China's Ageing Population's Impact On Health Care Spending

The change of population structure and the rapid ageing process lead to the change of health care demand and health care expenditure and have been a big challenge for health care system. The ageing has a higher health depreciation rate and a stronger demand for health care, so health care expenditure will grow with the deepening of the ageing. However, some factors such as good economic conditions, adequate health care resource supply and so on have influence on the allocation of health care resource and the ageing’s health care demand, so maybe health care expenditure will decline with the deepening of the aging. Therefore the relationship between the ageing and health care expenditure is obscure.As a getting old before being rich developing country with a great population and urban-rural dual structure, whether ageing will lead to the growth of health care expenditure in our country is worthy of further discussion. Existing literatures have little attention on the relationship between ageing and health care expenditure and haven’t answered the following three questions:what has been the real relationship between ageing and health care expenditure in the past20years, especially based on the urban-rural difference? How’s the mechanism between ageing and health care expenditure? Will ageing accelerate health care expenditure in the future with the urban-rural composition? Eight chapters will be employed to answer the above-mentioned three questions in this study. Firstly, based on the objective facts and past literatures, we systematically review the relationship between ageing and health care expenditure in different countries, explore the mechanism between ageing and health care expenditure, analyse ageing’s contribution to the growth of health care expenditure. Secondly, we use provincial panel data (2002-2008) at macro level and CHNS pooled cross-sectional data (1991-2009) at micro level to test whether ageing is one of the determinants of health care expenditure, estimate ageing’s contribution, explore the mechanism between ageing and health care expenditure. Meanwhile, we set the simulation model to forecast the health care expenditure in the future. Finally, we put forward some corresponding suggestions.Econometric analysis is the main content and innovative point. It targets outpatient and inpatient as some types of health care expenditure and its results are as followings.First, the ageing’s health care demand has not been met which has not accelerated health care expenditure in the late1990s. However, ageing has a positive relationship with the health care expenditure since the21st century. Ageing contribution to the growth of health care expenditure is limited, less than income, medical technology.Second, from the urban-rural difference, the demand for urban ageing’s health care has been met which drove up the health care expenditure. Meanwhile, in rural, ageing has little relationship with the health care expenditure because some factors such as a low economic development level, imperfect medical security system, scarce medical resource supply and so on can’t meet the rural ageing’s health care demand. Even the rural ageing has negative relationship with real per capita out-of-pocket health expenditure.Third, more and more medical resource is allocated to the ageing by medical technology and medical insurance system which will meet the ageins’s health care demand. On the other hand, from the micro individual level, income and health will impact the demand for health care and health care expenditure. In rural, income, education, government’s financial input will make the ageing easier to obtain health care service.Fourth, from the trend of health care expenditure, the ratio between health care expenditure and GDP will reach about8%-10.6%in2030,40percent of all medical resource will be allocated to the ageing in2050. If the rural ageing has the same satisfaction with the urban ageing in the demand for health care, the ratio between health care expenditure and GDP will enhance0.07-1.6percent. The rapid ageing process will accelerate the ratio between health care expenditure and GDP, however, the health care expenditure will be controlled by abandoning one-child policy and effective medical cost-control.The policy meanings in this study are as followings. First, based on the urban-rural composition and decreasing gaps between urban and rural, the rural ageing will accelerate the rapid growth of health care expenditure, so the policy makers will take some effective measures to tackle the rapid growth of health care expenditure and have a proper recognition of the higher probability of the rapid growth of health care expenditure in rural. Second, ageing’s contribution to the growth of health care expenditure is limited, but it will play a more important role in the growth of health care expenditure with the rapid ageing process. In the future, it needs more medical resource allocated to the ageing. Based on the above-mentioned, we should have a good grasp of population structure trait. On one hand, some effective measures will be taken to tackle the rapid growth of health care expenditure, on the other hand, some effective measures will be took to meet the ageing’s demand for health care. In the future, the health ageing should be advocated, medical resources are optimized allocated to the ageing, meanwhile it will has more attention to the ageing in managed care, government’s financial input, nursing insurance system, medical insurance system. It is the good way to meet the challenge from the ageing on health care system.