Medical innovation and age-specific trends in health care utilization: Findings and implications Albert Wong a, b, * , Bram Wouterse b, c , Laurentius C.J. Slobbe c , Hendriek C. Boshuizen a, d, e , Johan J. Polder b, c a National Institute for Public Health and the Environment, Centre for Methodology and Information Services, Department of Statistics and Mathematical Modeling, Bilthoven, The Netherlands b University of Tilburg, Faculty of Social and Behavioral Sciences, Department Tranzo, Tilburg, The Netherlands c National Institute for Public Health and the Environment, Centre for Public Health Forecasting, Bilthoven, The Netherlands d Wageningen University and Research, Biometris, Wageningen, The Netherlands e Wageningen University and Research, Division of Human Nutrition, Wageningen, The Netherlands article info Article history: Available online 6 December 2011 Keywords: Netherlands Age-specific trends Health care utilization Ageing Medical technology Intergenerational solidarity abstract Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981e2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of inter- generational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology. Ó 2011 Elsevier Ltd. All rights reserved. Introduction Health care utilization in the Netherlands and most Western countries has risen considerably in recent decades, and as a result, the health care expenditures (HCE) have experienced a large growth as well. Over the period 1981e2008, the share of HCE in the Gross Domestic Product has risen from 7.6% to 9.9% in the Neth- erlands. HCE have increased from 13 billion to 59 billion euros (current prices), which corresponds with an increase of over 450% (OECD Health Data, 2010). In the Dutch definition of health care, which includes many long-term care provisions, this increase was even higher (Statistics Netherlands, 2010). The growth in HCE is expected to continue in the following decades, as a consequence of the ageing population, which will put considerable pressure on health care financing. Additionally, it requires a greater amount of intergenerational solidarity in countries with mandatory health insurance or social insurance systems, such as the Netherlands (Ministry of Welfare, Health and Sport, 2010). Since there are more elderly in absolute and relative terms, the non-elderly (working population) need to contribute higher premiums or tax payments while receiving a smaller proportional amount of care in return. In other words, the net payments of non-elderly increase with the ageing of the population. Ageing has garnered a lot of attention in health economics. Increasing life expectancy leads to more health care utilization over the total life span, which will lead to further gains in life expectancy, * Corresponding author. National Institute for Public Health and the Environ- ment, Centre for Methodology and Information Services, Department of Statistics and Mathematical Modeling, Antonie van Leeuwenhoeklaan 9, Bilthoven, The Netherlands. Tel.: þ31 30 274 7564. E-mail address: albert.wong@rivm.nl (A. Wong). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2011.10.026 Social Science & Medicine 74 (2012) 263e272