gms | German Medical Science

Background: Demographic changes in general and the aging of our society in particular is a well known problem for the public economy. So in the system of statutory health insurances the growing number of elderly patients is often seen as relevant for further economic development. The question arises if the aging of society is the main reason for the cost increase or if there might be other implications as for example medical development. The expenses for prescribed drugs are the second largest part in the costs of statutory health insurances and an ever-growing one. Therefore on behalf of gross expenditures of prescribed drugs, we analysed age dependent costs and number of patients for the years 2006 to 2010 and developed prognosis up till 2014. Next we looked for medication differences with respect to different ages.

Materials and methods: We examined drug prescription data of a regional representative sample of statutory health insurances. According to age, costs were analysed from 2006 to 2010 and the situation for 2014 was prospected. This was achieved by a kind of Markov model based on annually transition coefficients for age and expenses. Furthermore we considered age specific cost-development.

In order to evaluate the influence of medication differences, we examined drug groups (level two of the international ATC – anatomical therapeutic chemical – classification) with respect to cost-proportion of total expenditure, quantities prescribed and price per patient.

Results: In order to evaluate the influence of demographic changes, age distributions of patient-numbers and according to costs were examined. For the period 2006 to 2010 as well as the projected period till 2014, the fraction of patients older than 65 years moderately increased whereupon the fraction of costs for this population sank slightly. The highest increase could be found in the fraction of expenses for the 40 to 50 year old. For drug groups with high rise in costs, different patterns can be found. One of these has a peak for the age group 65 to 75 years (type A) while another shows the highest cost-proportion for the 40 to 50 year old (type B). Drugs with low costs per patients are likely to show a distribution of type A while high priced drugs are either similar distributed to total expenses or show type B distribution.

Conclusions: The aging of society seems not to be the major reason for the cost increase in the public health system. Elderly patients do get a high number of medicals but these by the majority belong to ATC groups with a low cost per patient ratio. The innovative and highly expensive drugs are focused on middle aged patients. It is that age group which shows an increase in cost ratio. Therefore we conclude that the aging of our society might have a minor effect on the economic situation of the public health system, but that the growing number of highly expensive innovative drugs already has high effect and will increase in influence.