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Health, Life Expectancy, and Health Care Spending among the Elderly
Open accessAbstract
BACKGROUND: Life expectancy among the elderly has been improving for many decades, and there is evidence that health among the elderly is also improving. We estimated the relation of health status at 70 years of age to life expectancy and to cumulative health care expenditures from the age of 70 until death. METHODS: Using the 1992-1998 Medicare Current Beneficiary Survey, we classified persons' health according to functional status and whether or not they were institutionalized and according to self-reported health. We used multistate life-table methods and microsimulation to estimate life expectancy for persons in various states of health. We linked annual health care expenditures with transitions between health states. RESULTS: Elderly persons in better health had a longer life expectancy than those in poorer health but had similar cumulative health care expenditures until death. A person with no functional limitation at 70 years of age had a life expectancy of 14.3 years and expected cumulative health care expenditures of about 136,000 dollars (in 1998 dollars); a person with a limitation in at least one activity of daily living had a life expectancy of 11.6 years and expected cumulative expenditures of about 145,000 dollars. Expenditures varied little according to self-reported health at the age of 70. Persons who were institutionalized at the age of 70 had cumulative expenditures that were much higher than those for persons who were not institutionalized. CONCLUSIONS: The expected cumulative health expenditures for healthier elderly persons, despite their greater longevity, were similar to those for less healthy persons. Health-promotion efforts aimed at persons under 65 years of age may improve the health and longevity of the elderly without increasing health expenditures.
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“Research has shown that very old individuals with lower functional capacities face greater healthcare costs than their more physically capable peers [659], with these expenses being notably higher for those in care facilities [672].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [672]
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“Aging is associated with increased healthcare costs, which increase with declining health and functional ability [[672], [673], [674]].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [672]
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Metadata
- Authors
- Lubitz, J., Cai, L., Kramarow, E., & Lentzner, H.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2003-09-11
- Volume
- 349
- Issue
- 11
- Pages
- 1048-1055
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1967237446
- Cited by
- 513
- References
- 26
- Citations by year
- 2026: 3 · 2025: 17 · 2024: 14 · 2023: 15 · 2022: 15 · 2021: 16 · 2020: 21 · 2019: 19 · 2018: 29 · 2017: 33 · 2016: 32 · 2015: 30 · 2014: 22 · 2013: 25 · 2012: 25
- FWCI
- 55.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- life expectancy, health care expenditure, older adults, functional status, activities of daily living, institutionalization, self-reported health, health status, longevity, health promotion, Medicare Current Beneficiary Survey
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Health Expenditures, Persons with Disabilities, Disabled Persons, Health Status, Health Surveys, Humans, Life Expectancy, United States, Life Tables
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