Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study

BMJ 1998;317:111-115 ( 11 July )

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Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study

Willem Jan Meerding, health economist, ^a Luc Bonneux, medical epidemiologist, ^a Johan J Polder, health economist, ^a Marc A Koopmanschap, health economist, ^b Paul J van der Maas, professor of public health. ^a

^a Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Netherlands, ^b Institute of Medical Technology Assessment, Department of Health Policy and Management, Erasmus University Rotterdam, Netherlands

Correspondence to: Dr Meerding meerding{at}mgz.fgg.eur.nl

Objectives: To determine the demands on healthcare resources caused by different types of illnesses and variation withage andsex.
Design: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most importantsectors (hospitals, nursing homes, inpatient psychiatric care,institutions for mentally disabled people) have national registries.Total expenditures for each sector were subdivided into 21 agegroups, sex, and 34 diagnosticgroups.
Setting: Netherlands, 1994.
Main outcome measures: Proportion of healthcare budget spent on each category of disease and cost of health care perperson at variousages.
Results: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adultlife and increased exponentially from age 50 onwards till theoldest age group ( $>=$ 95). The top five areas of healthcare costswere mental retardation, musculoskeletal disease (predominantlyjoint disease and dorsopathy), dementia, a heterogeneous groupof other mental disorders, and ill defined conditions. Stroke,all cancers combined, and coronary heart disease ranked 7, 8,and 10,respectively.
Conclusions: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularlymental disability. A large share of the healthcare budget is spenton long term nursing care, and this cost will inevitably increasefurther in an ageing population. Non-specific cost containmentmeasures may endanger the quality of care for old and mentallydisabledpeople.

Key messages

Little is known about demands for health care outside acute sectors
In the Netherlands health costs are strongly age dependent, increasing exponentially after age 50
The five highest healthcare costs are for mental retardation, musculoskeletal disease, dementia, other mental disorders, and ill defined conditions
Coronary heart disease, all cancers, and stroke accounted for only 9% of costs
The main healthcare costs are for care not cure and costs are likely to increase rapidly in an ageing society

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