인구고령화와 의료비 = Aging and Health Care Expenditure

국문 초록 (Abstract)

사망률의 하락과 평균수명의 증가에 힘입어 대부분의 OECD 국가들에서 65세 이상 노인인구가 빠르게 늘어나고 있다. 또한 2차 세계대전 후(한국은 한국전쟁 후)에 태어난 베이비붐 세대는 은퇴를 시작했거나 대규모 은퇴를 앞두고 있다. 이러한 베이비붐 세대가 노인 그룹에 본격적으로 합류하기 시작하면 앞으로 국민의료비가 폭발적으로 늘어날 것이라는 우려가 높아지고 있다. 본 연구는 OECD 및 WHO의 데이터를 분석하여 횡단국가적 수준에서 ``건강한 고령화`` 현상이 나타나고 있음을 확인했다. 또한 의료비는 ``나이의 함수(a function of age)``이라기보다는 ``사망에 이르는 시간의 함수(a function of proximity to death)``라는 사실을 확인하고 있다. 본 연구의 결과는 의료비 결정요인으로서의 인구를 분석함에 있어 인구구조(age composition)의 변화에 대한 분석만으로는 충분치 못하며, 반드시 국민들의 ``건강상태 변화``와 ``사망관련 비용``을 함께 고려해야 한다는 것을 알려주고 있다. 본 연구를 통해 크게 두 가지 시사점을 얻을 수 있다. 첫째, 장래의 국민의료비를 추계할 때는 ``건강한 고령화``와 ``사망관련 비용`` 요인을 적극 반영해야 한다는 점이다. 기존의 추계방식처럼 늘어난 노인 숫자에 노인인구 1인당의료비를 곱해 노인 의료비를 계산하는 것은 의료비를 과대 추정(over-estimation)할 가능성이 있다. 둘째, 건강증진사업 등 건강투자를 늘려 ``건강한 고령화``를 통해 노인들의 장애 발생 시기를 뒤로 늦출 수 있다면 의료비의 증가를 억제 할 수 있다는 점이다.

다국어 초록 (Multilingual Abstract)

The elderly population in most OECD countries is rapidly growing because of declining death rates and increasing life expectancy. Population aging has caused concerns about the burden of health care expenditures. Future health care expenditures are, particularly, expected to soar as the baby boom generation is going to retire in the near future. There has been a wide belief that there is a mechanistic relationship between the population aging and the rapid growth of national health spending. However, many domestic studies on both healthy aging and death-related costs have shown some reservations to such a belief. This study based on cross-country comparison shows the possibility of a decline of disability in developed countries, compared with the increased life expectancy(healthy ageing hypothesis). This study also showed that the relationship between age and health expenditure was weak and possibly inverse once proximity to death was controlled for. Death ratio was more important as a determinant of health costs than age itself(death-related cost hypothesis). The results of this study cast two suggestions among others. Firstly, simple projections based on age-specific health expenditure will be misleading. Healthy aging and death-related costs should be taken into account in projections of future health care costs to avoid overestimation. The longer life expectancy of baby-boom generation may not bring as great an increased burden for the health care costs as many fear. Secondly, if we can postpone the time of death to higher ages through healthy aging, we can put a brake on the health care costs for the elderly. Health promotion and investment for health, therefore, would contribute not only to the health of population but also to mitigation of the cost increase for health care.

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