Revised cost projections for Swedish LTC 2005-2040 Presentation at the 21 st REVES conference in Copenhagen 09-05-27 Mårten Lagergren Marti Parker Mats Thorslund
The calculations have been based upon Statistics Sweden population forecast incl. mortality Statistics Sweden Survey of Living Conditions (ULF) 1980-2006 Costs for LTC in relation to degree of dependency ( ADL- dependency or Statistics Sweden health index) per age- group and gender according to surveys in 8 Swedish municipalities (1994, 2002 and 2007)
Population forecast 2005-2040 250 200 Men 65-74 150 Men 75-84 Men 85 - Women 65-74 100 Women 75-84 Women 85-50 0 2005 2010 2015 2020 2025 2030 2035 2040
Indicators of need for LTC in the ULF-surveys Self-reported general state of health Reduced functioning due to illness Mobility disability Dependency in instrumental ADL (laundry, cleaning etc.) Statistics Sweden Index of health Dependency in personal ADL (bathing, dressing, toilet etc.)
Proportion with LTC and costs per person (SEK) Proportion with LTC LTC costs per person Not severe ill-health 9.2% 20 455 Severe ill-health 45.0% 176 578 No ADL-dependency 4.6% 4 205 ADL-dependency 77.9% 300 552
Proportion of elderly persons with at least one ADL-dependency according to ULF percent 50 45 40 35 30 25 20 15 10 5 0 1980 1984 1988 1994 1998 2002 2006 Män 65-74 Män 75-84 Män 85 - Kvinnor 65-74 Kvinnor 75-84 Kvinnor 85 -
Projections of proportions of ADL-dependent persons for the period 2005-2020 per age.- group and gender base-period 1996-2006 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 69% 60% 51% 42% 44% 37% 30% 33% 24% 25% 19% 14% 15% 8% 10% 12% 4% 4% 6% 7% 2005 2010 2015 2020 Män 65-74 Män 75-84 Män 85 - Kvinnor 65-74 Kvinnor 75-84 Kvinnor 85 -
Proportion of persons reporting bad health per age-group group and gender 1980-2006 40% 35% 30% Män 65-74 25% Män 75-84 Män 85-20% Kvinnor 65-74 15% Kvinnor 75-84 Kvinnor 85-10% 5% 0% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Proportion of persons reporting reduced functioning depending on chronic illness per age-group group and gender - 1980-2006 60% 50% 40% 30% 20% Män 65-74 Män 75-84 Män 85 - Kvinnor 65-74 Kvinnor 75-84 Kvinnor 85-10% 0% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Proportion of persons with mobility disability per age-group group and gender 1980-2006 90% 80% 70% 60% 50% 40% 30% Män 65-74 Män 75-84 Män 85 - Kvinnor 65-74 Kvinnor 75-84 Kvinnor 85-20% 10% 0% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Proportion of persons with at least one dependency in instrumental ADL per age- group and gender 1980-2006 90% 80% 70% 60% 50% 40% 30% Män 65-74 Män 75-84 Män 85 - Kvinnor 65-74 Kvinnor 75-84 Kvinnor 85-20% 10% 0% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Proportion of persons with severe ill-health according to Statistics Sweden health index per age-group group and gender 1980-2006 50% 45% 40% 35% Män 65-74 30% Män 75-84 Män 85-25% Kvinnor 65-74 20% Ki Kvinnor 75-84 Kvinnor 85-15% 10% 5% 0% 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Projected proportion of persons with severe ill- health according to the Statistics Sweden Health index per age-group group and gender 2005-2025 base-period 1980-2006 40% 35% 30% Män 65-74 25% Män 75-84 Män 85-20% Kvinnor 65-74 15% Kvinnor 75-84 Kvinnor 85-10% 5% 0% 2005 2010 2015 2020 2025
Projected proportion of persons with severe ill- health according to the Statistics Sweden Health index per age-group group and gender 2005-2025 Base-period 1996-2006 45,0% 40,0% 35,0% 30,0% 0% Män 65-74 Män 75-84 25,0% Män 85-20,0% Kvinnor 65-74 Kvinnor 75-84 15,0% Kvinnor 85-10,0% 5,0% 0,0% 2005 2010 2015 2020
Cost calculations 2005 2040 according to four different health assumptions (Statistics Sweden Health index) Unchanged health (per age-group group and gender) Health trend 2005-2025 based upon the development 1980 2006, unchanged health 2025-2040 Health trend 2005-2025 based upon the development 1988 2006, unchanged health 2025-2040 Health trend 2005-2025 based upon the development 1996 2006, unchanged health 2025-2040
Summary of LTC cost development in percent in the four cases (index, 2005 =100) 180,0 170,00 160,0 150,0 140,0 Unchanged health Projection, base-period 1980-2006 130,0 Projection, base-period 1988-2006 120,0 Projection, base-period 1996-2006 110,0 100,00 90,0 80,0 2005 2010 2015 2020 2025 2030 2035 2040
Cost projection assuming constant cost per age-group, group, gender and remaining years of life
Mortality per age-group group and gender and future development according to Statistics Sweden Men Age-group 65-69 70-74 75-79 80-84 85-89 90-0.015015 0.026026 0.044044 0.078078 0.140 0.296 Assumed yearly reduction (percent) 2006/15 2.25% 2.00% 2.00% 2.00% 1.00% 0.50% 2016/40 1.69% 1.50% 1.50% 1.50% 0.75% 0.38% Women Age-group 65-69 70-74 75-79 80-84 85-89 90-0.009 0.015 0.027 0.051 0.100 0.234 Assumed yearly y reduction (percent) 2006/15 1.40% 1.40% 1.40% 1.40% 1.00% 0.50%
Costs for LTC per person depending on remaining years of life per age-group group and gender 65-74 75-7979 80-8484 85-8989 90+ Men Dying year 0 51.5 161.2 78.6 196.5 165.0 Dying year 1 34.8 113.7 73.1 166.8 151.8 Di Dying year 2 31.6 69.99 70.1 119.0 99.4 Dying year 3 31.3 39.2 54.1 43.7 49.9 Dying year 4 12.4 11.6 27.9 32.8 59.6 Survivor efter 5 years 84 8.4 17.0 21.5 32.9 229.4 Women Dying year 0 37.7 59.0 153.8 192.7 354.4 Di Dying year 1 34.9 88.5 191.6 241.44 382.5 Dying year 2 58.3 73.2 146.2 177.3 284.5 Dying year 3 21.0 45.8 131.7 135.4 224.8 Di Dying year 4 33.33 47.8 76.8 148.11 187.77 Survivor efter 5 years 6.1 12.8 46.0 96.7 350.0
Cost increase in percent 2005-2040 assuming unchanged costs per remaining years of life compared to projections based upon age-group group and gender only (alt. simple) 220 200 180 160 140 Women, rem.years Women, simple Men, rem.years Men, simple All, rem.years All, simple 120 100 2005 2010 2015 2020 2025 2030 2035 2040
Summary Assuming unchanged costs per age-group group and gender the total costs for LTRC in Seden will increase by 65-70% in the period 2005-2040 of unchanged costs per age-group, group, gender and remaining gy years of life results in somewhat lower cost increase 60-65% If projections are based upon the health trends in the period 1996-2006 (Statistics Sweden health index) the projected cost increase stays about the same 60-65%. Assuming instead a health development according to the trend 1980-2006 results in an even lower projected cost increase - around 50%
Conclusions The costs in fixed prices for providing public LTC in Sweden on the same level as today will increase by 50-70% during the period 2005-2040 The cost increase will be less if ill-health and dependency among the elderly continues to develop in a positive way as observed in recent decades though hardly much lower than 50%.