Men and women in the public health system: A comparison of costs
Destatis, 3 February 2009
Population and illness costs
For the maintenance and recovery of our health, considerable funds are spent every year: In Germany, costs of illness to the amount of about Euro 236 billion, that is Euro 2,870 per capita, were incurred for the prevention, treatment, rehabilitation and care of ill people in 2006.
When examining the costs in the health sector, there is one particular feature easily catching the eye: While in 2006, the population comprised about 4% more women than men, the costs of illness of women exceeded those of men by 36%. How can that difference between sexes be explained?
Costs around contraception, pregnancy and birth
Costs of illness are allocated to medical diagnoses on the basis of the “International Statistical Classification of Diseases and Related Health Problems” (ICD). That classification has been developed by the World Health Organization for health statistics, so that illness matters can be covered in detail and completely in an international comparison. Costs around contraception, pregnancy and birth are part of that and are allocated to the persons making use of such benefits. In what way do the costs around reproduction contribute to that difference between sexes?
For women, Euro 3.1 billion were incurred for making use of the health system through pregnancy, birth and childbed in 2006. Another Euro 1.5 billion for women and Euro 0.2 billion for men were incurred for problems relating to reproduction. When adjusted for those reproduction-related costs, the original difference between sexes decreases from Euro 35.9 billion to Euro 31.5 billion. In other words: Not considering the benefits around contraception, pregnancy and birth, the illness costs of women still markedly exceed those of men (by just under 32%), though not to the original extent (see also “Cost variables”: Variant A).
Women – High life expectancy, high illness costs?
The demographic situation in Germany is characterised by a special feature, which in the literature is described as the “feminisation of old age”. This refers to the markedly larger share of women among the older population. According to the population statistics, 58% of the population aged 65 and over were female on an annual average in 2006, and for those aged 85 and over the female percentage was 75%. The unbalanced ratio between sexes is mainly due to the two world wars and to the higher life expectancy of women.
Illness costs by age and sex
For illness costs, too, the relation between sexes shifts in old age: From the age of 65 years, 62% of the costs were incurred for women and from the age of 85 the percentage was even 80%. It seems to be an obvious conclusion that the fact that women make more use of the health system might be connected with their larger share in the older population. In other words: How large would the cost difference be if there were just as many older women as older men?
That hypothetical case can be calculated. For that purpose, the cost distributions of the sexes are age-standardised by applying the average age-specific per-capita illness costs of women to the age structure of the male population. With that approach, the distribution of illness costs is estimated under the assumption that the age structure of the male population and that of the female population are absolutely identical (with otherwise constant conditions).
The result of that calculation shows: When age-standardised, the expected illness costs of women exceed those of men by just 11%. At the same time, the original cost difference is down to Euro 10.7 billion. When also deducting the reproduction-related benefits, the expected value for women exceeds that of men by only 6%. In that case, the difference between sexes is Euro 6.1 billion (see chart “Cost variables”: Variant B).
Those figures are the result of a hypothetical calculation example: Based on the given real situation, and making specific assumptions, fictitious cost distributions are calculated. They show, however, that the difference between sexes can be interpreted to a considerable extent, though not entirely, as an age structure effect.
Costs in nursing care facilities
Various studies point out that women more often take care of their spouse/partner in old age, whereas they themselves more often depend on non-family nursing care services, which frequently are rather expensive. This is mainly attributed to the, on average, higher life expectancy and the lower age at marriage of women. Those facts might explain the sex-specific distribution of illness costs in nursing care facilities: In 2006, a good tenth (Euro 26.2 billion) of the total illness costs were incurred in out-patient or (part-time) in-patient nursing care facilities. Here, the share of women was higher in general, and particularly in old age: From the age of 65, it was 76% and from the age of 85, it was even 85%.
Cost variables
It can also be estimated how much those costs contribute to the difference between sexes: When deducting from the age-standardised and reproduction-adjusted illness costs the costs incurred in nursing care facilities, the difference between sexes if further reduced: In that hypothetical case, it is just Euro 3.7 billion. At the same time, the expected value for women exceeds that for men by just 4% (see chart “Cost variables”: Variant C).
Illness costs of women and men converging
Looking back to 2002 shows that the difference in illness costs between women and men was even larger in the past. From 2002 to 2006, the difference decreased by Euro 2.8 billion. While the costs of women exceeded those of men by 43% in 2002, that percentage was down to 36% four years later.
The reason is that illness costs of men grew much more rapidly than those of women. This was particularly evident in the age group of 65 years and over: Compared with 2002, the illness costs of men in that age group rose by 25% (Euro 8.5 billion), whereas for women the rate of increase was 13% (Euro 8 billion). And especially in that age group, a particularly large increase in costs (+ Euro 16.5 billion) was observed. For comparison, total illness costs increased by Euro 17.2 billion in that period.
One of the reasons here is the demographic trend. As the number of men among the older population markedly increased, the development of the average per-capita illness costs is more moderate: Compared with 2002, they rose by 5.3% (+ Euro 320) for men aged over 64 years and by 3.8% (+ Euro 270) for women of the same age.
Author
Manuela Nöthen - Federal Statistical Office
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