by Matt Townsend
It is commonly understood that population ageing and the growing numbers of older people will place additional strain on all parts of the health and social care system. However, when it comes to health expenditure at the end of life, recent international evidence suggests that not all costs will increase equally, and some may proportionately lessen.
In a report for the Government Office for Science I looked at the changing dynamics of an ageing population, with a focus on end of life care. This informed the Future of an Ageing Population final report, which utilised evidence, trends and projections to comment on the likely impacts of an ageing population, and identify any related policy implications within the UK. It names a number of key priorities within health and social care, including:
- adapting health and care systems to better prevent and manage chronic conditions;
- improving the support available to family and other unpaid carers; and
- ensuring assistive technologies are available in homes and communities to improve health, and reduce future health and care spending.
International evidence on population ageing and end of life care
End of life care is a complex process that will typically involve multiple health and social care providers. Current evidence indicates that in the last three months of life: acute care costs are the largest single sector cost, averaging £4,600 per person; local authority social care costs were found to average £1,000 per individual who died; GP consultations cost approximately £150; and district nursing care averaged £280 per death.
I carried out a widespread review of the economic impacts of an ageing population on end of life care costs and found that population ageing is likely to increase acute care (hospital) expenditure at end of life, but only moderately. However, a stronger proportional increase should be expected for end of life expenditures in long-term and social care.
The reason that acute care expenditure at end of life is expected to only moderately increase is due to the dynamic of two interrelated factors: proximity of death and compression of morbidity. People are living longer without ill health, as it is delayed and compressed into a shorter period of illness before death. With people living longer, in any given year you can expect less deaths and less acute care expenditures. Trends show that numbers of admissions and bed-days keep falling for each age cohort entering old age, therefore, the ageing population is unlikely to cause capacity issues for acute care.
On the other hand, an ageing population is likely to increase demand for long-term and social care, particularly at the end of life, because as people get older they are more likely to experience age related health conditions that are increasingly managed outside of acute care.
How can the UK health system respond to an ageing population?
This review has highlighted several areas which interact with cost and provision of care in an ageing population suggesting that changes in these areas can limit costs and or improve care:
- Multi-morbidity and dementia
These are both highly associated with increased health expenditure at end of life. Individuals with multi-morbidity need a more complex care environment and people with dementia are likely to spend more time in hospital. The care system needs to adapt to better serve these individuals which may allow greater cost-control during a period of population ageing.
- Unpaid care
An appropriate policy response to the unpaid care gap is needed. The gap is expected to increase as changing family dynamics and structures mean there will be less people available to offer unpaid care, without an appropriate policy response this will have a negative impact on the future quality and supply of health and social care.
- Medical technology
In the evidence review medical technology was consistently acknowledged as the biggest driver of health spending at end of life. Efforts should be made to prioritise medical innovations that improve quality of life. Initiatives that use medical technology to help people to remain living at home with complex or chronic diseases could lead to savings in long-term care, and greater labour force participation.
- End of life interventions
Palliative care teams, advance care planning, and integrated care for complex patients with multi-morbidities have all been associated with cost savings.
While it is clear that an ageing population will increase expenditure within the health and social care system, there are already several positive signs that the UK is adapting to the needs of an older and more complex patient cohort.
Townsend M (2016) Evidence Review: The Impact of an Ageing Population on End of Life Care Costs, Personal Social Services Research Unit, London.
Government Office for Science (2016) Future of an Ageing Population. Foresight Report, Government Office for Science, London.
About the author
Matthew Townsend is a PhD student at the LSE. At the time of writing he was Research Officer within the Personal Social Services Research Unit at the LSE.