Counting backward to health care's future: using time-to-death modeling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures

Milbank Q. 2007 Jun;85(2):213-57. doi: 10.1111/j.1468-0009.2007.00485.x.


In most developed countries, as the largest population cohorts approach the age of sixty-five, the impact of population aging on health care expenditures has become a topic of growing interest. This articles examines trends in elderly disability and end-of-life morbidity, estimations of the cost of dying, and models of expenditures as a function of both age and time-to-death and finds broad improvement in mortality and morbidity among the elderly in the developed world. Reduced mortality and low growth in the costs associated with dying could reduce forecasted expenditures, but high growth in expenditures for those not close to death and for nonhospital services could create new economic pressures on health care systems.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Age Factors
  • Aged
  • Cost of Illness*
  • Forecasting
  • Health Expenditures / trends*
  • Health Services for the Aged / economics*
  • Health Status*
  • Humans
  • Life Expectancy / trends*
  • Male
  • Middle Aged
  • Models, Econometric
  • Population Dynamics
  • Terminal Care / economics*
  • United States