Impact of Population Ageing in New Zealand on the Demand for Health and Disability Support Services, and Workforce Implications



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Impact of Population Ageing in New Zealand on the Demand for Health and Disability Support Services, and Workforce Implications

Background Paper prepared for the Ministry of Health

Justine Cornwall and Judith A Davey

New Zealand Institute for Research on Ageing (NZiRA)


and the Health Services Research Centre (HSRC),
Victoria University of Wellington






Citation: Cornwall J and Davey J. 2004. Impact of Population Ageing in New Zealand on the Demand for Health and Disability Support services, and Workforce Implications. A background paper completed for the Ministry of Health in June 2003 by the New Zealand Institute for Research on Ageing (NZiRA) and the Health Services Research Centre (HSRC), Victoria University of Wellington. Wellington: Ministry of Health.

Published in December 2004 by the Ministry of Health, Manatü Hauora, PO Box 5013, Wellington, New Zealand

ISBN 0-478-25787-2 (Book)


ISBN 0-478-25788-0 (Internet)
HP 4038

This document is available on the Ministry of Health’s website: http://www.moh.govt.nz




Acknowledgements


The projections included in this report were calculated by Antony Raymont of the Health Services Research Centre and Robert Lynn of the Ministry of Health. Melissa Toohey provided valuable help with library searches and Susan Bidwell assisted with the literature search. We would also like to thank Jackie Cumming for her assistance.


Contents


Acknowledgements iii

Contents v

Introduction 1

New Zealand demographic trends 3

Age composition of the population aged 65 and over 3

1 Identifying the Issues and Future Challenges for Health Systems: An Overview of the International Literature 7

2 Health Status and Life Expectancy 11

Life expectancy 11

Mortality rates 13

Health status 13

3 Trends in Health Care Use 16

Proximity to death 17

New Zealand patterns of use 18

New Zealand projections 19

4 Disability Trends 22

Cohort effects 26

Compression of morbidity 26

International disability projections 28

New Zealand disability trends 29

5 Trends in Age-related Illness and Disease 33

Rates and measures 33

New Zealand evidence 35

6 Long-term Care Issues 50

7 Implications for the Health and Disability Workforce 55

8 International Directions in Health Reform and Policy 58

Systems of integrated care for frail older people 59

9 Other Factors influencing Projections in the Health Services Sector 63

Informal support issues 63

Informal care in New Zealand 66

Rising client/ consumer expectations 69

Technological advances 70

10 Conclusion 72

Life expectancy 72

Mortality rates and proximity to death 72

Cohort-based health status 73

Health service use 73

Disability rates and service use 73

Age-related disease trends 73

Use of long-term care 74

Implications for the health workforce 74

Informal care 74

Policy responses 75

Rising client and consumer demands 75

Technological change 75

Glossary and Abbreviations 77

Abbreviations 77

Glossary 77

References 79



List of Tables



Table 1: Percentage of total population 65 and over, by age group, 2001 base and series 4 projections 3

Table 2: Projected population, by age group and ethnicity, 2001 (base) and projections for 2011 and 2021 4

Table 3: Ethnic groups as a percentage of total population, 2001 (base) and projections for 2011 and 2021 4

Table 4: Age group 65 and over, by ethnicity, 2001 (base) and projections for 2011 and 2021 5

Table 5: Life expectancy at selected ages, by gender, New Zealand, 199597 11

Table 6: Life expectancy (years) at selected ages, by gender and ethnicity, 199597 12

Table 7: Estimated hospital and primary care costs in New Zealand, by gender, 2001, 2011 and 2021 20

Table 8: Discharges and weighted discharges 2001/02, 2011/12 and 2021/22, and percentage change in weighted discharges 21

Table 9: DALE estimates at birth and at age 60, for selected WHO member states 22

Table 10: Expectation of years lived with disability, men and women, selected WHO member states, 1999 23

Table 11: Level of disability, by age and residential status, 2001 31

Table 12: Prevalence of multiple disability, by age and residential status, 2001 31

Table 13: Estimated DSS expenditure by gender, 2001, 2011 and 2021 32

Table 14: Projections for DSS expenditure to 2011 and 2021, by gender, assuming increased life expectancy and delayed onset of disability 32

Table 15: Ten projected leading causes of DALYs in 2020 according to the baseline projection in the Global Burden of Disease and Injury Study 34

Table 16: Base death rates and numbers of deaths for ischaemic heart disease, 1998/2000, with projected deaths to 2011 and 2021 (medium projection), by gender and ethnicity 38

Table 17: Base death rates and numbers of deaths for stroke, 1998/2000, with projected deaths to 2011 and 2021 (medium projection), by gender and ethnicity 39

Table 18: Base death rates and numbers of deaths for COPD and asthma, 1998/00, with projected deaths to 2011 and 2021 (medium projection), by gender and ethnicity 42

Table 19: Base death rates and numbers of deaths for diabetes, 1998/00, with projected deaths to 2011 and 2021 (medium projection), by gender and ethnicity 43

Table 20: Male and female cancer registrations, 1996 and projections to 2011 44

Table 21: Base death rates and numbers of deaths for all cancers, 1998/00, with projected deaths to 2011 and 2021 (medium projection), by gender and ethnicity 45

Table 22: Medium projected deaths from musculoskeletal disease from base 1998/2000 to 2011 and 2021, by gender for the ‘other’ ethnic group 46

Table 23: Projected percentage change in mortality from falls resulting in fractures, by age and gender, for ‘Other’ ethnicity, 2001(base) to 2021 47

Table 24: Base death rates and numbers of deaths from fractures, 1998/2000, with projected deaths to 2011 and 2021 (medium projection), by gender and ethnicity 48

Table 25: Percentage of people caring for an ill or disabled person, by age and gender, 2001 66

Table 26: Age group 2039, percentage who looked after someone ill or disabled, by gender and ethnicity, 2001 67

Table 27: Age group 4059, percentage who looked after someone ill or disabled, by gender and ethnicity, 2001 67

Table 28: Age group 60 and over, percentage who looked after someone ill or disabled, by age and gender, 2001 68

Table 29: Distribution of people who looked after ill or disabled members of own household, by age and gender, 2001 68

Table 30: Distribution of people who looked after ill or disabled members living in other households, by age and gender, 2001 69



List of Figures



Figure 1: Medical and surgical hospital discharge rates for people aged 65 and over, by age group, 1988/89 to 2000/01 19

Figure 2: Prevalence of disability, by age and gender, 2001 29

Figure 3: Level of disability, by age, 2001 30

Figure 4: Estimated average number of residential care residents, by age group and gender, 2000/01 53







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