ABSTRACT
This chapter shows how a different evolution of health can alter the impact of demographic changes on health care expenditures, particularly declining mortality. Declining population and aging, two facets of demographic change, are major sources of concern. The hypothesis concerning constant costs by age implies that age-specific prevalences of morbidity or disability would remain stable while the age-specific mortality rates decline. Constant disability rates accompanied by declining mortality mean that the proportion of years lived in good health are dwindling because the years gained lie in age groups in which disability rates are high. Mortality particularly affects the oldest old, the age group with the highest age-specific expenditures. While growth in absolute expenditures reflects changes in the level of services required, given the changes in the size, age structure and health status of the population, growth in relative expenditures reflects changes in the burden borne by the population that funds such expenditures.
