Western Health Care Systems: Under Pressure from Demography Nicholas Eberstadt Henry Wendt Chair in Political Economy American Enterprise Institute eberstadt@aei.org Presentation at Panel on Health Care Innovation in a Time of Fiscal Austerity Information Technology and Innovation Foundation Washington, D.C. November 2, 2011
1,400,000 Auf Wiedersehen Total Births: Germany, 1960-2010 1,300,000 1,200,000 1,100,000 1,000,000 900,000 800,000 700,000 600,000 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Germany (including former GDR) Source: Eurostat, available at http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/
3000 Sayonara Births in Japan, Actual and Projected: 1947-2047 Births in thousands 2500 2000 1500 Actual - - - - - Projected 1000 500 Sources: 1947-2007 data: Statistical Survey Department, Statistics Bureau, Ministry of Internal Affairs and Communications. 2008-2047 data, US Census Bureau's International Data Base. Note: 1948, 1949, 1951-1954, 1956 and 1957 figures are total population under 1 year.
5,200,000 Where She Stops, Nobody Knows Total Births: Euroarea-17, 1960-2010 5,000,000 4,800,000 4,600,000 4,400,000 4,200,000 4,000,000 3,800,000 3,600,000 3,400,000 3,200,000 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Euro area (17 countries) Source: Eurostat, available at http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/
Population Structure: Germany, 2010 vs. 2040 (projected) 100+ 95-99 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 -4000000-3000000 -2000000-1000000 0 1000000 2000000 3000000 4000000 2040 Female 2040 Male 2010 Male 2010 Female Source: US CENSUS IDB, available at http://www.census.gov/population/international/data/idb/informationgateway.php
Population Structure: Western Europe, 2010 vs. 2040 (projected) 100+ 95-99 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 -10000000-8000000 -6000000-4000000 -2000000 0 2000000 4000000 6000000 8000000 10000000 2040 Female 2040 Male 2010 Female 2010 Male Note: Western Europe here defined as EU-15 plus UK, CH, NO and small adjacent islands and territories. Source: US CENSUS IDB, available at http://www.census.gov/population/international/data/idb/informationgateway.php
Population structure: Japan, 2010 vs. 2040 (projected) 100+ 90-94 80-84 Males Females 70-74 60-64 50-54 40-44 30-34 20-24 10-14 0-4 6,000 4,000 2,000 0 2,000 4,000 6,000 Source: US Census Bureau, International Data Base 2040 2010
Population structure: United States: 2010 vs. 2030 (projected) 100+ 95-99 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Males Females 2030 Females 2010 Males 2010 15000 10000 5000 0 5000 10000 15000 Population, thousands Source: US Census Bureau International Data Base Copyright Nicholas Eberstadt 8
Total Working Age Population (15-64) with Secondary or Higher Education: Selected US Treaty Allies, 1980-2040 (est. and proj., in 000s) 80000 Japan Germany France UK Italy South Korea 8000 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 Source: IIASA Education, available at http://www.iiasa.ac.at/research/pop/edu07/
350000000 Who Needs Immigrants, Anyhow? Eurostat s EU-27 Working Age (15-64) Population Projections, 2010-2040 340000000 330000000 320000000 310000000 300000000 No Migration With Migration 290000000 280000000 270000000 260000000 250000000 2010 2015 2020 2025 2030 2035 2040 Source: Eurostat, available at http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database
Don t Try This At Home, Kids Life Expectancy vs. Average Age of Retirement: Males, France, 1965-2007 (years) 80.0 75.0 70.0 65.0 60.0 55.0 1965-70 1967-72 1969-74 1971-76 1973-78 1975-80 1977-82 1979-84 1981-86 1983-88 1985-90 1987-92 1989-94 1991-96 1993-98 1995-00 1997-02 1999-04 2001-06 Average Age of Retirement Life Expectancy Source: Average age of retirement data from Statistics on average effective age and official age of retirement in OECD countries, http://www.oecd.org/document/47/0,3343,en_2649_34747_39371887_1_1_1_37419,00.html; OECD estimates based on the results of national labor force surveys, the European Union Labor Force Survey and, for earlier years in some countries, national censuses. Life expectancy data from Human Mortality Database. University of California, Berkeley and Max Planck Institute for Demographic Research. Available at www.mortality.org, accessed on November 7, 2008. 2007 Data from US Census Bureau, International Database, http://www.census.gov/cgi-bin/ipc/idbagg
Europe s Holidays From History Labor Force Participation Rates: Select Western Europe vs. Non-Europe OECD 90 Participation Rate (percentage) 80 70 60 50 40 30 20 10 Germany Italy France Spain USA Japan ROK 2007 0 55-59 60-64 65-69 70-74 75+ Years of Age Source: International Labor Organization, LABORSTA, http://laborsta.ilo.org/. Accessed on June 6, 2011; 5:15PM. Note: Data are for 2008, except for ROK (2007).
The Ghost of Christmas Present, Revisited: Gross Public Debt as % of GDP vs. 65+ Population as % of Total Population, Selected OECD Countries, 2010 200.0 Japan y = 7.0879x - 35.779 R² = 0.2891 Gross Public debt as % of GDP (%) 150.0 100.0 50.0 ROK Ireland Iceland USA Poland Slovakia New Zealand Canada Belgium France Portugal Hungary UK Netherlands Spain Austria Greece Finland Norway Denmark Sweden Czech Republic Switzerland Italy Germany EU-15 Countries Other OECD Countries Australia Luxembourg 0.0 10 12 14 16 18 20 22 24 65+ Population as % of total population (%) Sources: United Nations Population Division. World Population Prospects: The 2008 Revision Population Database. Accessed electronically at http://esa.un.org/unpp/index.asp; Organisation for Economic Co-operation and Development. OECD Economic Outlook No. 87 Annex Tables. Accessed electronically at http://www.oecd.org/dataoecd/5/51/2483816.xls. Note: This graphic is for affluent Western OECD members only.
An Aging Euro-Electorate Median Age and Median Voting Age: Greece, 1995-2040 (projected) 60 55 50 45 40 35 30 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 Median Age Median Age of Voters Source: US Census IDB, available at http://www.census.gov/population/international/data/idb/country.php