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13 Renewed Progress in Life Expectancy: The Case of the Netherlands--Johan Mackenbach and Joop Garssen
Pages 369-384

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From page 369... ... . A stagnation of mortality decline among the elderly has also been observed in a small number of other countries, particularly the United States and Denmark (Meslé and Vallin, 2006; Glei, Meslé, and Vallin, Chapter 2, in this volume) Read the entire page →
From page 370... ... After an analysis of patterns of decline by age, gender, and cause of death, we review all main groups of determinants: biological factors, factors in the physical and social environment, lifestyle factors, and health care factors. We used readily available data to assess whether changes in these factors have occurred preceding or coinciding with the changes in mortality that could plausibly explain the change in old-age mortality trend. Read the entire page →
From page 371... ... At age 65 (c) At age 80 SOURCE: Data from Statistics Netherlands (see http://statline.cbs.nl/statweb/ [accessed June 2010] Read the entire page →
From page 372... ... , and data from the 1999 and 2007 studies have been reanalyzed for this chapter to determine time trends of health care expenditure by age and gender. RESULTS Mortality Decline The exact turning point in the mortality trend is difficult to establish because of year-to-year fluctuations in the number of deaths, which are partly determined by climatic conditions (cold winters, hot summers) Read the entire page →
From page 373... ... Changes in Determinants Reviewing trends in a wide range of determinants of mortality, we did not find favorable trends among the elderly in health status indicators paralleling the trend in mortality, which suggests that declining mortality in this period cannot be attributed to improved biological conditions. Table 13-1 shows a few examples. Read the entire page →
From page 374... ... Men (b) Women SOURCE: Authors' analyses of data available at Statistics Netherlands. Read the entire page →
From page 375... ... Men (b) Women SOURCE: Authors' analyses of data available at Statistics Netherlands. Read the entire page →
From page 376... ... Pneumonia, 1990-2008 SOURCE: Authors' analyses of data available at Statistics Netherlands. Read the entire page →
From page 377... ... . More About the Changes in Health Care The acceleration of the hospital admission trend coincided with a clearcut change in growth of health care expenditure in the Netherlands. Read the entire page →
From page 378... ... per 10,000 py 80-84 3672 Hospital admission (cardiovascular per 10,000 py 80-84 798 disease) 1-year mortality after first admission for % 80+ any disease 1-year mortality after first admission for % 80+ coronary heart disease 1-year mortality after first admission for % 80+ stroke Health care expenditure BEuro n.a. Read the entire page →
From page 379... ... RENEWED PROGRESS IN LIFE EXPECTANCY 1999 2000 2001 2002 2003 2004 2005 2006 2007 11.4 10.5 10.4 13.0 12.6 13.2 14.1 24.5 29.9 31.3 31.6 32.8 35.5 34.9 31.6 33.6 30.6 31.3 35.5 32.7 31.2 30.0 18.1 19.2 18.6 17.0 21.6 20.9 17.5 18.9 68.3 68.9 71.3 67.5 65.8 62.1 58.0 59.3 101.7 103.8 106.0 111.4 115.4 118.2 115.7 113.7 57.2 52.4 57.6 64.5 67.7 79.5 83.6 84.6 1999 2000 2001 2002 2003 2004 2005 2006 2007 51.0 50.0 49.0 46.0 46.0 45.0 45.0 45.0 4.4 5.0 4.1 4.8 2.4 4.1 3.6 2.8 6.5 1.1 1.2 1.4 1.5 1.7 1.9 2.0 2.2 2.3 55.0 55.0 55.0 55.0 56.0 56.0 56.0 57.0 57.0 0.28 0.27 0.27 0.27 0.27 0.27 0.26 0.27 22.6 22.9 22.0 21.5 20.8 19.6 19.4 19.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 18.0 17.2 17.0 17.3 17.6 19.6 16.8 3.0 4.3 4.1 3.1 5.0 3.4 4.5 4.3 58.0 59.0 59.0 57.0 58.0 58.0 58.0 12.0 12.8 10.8 13.4 12.6 13.7 14.4 14.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 77.9 80.1 84.2 87.5 81.5 81.3 82.6 84.7 85.4 86.4 88.7 88.7 85.7 86.7 85.6 85.8 85.8 84.9 59.1 58.4 61.5 59.3 60.6 63.0 64.4 62.9 64.8 74.5 74.4 74.6 75.3 77.1 78.1 79.2 79.8 80.4 3854 3892 3962 4273 4592 4899 5196 5452 5731 788 771 796 827 855 899 933 957 980 25.8 25.2 24.7 24.0 23.1 22.3 34.3 33.1 33.8 32.0 30.3 28.2 52.2 51.3 50.7 48.1 47.1 44.6 42.1 43.6 46.0 48.0 50.0 51.7 53.1 54.5 56.2 2774 2949 3276 3639 3910 4026 4155 4316 4524 11.4 11.2 11.7 12.6 13.3 13.3 13.2 13.1 13.1 SOURCE: Data from Statistics Netherlands (see http://statline.cbs.nl/statweb/ [accessed June 2010] Read the entire page →
From page 380... ... . Detailed studies of health care expenditure by age and health care sector have been performed for 1999, 2003, and 2007 (see Figure 13-5) Read the entire page →
From page 381... ... Substantial and sustained mortality decline started in 2003, and if one assumes a certain delay between improved treatment and reduced death rates, the improvements in treatment should have started slightly earlier. This may indeed have been the case: the most rapid increases in health care expenditure occurred in 2001, 2002, and 2003, and the most rapid increases in hospitalization rates occurred in 2002, 2003, and 2004. Read the entire page →
From page 382... ... During these two decades, the Dutch government had successfully limited the growth of health care expenditure, first by a strict regulation of supply (hospital beds, expensive equipment, specialized personnel, etc.) , then by imposing budget constraints for in-patient care. Read the entire page →
From page 383... ... In conclusion, although important questions remain, the most plausible hypothesis for explaining the sudden reversal of old-age mortality trends in the Netherlands is more health care for the elderly, facilitated by a sudden relaxation of budgetary restraints. ACKNOWLEDGMENTS Lany Slobbe of the National Institute for Public Health and the Environment provided the data in Figure 13-5. Read the entire page →
From page 384... ... . Bilthoven, Netherlands: National Institute for Public Health and the Environment [in Dutch] Read the entire page →

From page 369...

... . A stagnation of mortality decline among the elderly has also been observed in a small number of other countries, particularly the United States and Denmark (Meslé and Vallin, 2006; Glei, Meslé, and Vallin, Chapter 2, in this volume)

13 Renewed Progress in Life Expectancy: The Case of the Netherlands--Johan Mackenbach and Joop Garssen Pages 369-384

13 Renewed Progress in Life Expectancy: The Case of the Netherlands--Johan Mackenbach and Joop Garssen
Pages 369-384