Population aging is likely to influence patterns of health care spending in both developed and developing countries in the decades to come. In developed countries, where acute care and institutional long-term care services are widely available, the use of medical care services by adults rises with age, and per capita expenditures on health care are relatively high among older age groups. Accordingly, the rising proportion of older people is placing upward pressure on overall health care spending in the developed world, although other factors such as income growth and advances in the technological capabilities of medicine generally play a much larger role.
Relatively little is known about aging and health care costs in the developing world. Many developing nations are just now establishing baseline estimates of the prevalence and incidence of various diseases and conditions. Initial findings from the WHO SAGE project, which provides data on blood pressure among women in six developing countries, show an upward trend by age in the percentage of women with moderate or severe hypertension (see Figure 12), although the patterns and age-specific levels of hypertension vary among the countries. If rising hypertension rates in those populations are not adequately addressed, the resulting high rates of cerebrovascular and cardiovascular disease are likely to require costly medical treatments that might have been avoided with antihypertensive therapies costing just a few cents per day per patient. Early detection and effective management of risk factors such as hypertension—and other important conditions such as diabetes, which can greatly complicate the treatment of cardiovascular disease—in developing countries can be inexpensive and effective ways of controlling future health care costs. An important future payoff for data collection projects such as SAGE will be the ability to link changes in health status with health expenditures and other relevant variables for individuals and households. This will provide crucial evidence for policymakers designing health interventions.
Figure 12. Percentage of Women with Moderate or Severe Hypertension in Six Countries: Circa 2009
Note: National data collections conducted during the period 2007-2010.
Source: Tabulations provided by the World Health Organization Multi-Country Studies Unit, Geneva, based on data from the Study on global AGEing and adult health (SAGE).
A large proportion of health care costs associated with advancing age are incurred in the year or so before death. As more people survive to increasingly older ages, the high cost of prolonging life is shifted to ever-older ages. In many societies, the nature and extent of medical treatment at very old ages is a contentious issue. However, data from the United States suggest that health care spending at the end of life is not increasing any more rapidly than health care spending in general. At the same time, governments and international organizations are stressing the need for cost-of-illness studies on age-related diseases, in part to anticipate the likely burden of increasingly prevalent and expensive chronic conditions—Alzheimer’s disease in particular. Also needed are studies of comparative performance or comparative effectiveness in low-income countries of various treatments and interventions.
The Costs of Cardiovascular Disease and Cancer
In high-income countries, heart disease, stroke, and cancer have long been the leading contributors to the overall disease burden. The burden from these and other chronic and noncommunicable diseases is increasing in middle- and low-income countries as well (Figure 6).
To gauge the economic impact of shifting disease profiles in developing countries, the World Health Organization (WHO) estimated the loss of economic output associated with chronic disease in 23 low- and middle-income nations, which together account for about 80 percent of the total chronic disease mortality in the developing world.
The WHO analysis focused on a subset of leading chronic diseases: heart disease, stroke, and diabetes. In 2006, this subset of diseases incurred estimated economic losses ranging from US$20 million to US$30 million in Vietnam and Ethiopia, and up to nearly US$1 billion in China and India. Short-term projections (to 2015) indicate that losses will nearly double in most of the countries if no preventive actions are taken. The potential estimated loss in economic output for the 23 nations as a whole between 2006 and 2015 totaled US$84 billion.
A recent analysis of global cancer trends by the Economist Intelligence Unit (EIU) estimated that there were 13 million new cancer cases in 2009. The cost associated with these new cases was at least US$286 billion. These costs could escalate because of the silent epidemic of cancer in less well-off, resource-scarce regions as people live longer and adopt Western diets and lifestyles. The EIU analysis estimated that less developed countries accounted for 61 percent of the new cases in 2009.
Largely because of global aging, the incidence of cancer is expected to accelerate in coming decades. The annual number of new cancer cases is projected to rise to 17 million by 2020, and reach 27 million by 2030. A growing proportion of the global total will be found in the less developed world, and by 2020, almost half of the world’s new cases will occur in Asia.