Modelling the Age Dynamics of Chronic Health Conditions: Life-Table-Consistent Transition Probabilities and their Application.

Surveys of chronic health conditions provide information about prevalence but not incidence and the process of change within the population. Our study shows how "age dynamics" of chronic conditions – the probabilities of contracting conditions at different ages, of moving from one chronic condition state to another, and of dying – can be inferred from prevalence data for those conditions that can be viewed as irreversible. Transition probability matrices are constructed for successive age groups, with the sequence representing the age dynamics of the health conditions for a stationary population.

Age of pension eligibility, gains in life expectancy, and social policy.

Canadians are living longer and retiring younger. When combined with the aging of the baby-boom generation, that means that the “inactive” portion of the population is increasing and there are concerns about possibly large increases in the burden of support on those who are younger. We model the impact of continued future gains in life expectancy on the size of the population that receives public pension benefits.

Income replacement in retirement: longitudinal evidence from income tax records.

Applying an employment-income-based procedure for determining retirement, we analysed a large longitudinal data file of Canadian personal income tax returns for individuals to determine who has retired and to assess how successful they are in maintaining their incomes after retirement. The methodological approach may be of interest for possible application in other countries that have suitable data. Our main conclusions are as follows.

Chronic health conditions: changing prevalence in an aging population and some implications for the delivery of health care services.

Since the prevalence of many chronic health conditions increases with age, we might anticipate that as the population ages the proportion with one or more such conditions, and the cost of treatment, would rise. How much would the overall prevalence of chronic conditions increase in a quarter century if age-specific rates of prevalence did not change? How much would the requirements for health care resources increase? How much difference would it make to those requirements if people had fewer chronic conditions? The overall prevalence rates for almost all conditions associated mostly with old age would rise by more than 25 per cent, and health care requirements would grow more rapidly than the population - more than twice as rapidly in the case of hospital stays - if the rates for each age group remained constant. Even modest reductions in the average number of conditions at each age could result in substantial savings.

What is retirement? A review and assessment of alternative concepts and measures.

Because the concept of retirement is prominent in both popular thinking and academic studies, it would be helpful if the notion were analytically sound, could be measured with precision, and would make possible comparisons of patterns of retirement over time and among different populations. This paper reviews and assesses the many concepts and measures that have been proposed, summarizing them in groupings that reflect non-participation or reduced participation in the labour force, receipt of pension income, end-of-career employment, self-assessed retirement, or combinations of those characteristics. It concludes that there is no agreed measure and that no one measure dominates.

Users and suppliers of physician services: a tale of two populations.

Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, especially in the light of the widespread phenomenon of population aging. To determine the extent to which shortages exist, one needs to study the population of users of physician services as well as that of the physicians themselves. The authors study both, using the province of Ontario, Canada, as an example.

Healthy aging at older ages: are income and education important?

Being higher on the socio-economic scale is correlated with being in better health, but is there is a causal relationship? Using 3 years of longitudinal data for individuals aged 50 and older from the Canadian Survey of Labour and Income Dynamics, we study the health transitions for those who were in good health in the first year, focusing especially on income and education. The initial good health restriction removes from the sample those whose incomes may have been affected by a previous history of poor health, thus avoiding a well-known problem of econometric endogeneity. We then ask, for those in good health, whether later transitions in health status are related to socio-economic status.

The transition from good to poor health: an econometric study of the older population.

This is a study of the influence of socioeconomic factors on the state of health of older Canadians. Three years of panel data from the Survey of Labour and Income Dynamics are used to model the transition probabilities between good and poor health. Care is taken to avoid the problem of endogeneity of income in modelling its effects, and to adjust reported income to free it from its strong association with age at the time of the survey.

Exploring the effects of population change on the costs of physician services.

The effects of population aging on future health care costs are an important public policy concern in many countries. We focus in this paper on physician services and investigate how changes in the size and age distribution of a population can affect the aggregate and per capita costs of such services. The principal data set (unpublished, for Ontario) provides information about payments to physicians, by age and sex of patients.