The effect of age and time to death on health care expenditures: the Italian experience

A large body of literature, mainly based on hospital costs, shows that time to death (TTD) is by far a better predictor of health spending than age. In this paper, we investigate if this finding holds true also in presence of outpatient costs (drugs, diagnostic tests and specialist visits). Our analysis is based on data obtained from the Health Search-SiSSI database, which contains patient-level data collected routinely by General Practitioners in Italy since 2002. We study individuals aged 19 and older, during years 2006-2009. By means of a two-part model, which accounts for the presence of zero expenditure, we find that TTD is a good predictor of outpatient costs in Italy, but age remains a strong driver. These results suggest that age and TTD can have different role in shaping health care costs according to the component of health expenditure examined. Therefore, our advice to policy makers is to use disaggregated models to better disentangle these contributions in order to produce more reliable health spending forecasts.