Scottish Longitudinal Study
Development & Support Unit

Current Projects

Project Title:

Population ageing: What are the implications for healthcare expenditure in Scotland?

Project Number:



Claudia Geue (University of Glasgow)
Andrew Briggs (University of Glasgow)
James Lewsey (University of Glasgow)
Paula Lorgelly (University of Glasgow)

Start Date:

Approved on 02-02-2010


With the largest population cohorts approaching the age of 65, it has previously been anticipated that costs for public services such as HC will increase (Dang et al., 2001). Compared to the rest of the UK, population ageing in Scotland will be even more pronounced due to differences in the demographic composition (GRO for Scotland, 2007). Over the last few years there have been a number of studies that consider PTD in addition to age and how this affects HC expenditure. It is now general agreement in the health economics field that HC costs are not only driven by age, and that considering only age may lead to an overestimation of future HC expenditure (Seshamani and Gray, 2004a, 2004b; Zweifel et al, 1999). However, studies aiming to explain the relationship between age, PTD and HC expenditure so far have lead to varying results, due to the use of different methodological approaches. These studies have used either descriptive or regression methods, have chosen different samples (survivors and/or decedents, people over/under the age of 65) as well as different HC sectors to estimate costs.

Only one study in 2001 has so far looked at PTD and HC utilisation in Scotland but a full report has never been published (Graham and Normand, 2001). It represents a preliminary approach to exploring this relationship using Scottish data and leaves scope for extensive future research in this area, such as: how does the presence of co-morbidity affect the decision to treat? It is also worth to further explore different economic costing methodologies.

It is important for health policy and expenditure projections, to fully understand the relationship between age, death and expenditure on health care (HC). There is evidence from national studies that shows that older age groups incur less acute HC costs than previously anticipated (Zweifel et al, 1999, Hakkinen et al, 2008) If the current approach to projecting costs into the future leads to overestimation, then there is potential for this research to inform a new method which would facilitate reallocation of scarce public money. Similarly, if current methods underestimate future spending, additional funds would be needed. This PhD project will investigate the dynamics of the relationship between age, proximity to death (PTD) and HC expenditure for Scotland.


Dang T, Antolin P, Oxley H. (2001). Economics departments working papers no 305, ECO/WKP (2001)31. Paris: Organisation for Economic Co-operation and Development (OECD); Fiscal Implications of Ageing: Projections of age-related spending.

General Register Office for Scotland. (2007). "Projected Population of Scotland (2006-based)." link

Seshamani M and Gray, A (2004a). "Ageing and health-care expenditure: the red herring argument revisited." Health Econ 13(4): 303-14.

Seshamani M and Gray, A M (2004b). "A longitudinal study of the effects of age and time to death on hospital costs." J Health Econ 23(2): 217-35.

Zweifel P, Felder, S and Meiers, M (1999). "Ageing of population and health care expenditure: a red herring?" Health Econ 8(6): 485-96.

Graham B and Normand, C (2001). Proximity to death and acute health care utilisation in Scotland. Final Report, Chief Scientist Office.

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