DEMOGRAPHIC AND EPIDEMIOLOGIC DETERMINANTS OF HEALTH-CARE COSTS IN NETHERLANDS - COST OF ILLNESS STUDY

Objectives:To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. Design: I nformation on healthcare use was obtained from all 22 healthcare secto rs in the Netherlands. Most important sectors (hospitals, nursing home s, inpatient psychiatric care, institutions for mentally disabled peop le) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. Setting: Netherlands, 1994. Main outcome measures: Proportion of healthcare bu dget spent on each category of disease and cost of health care per per son at various ages. Results: After the first year of life, costs per person for children were lowest Costs rose slowly throughout adult lif e and increased exponentially from age 50 onwards till the oldest age group (greater than or equal to 95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of othe r mental disorders, and ill defined conditions. Stroke, all cancers co mbined, and coronary heart disease ranked 7, 8, and 10, respectively C onclusions: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing popu lation, Non-specific cost containment measures may endanger the qualit y of care for old and mentally disabled people.