Gaëlle Balestat, 2007. "Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications," OECD Health Working Papers 26, OECD Publishing.
    21. Paul McNamee, 2004. "A comparison of the grade of membership measure with alternative health indicators in explaining costs for older people," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 379-395, April.
    22. Linda Martin & Robert Schoeni & Patricia Andreski, 2010. "Trends in health of older adults in the United States: Past, present, future," Demography, Springer;Population Association of America (PAA), vol. 47(1), pages 17-40, March.
    23. Liu, Lei & Strawderman, Robert L. & Cowen, Mark E. & Shih, Ya-Chen T., 2010. "A flexible two-part random effects model for correlated medical costs," Journal of Health Economics, Elsevier, vol. 29(1), pages 110-123, January.
    24. Leonard J. Paas & Jeroen K. Vermunt & Tammo H. A. Bijmolt, 2007. "Discrete time, discrete state latent Markov modelling for assessing and predicting household acquisitions of financial products," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 170(4), pages 955-974, October.
    25. Agnes Lievre & Nicolas Brouard & Christopher Heathcote, 2003. "The Estimation Of Health Expectancies From Cross-Longitudinal Surveys," Mathematical Population Studies, Taylor & Francis Journals, vol. 10(4), pages 211-248.
    26. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
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    Cited by:

    1. Paolo Li Donni & Ranjeeta Thomas, 2020. "Latent class models for multiple ordered categorical health data: testing violation of the local independence assumption," Empirical Economics, Springer, vol. 59(4), pages 1903-1931, October.
    2. Arjen Hussem & Casper Ewijk & Harry Rele & Albert Wong, 2016. "The Ability to Pay for Long-Term Care in the Netherlands: A Life-cycle Perspective," De Economist, Springer, vol. 164(2), pages 209-234, June.
    3. Andrea Principi & Henrike Galenkamp & Roberta Papa & Marco Socci & Bianca Suanet & Andrea Schmidt & Katharine Schulmann & Stella Golinowska & Agnieszka Sowa & Amilcar Moreira & Dorly J. H. Deeg, 2016. "Do predictors of volunteering in older age differ by health status?," European Journal of Ageing, Springer, vol. 13(2), pages 91-102, June.
    4. Arjen Hussem & Casper Ewijk & Harry Rele & Albert Wong, 2016. "The Ability to Pay for Long-Term Care in the Netherlands: A Life-cycle Perspective," De Economist, Springer, vol. 164(2), pages 209-234, June.
    5. Adnane Maalaoui & Nada Rejeb & Meriam Razgallah & Mirko Perano & Alberto Dello Strologo, 2023. "Perceived health as human capital in entrepreneurial intention among people with disability," International Entrepreneurship and Management Journal, Springer, vol. 19(3), pages 1367-1394, September.
    6. Lindgren, Björn, 2016. "The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Health and Social Care," Working Papers 142, National Institute of Economic Research.
    7. Galina Besstremyannaya, 2014. "Heterogeneous effect of coinsurance rate on healthcare costs: generalized finite mixtures and matching estimators," Discussion Papers 14-014, Stanford Institute for Economic Policy Research.

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    More about this item

    Keywords

    Health care expenditure modeling; Aging; Latent Markov model;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • C33 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Models with Panel Data; Spatio-temporal Models

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