Cost of diseases in international perspective

This study compares the health care costs of The Netherlandswith the United States and Sweden and estimates the impact ofdemographic change on costs. Total health care costs were allocatedto disease, age, sex and specific subsectors. For The Netherlands75% of the costs in 1988 were assigned to specific diseases.Costs of mental disorders and other chronic non-fatal diseasesdominate, followed by cardiovascular diseases. The effect ofage is strong from age 70 years onwards. The effect of sex,adjusting for age, is small, except for elderly women, who aremore expensive. Both total and disease-specific costs are similarin The Netherlands and Sweden, but differ from those in theUS. The available data suggest that the differences in medicalpractice and health care systems may explain a substantial partof the divergent results; demographic or epidemiologic aspectsseem less important. Ageing induces, in the Dutch case, a modest0.7% annual increase in costs. The contribution of other forcesin the increase of costs is probably more important. A structuralupward pressure on costs also prevails in The Netherlands andSweden, but it is more prominent in the US, due to a large amountof expensive surgery and high administration costs.