Wednesday, February 22, 2012

The Old factor

Just catching up on some things.  A few have asked me about an article a couple weeks ago covering some work from Harold on how Pittsburgh's medicare spending per capita compares to other regions.  In summary I read: it's really high. 

It just got me thinking.  Whenever I see anything like this I wonder about the impact of age demographics. I can't tell from the PG's coverage if there is a fuller reference to look at as it does not give a specific cite, but I think it all follows directly from the data in the map at the the Dartmouth Atlas .  So this isn't really intended as a reaction to that article as a general look at what is going on within the elderly population here compared to elsewhere.  Still that map there on the Dartmouth Atlast sure appears to me superficially to have a strong correlation to maps of age in the US; at least that big older swath through Appalachia.  I can't begin to say much about what is going on in Texas and the Gulf Coast.

Even just looking at the local elderly population it is not quite the same as the elderly populations elsewhere.  I made a graph of how Pittsburgh's elder population compares to other metropolitan regions.  This is what I get for the breakdown of "Older Old" population, I'll use the population age 85 and over here, as a propoprtion of the population age 65 and over. 

So that is a pretty significant range across metro areas.  Some have much older elderly populations than others. Hard to imagine that does impact expendtures on health care here compared to elsewhere. That would especially be true of a Medicare served population which is older to begin with.  It may be an age factor that is accounted for in the initial benchmarking of this data, I don't know. 

This all would matter in the health care context a lot since at least the economists have worked out that a large chunk of Medicare spending is all tied up in end of life care. So if you have a lot bigger proportion of your population nearing mortality, then you might expect that to show up in the health care costs in aggregate. Since Pittsburgh remains the only large metro area with a natural population decline (more deaths than births) we remain an outlier across a lot these demographics. 

Just to think about is all.


Anonymous MH said...

I'd bet the youngish elderly are less healthy here than those of a similar age elsewhere. Migrants trend healthy meaning those left trend the other way.

Wednesday, February 22, 2012 7:48:00 PM  
Anonymous The Wiz said...

The elderly elderly population is a testament to the quality care people have here. Otherwise they would pass away before becoming one of the elderly elderly.

Wednesday, February 22, 2012 9:59:00 PM  
Anonymous DBR96A said...

The attrition of the elderly is the last step in Pittsburgh's demographic reset. That will happen over the course of this decade. I don't know if the Pittsburgh MSA will grow in the 2010's, but I do know that it will get younger.

Thursday, February 23, 2012 2:14:00 AM  
Anonymous Anonymous said...

I'd be interested to see a graph comparing ratio of old old popn to young popn in each metro area. Boston, SD, SF, NYC, Portland, Seattle, etc. feel younger than Pittsburgh, even though they look to be fairly similar in terms of old old. Pittsburgh has significantly fewer young people than those other cities, right?

Thursday, February 23, 2012 8:58:00 AM  
Blogger joe said...

Great post Chris. I added my two cents over on my gerontological back porch, but in 50 words or less here:

Portland and Seattle have significantly lower readmission rates but nearly as high Older Old proportions. We need to change practice patterns in a big way here, and we can start by getting more providers and payers more on board with Harold Miller's homegrown innovations in using payment reform to reduce readmissions (.pdf)

Friday, February 24, 2012 7:56:00 AM  
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