14 April 2006 International Association for the Health and Ageing Study of Insurance Economics Research Programme on Health and Productive Ageing I. GUEST EDITORIAL 2 Depression in middle age and old age – Geneva consequences for the future Mike Martin and Elke Voss write on affective disorders, in particular depression, that affect more and more people at Association middle age, and address what ageing and mental health will look like in old age in the very near future. Information II. ARTICLE I 6 ewsletter The Effects of quality reporting in U.S. healthcare markets N - Kyna Fong adresses “report cards” on healthcare quality, designed to aid purchasers and consumers in making better decisions. How and to what extent those report cards are effective remains to be seen. III. ARTICLE II 8 Living without disability - François Herrmann, Jean-Marie Robine and Jean-Pierre Michel write on the concept of disability and the trends in disability free life expectancy. IV. ARTICLE III 11 Caring for their parents - Paula C. Mateus de Albuquerque Mateus discusses the link between living arrangements of the elderly and the number of children from a game theory point of view. V. CONFERENCES SUMMARY 13 Summary of the third Health and Ageing Geneva Association conference on “Longevity – A Medical and Actuarial Challenge” VI. CALL FOR PARTICIPATIONS 15 Fourth Health and Ageing Geneva Association conference on “Chronic conditions and insurance” VII. EDUCATION IN HEALTH ECONOMICS 16 VIII. HEALTH CONFERENCES 17 IX. PUBLICATIONS ON HEALTH ISSUES 18 X. GENEVA ASSOCIATION PUBLICATIONS 19 XI. GENEVA ASSOCIATION CONFERENCES 21 The Geneva Association • General Secretariat • 53 route de Malagnou • CH - 1208 Geneva Tel. +41-22-707 66 00 • Fax +41-22-736 75 36 • [email protected] • www.genevaassociation.org The Geneva Association Health and Ageing N° 14/April 2006 RESEARCH SUMMARY Major concerns are generally directed at the rising health costs resulting from technological advances and the changing demographic structure whereby the population aged over 60 largely exceeds that of other age groups in most developed countries. Importance is placed on two major issues. First, the change in demographic structures leading to the perceived “ageing society”. And, second, technological advances, which are thought to result in increasing health costs. It is important to view these issues from the proper perspective. We are not ageing as a society but benefiting from an extended period of good health, which is largely a consequence of technological advances and healthier life styles. It is not the increased spending on health that should be the concern but what it is spent on. It is crucial that the nature of spending is well analyzed and the benefits clearly understood. Current health systems in almost all countries are mainly non-funded pay-as-you-go systems with more or less pronounced intergenerational redistribution. Faced with a shrinking tax base and an increase in health costs, they are bound to experience greater and greater difficulties. Private systems and funded systems that allow accumulation of funds are slowly appearing as alternatives. This evolution raises many unknowns, especially in terms of financing and participation but also of solidarity and equity. As the life cycle is getting longer, people have the opportunity to be productive for a longer period of time than before, which will therefore extend the period of wealth accumulation. This can allow funds or premiums to build up over a long period in order to cover the cost of care in the later stages of life. A majority of countries have already combined both public and private schemes in a bid to create a health financing system that could cope with the increasing difficulties it faces. The Geneva Association Research Programme on Health and Ageing seeks to bring together facts, figures and analyses linked to issues in health. The key is to test new and promising ideas, linking them to related studies and initiatives in the health sector and trying to find solutions for the future financing of healthcare. We are particularly interested in: - The impact of an ageing population in health insurance systems. - The effect of technology on health insurance. - Development of health care systems and the capitalization issue. - The interaction of public and private systems in health provision. - Performance of health systems. - Health issues for an ageing population in the workplace. - Factors that influence health status. - Factors responsible for the increase in health spending. - Factors that contain the increase in health cost. The Geneva Association Information Newsletter – Health and Ageing is linked to the Research Programme on Health and Productive Ageing and is published biannually in April and October. Download the electronic version from: http://www.genevaassociation.org/health_and_ageing.htm Printed copies: 1000. Unrestricted circulation. Free of charge. Editor: Dr Christophe Courbage, The Geneva Association For information and suggestions, please write to the Editor at the Geneva office. © Copyright 2006. The International Association for the Study of Insurance Economics. ISSN:1605-8283 1 The Geneva Association Health and Ageing N° 14/April 2006 I. GUEST EDITORIAL Depression in middle and old age - consequences for the future By Mike Martin* & Elke Voss+ Mental health problems severely decrease the quality of life of the persons affected and their environment. What makes data on the age-related changes in depression so important is that recent studies on prevalences of psychiatric disorders in middle age suggest a high and worldwide increasing rate of mental disorders in middle aged adults. In addition, a 2002 WHO study on the most recent Executive Summary of the Global Burden of Disease and Injury Series indicates that the burden of psychiatric conditions in middle age is frequently underestimated, and most likely undertreated. According to this report, five of the ten leading causes of disability worldwide (measured in years lived with disability), were psychiatric conditions (Hogan, 2000; WHO, 2002). As one can see from current demographic data, the largest age group currently growing into old age are the middle-aged, that is, persons between 40 and 65. This large age group will determine what aging and what mental health will look like in old age in the very near future. Why should this age group be at risk for depression? Recent work has speculated that the high rate of psychiatric disorders in middle age could be due to (1) the high level of demands from work and family at middle age, i.e., between age 40 and 50, (2) the fact of being a member of the large birth cohorts of the baby boomers and/or witness of social change processes like globalization, or (3) the influence of midlife crises (cf. Willis & Martin, 2005). Looking at data from an ongoing longitudinal study in Germany, the Interdisciplinary Longitudinal Study of Adult Development (ILSE), one may examine a representative sample of middle-aged 40+-year-olds and older 60+-year-olds (Voss et al., in press). One main area of data collection are measures of mental and physical health. The intake sample consisted of 1000 persons in the two age groups, with slightly more men than women (based on the fact of lower life expectancy of men and an anticipated longitudinal follow-up of 20 years). The sample consisted of 895 persons at the second measurement occasion, and this return rate of close to 90% can be considered excellent. Although the sample is slightly better educated and has a slightly higher income, it is generally representative of their age groups. That is why data from this study can serve as a basis for quasi-epidemiological examinations concerning the frequency of affective disorders (Martin & Zimprich, 2005). Figure 1. Prevalence and incidence rates for affective disorders in 41-43 (Born 1950/52) versus 61-63-year- olds (Born 130/31) 1930/32) 30 25 20 20.2 15 In % 10 9.5 10.3 5 5.1 3.4 6.3 0 Lifetime 4-year Prevalence Incidence Prevalence Born 1930/32 Born 1950/52 * Professor for the Psychology of Aging and Director of the Institute of Gerontology at The University of Zurich, Switzerland. Email: [email protected]. + Senior research fellow Institute of Gerontology at The University of Heidelberg, Germany. 2 The Geneva Association Health and Ageing N° 14/April 2006 Data from this study suggest that in all three measures, the younger cohort of 40+-year-olds reports significantly higher prevalences for the lifetime, over a four-year longitudinal period and current level of incidence. This suggests that the findings from other countries can be replicated and that middle aged adults show higher rates of affective disorders (Voss et al, in press). Figure 2. Lifetime prevalence rates for several affective disorders in 41-43- (Born 1950/52) versus 61- 63-year-olds (Born 1930/32) cohort 1930/32 cohort 1950/52 cohort Mental disorders % (n) (N=483) (N=494) differences Chi-Square ssd manifest ssd manifest Lifetime prevalence at T1 Any affective disorder 4,0 (19) 9,1 (44) 5,1 (25) 19,2 (95) 22,1 *** Major depressive disorder 3,5 (17) 7,7 (37) 4,9 (24) 17,6 (87) 23,7 *** Any anxiety disorder 5,6 (27) 12,4 (60) 8,1 (40) 7,7 (38) 7,8 * Panic disorder 0,8 (4) 1,0 (5) 0,8 (4) 2,0 (10) 2,5 Agoraphobia without pd 1,5 (7) 4,6 (22) 1,2 (6) 2,0 (10) 6,2 Simple Phobia 1,9 (9) 4,6 (22) 7,1 (35) 2,0 (10) 21,7 *** Social Phobia 4,0 (19) 4,0 (19) 1,8 (9) 1,0 (5) 13,1 ** Any substance use disorder 1,5 (7) 2,1 (10) 3,6 (18) 6,1 (30) 15,1 *** Significance: *p≤0.05; **p≤0.01; ***p≤0.001 If analyses are conducted in more detail, it is again striking that rates of disorders are higher in middle aged, not older adults.