TY  - THES
AB  - Background:
The main subject of this work is the need for long-term care (LTC), a disability to carry out basic activities of daily living. The monitoring of long-term care need provides an insight into population health. As Germany is a country of low and steadily decreasing mortality, an understanding of the relationship between health and lengthening life is essential. In addition, this need implies an entitlement to specific benefits within the German welfare system. Research on long-term care utilization can show prospects for health-related services in the course of demographic aging.
Research approach:
The development of long-term care need in Germany 1999-2007 is assessed by applying the models of compression of morbidity (Fries 1980), expansion of morbidity (Gruenberg 1977) and dynamic equilibrium of morbidity and mortality (Manton 1982).
Data and methodology:
The main data sources are the biennial care need statistics linked to population statistics 1999-2007. In 1999, the eligibility criteria and procedures of the LTC insurance had settled and the introduction effects had been overcome. Thus, an undistorted time series from 1999 to 2007 is assumed.
As the LTC insurance covers an extremely high proportion of the population, a population-based approach is justified. The official population numbers provide a near-perfect denominator for calculating the LTC prevalence by sex and age.
The research question requires an analysis of life expectancy and length of care over time by the Sullivan method, which is a merge of period life tables with age-specific prevalence. It splits life expectancy into one part "in" and one part "out of" LTC. The results are classified as compression vs. expansion of morbidity in absolute and relative terms (Nusselder 2003). To verify the dynamic equilibrium model, an additional analysis of the severity level is required.
Main results:
Development during the observation period 1999-2007
1. The age-standardized LTC prevalence decreased.
2. The LTC prevalence was redistributed towards milder severity levels
3. Life expectancy and disability-free life expectancy steadily increased in all population segments (sex/region).
4. In 2007, newborn males could expect 22 months and females 41 months of long-term care need of the severity levels I, II and III. There was a steady increase over time ("absolute expansion of LTC"). In 1999, males expected 19 months and females 36 months of LTC need.
5. In 2007, newborn males could expect 10 months and females 19 months of long-term care need of the most severe levels (II and III). There was no steady change since 1999.
6. In 2007, newborn males experienced about 98 percent of their life expectancy free of long-term care need (levels I to III), females about 96 percent. Over time, a slight decrease in this ratio can be noticed ("relative expansion of LTC"). There was no change in the most severe levels II and III.
Projections:
7. A projection method of "linear SMR" was developed by the author to work very closely with the empirical findings (decrease in prevalence). It results in 3.00 million recipients in 2030. In addition, alternative methods are presented and applied.
Discussion:
During 1999 and 2007, Germany experienced both absolute and relative expansion of long-term care need (level I to II). For the most severe levels II and III neither expansion nor compression was found. Thus, the results fit the dynamic equilibrium model which assumes the increase in life expectancy to be based on milder impact and slower progression of morbidity.
The compression-vs.-expansion conceptualization of Nusselder 2003 is merely descriptive. It does not imply value judgments such as "improvement" or "deterioration" of population health.
Alternatively, the World Health Organization promotes summary measures of population health (SMPH) which allow a degree of value judgment, such as in statements like "population A is healthier than population B". These measures ideally fulfil five criteria. The Sullivan disability-free life expectancy meets two out of these five criteria. So long as the limits of the Sullivan approach are acknowledged, it is feasible to regard the increase of disability-free life expectancy as an improvement of population health in Germany 1999-2007.
DA  - 2010
KW  - Lebenserwartung
KW  - Sterbetafel
KW  - Überalterung
KW  - Deutschland / Pflegeversicherungsgesetz
KW  - Pflegebedürftigkeit
KW  - Prognoseverfahren
KW  - Prävalenz
KW  - Gesunde Lebenserwartung
KW  - Sullivan-Methode
KW  - Schweregrad
KW  - Health expectancies
KW  - Sullivan method
KW  - Summary measures of population health
LA  - ger
PY  - 2010
TI  - Pflegebedürftigkeitsfreie Lebenserwartung in Deutschland : ein Beitrag zur Debatte um die Kompression von Morbidität
UR  - https://nbn-resolving.org/urn:nbn:de:hbz:361-17851
Y2  - 2024-11-24T17:15:45
ER  -