Ageing and Growing Health Care Costs: The Political Pathway

• In Event: Public Meets Health Policy: How Public Influences Up, How Policy Influences Down

Abstract

There is an ongoing debate concerning the effect of population ageing on health care cost growth. On the one hand, since per capita health care costs tend to rise exponentially in old age, total health care costs grow mechanistically with the rising the share of the elderly in the population. Moreover, ageing decreases GDP growth, which favours an expansion of the share of health care spending relative to the economy. On the other hand, older individuals today are in much better health than previous generations were, thereby reducing their impact on health care costs. Additionally, other factors, such as medical and technological progress, have a significantly larger effect on health care costs than ageing. We contend that these debates have not considered an important political channel.

We rely on an original survey using experimental techniques to measure priorities between health cadre and other social policies conducted in February in four countries among 12 000 respondents. We argue that once their preferences and priorities are properly measured, older citizens prioritize health care over other public expenditures, without necessarily wanting growing health-care costs to contribute to a larger overall public budget. Indeed, previous studies have found that age is negatively correlated with willingness to pay for health care (Gugushvili 2022). Hence, an older population is more likely to accept that the health care budget crowds out other public expenditures. Moreover, we argue that older individuals are more likely to reward or punish the incumbent government for the perceived performance of the health care system and to vote for the party that they believe has issue ownership over health care.

This is a significant contribution to the literature since most of the previous studies on public opinion towards health care expenditures rely on unconstrained questions about health care and are unable to measure the trade-offs between health care and other policies. Hence, previous studies (and the authors’ own analysis of ISSP surveys) have not found that age is related to preferences for health care spending (Jordan 2010; Naumann 2018; Vallée-Dubois 2022), except for Busemeyer (2022) who uses a wording experiment comparing preferences for health care in constrained and unconstrained scenarios. Moreover, our results have important political implications. As the population gets older, parties are also more likely to prioritize health care over other public expenditures, thereby contributing to a politically driven mechanism of growing health-care costs.

Authors

• Olivier Jacques, University of Montreal, School of Public Health

• Sharon Baute, University of Konstanz

• Marius Busemeyer, University of Konstanz

• David Weisstanner, University of Aarhus