Key inves

1
The Whitlam Institute Forum
Health and Ageing Lifetime Research
Professor John McCallum, Dean CSHS, University of
Western Sydney
2
Projected population profileAustralia 1997 - 2041
Hence the intergenerational issues!
3
Projected SpendingIntergenerational Report 2002
4
Mr Costellos Job Application?

• Require an extra 84bn per year to cover costs of
  ageing in 40 years
• However 62bn are extra health (1/4) and
  pharmaceuticals (3/4)
• Only 22bn due to aged care, pensions etc with
  help of some offsets from lower unempl and educ
  costs.
• Health cost increases caused by increasing use
  of hi-tech, more expensive services drugs NOT
  ageing itself.
• Where are the payoffs from expensive drugs?
  Lifestyle alternatives?

5
Intergenerational Report Priorities

• Balanced budget, government debt low
• Efficient and effective medical health system,
  complemented by widespread participation in
  private health insurance
• Containing growth in the Pharmaceutical Benefit
  Scheme (PBS)
• Affordable and effective residential aged care
  system
• Preserving a well-targeted safety net
• Encouraging mature age employment
• Encouraging private saving for retirement

6
The Dubbo Study background

• Longitudinal community study of elderly 60
  years mean age 69 years
• 2805 not institutionalised, 1233 men and 1572
  women, 73 of eligible population, followed from
  Quarter 4 1988 to Quarter 3 2002
• To identify behaviours and service use patterns,
  and predictors of mortality, hospitalisation,
  residential care, disability key diseases like
  CHD, Stroke, Dementia etc
• AHEAD Study introduced in Year 2000-1 in
  survivors to investigate asset and health
  dynamics of the old old.

7
An Efficient and Effective Health System

8
Entire Population 1988 to 2001
This is service usage of the total cohort Note
high use of entitlements including age pension
from age 60/65.
9
Admission to hospital during the last year of
life
10
Health needs 1988 and hospital admission effects
CHD, stroke, diabetes, BP medication, impaired
breathing, self-rated health
Referral by GPs and specialists
accidents emergency?
Hospital Admission
11
Growth in Pharmaceutical Benefits Scheme

12
Patterns of prescribed medication use amongst
survivors ()
13
Affordable and Effective Residential Aged Care
System

14
Care burdens and nursing home admission effects
Disability, depression, stroke,
incontinence, impaired resp. function
ACAT assessment
increasing need dependency
increased ageing effects comorbidity across
the period?
Nursing Home
15
Private health insurance and nursing home
admission?
Less disability delayed ageing? ACAT
decision
Private health insurance
Elective surgery convalescence
No Effect?
Nursing home
16
The New International Paradigm

• Denmark closed or converted nursing homes to
  specialised modified housing emergency
  medical care with expanded and 24 hour home care
• British Royal Commission shared responsibility
  between the individual and the State with living
  costs and accommodation paid by private
  individuals
• British Columbia home care saved 40 at low
  levels, 60 at medium 75 at high need levels -
  major costs of transitions and death
• single point of entry, consistent screening
• coordinated at system level, standardised
  assessment placement to both care types
• case management for all cases

17
Child contact x risky life events ()
18
Concluding comments

• There are significant intergenerational issues
  with ageing and health
• Is private health insurance equitable?
• PBS costs will increase and gene therapies will
  add another dimension
• An effective nursing home sector depends on
  having better and more effective community
  services
• Informal family support parallels public
  entitlements a partnership?
• Economics is a central part of health and ageing!

19
How does alcohol protect against nursing home
admission?
Moderate alcohol intake
Dementia (Rel Risk 0.48)
No Effect?
Nursing home