Health care expenditure

In the Trend Scenario, real health care expenditure will increase to 174 billion euro in 2040. This is a doubling compared with 2015. The expression ‘real health care expenditure’ implies that price developments are not included in the projection of expenditures. Hence, expenditure is expressed in 2015 prices. The scope used for health care expenditure is based on a societal definition of direct medical health care costs and includes both public and private expenditures. Expenditures on child care (nursery), welfare services and youth care are not included. The projection is based on an analysis of health care costs during the period 2003-2015. In this period, real health expenditure increased by on average 2.8 percent per year. In the recent period 2013-2015 strict cost control was maintained. The resulting limited growth in health expenditure was included in the trend analysis (see next graph). Health care expenditure as a share of GDP will increase from 12.7 percent in 2015 to 16.4 percent in 2040. This is based on an assumed GDP growth of 1.8 percent per year.

In the Trend Scenario, health care expenditure per capita will rise from 5,100 euro in 2015 to 9,600 euro in 2040. Expenditures per capita are partly publicly funded, through insurance premiums, and partly by other sources: other expenditures. These other expenditures are mainly co-payments and complementary health insurances. The publicly funded expenditures will rise from 3,800 euro per person in 2015 to 7,700 in 2040; the other expenditures will rise from 1,200 euro in 2015 to 1,900 in 2040. The ratio of public funds and other funds is a policy choice. The Trend Scenario assumes that no new policy will be implemented. Hence, the future ratio between public and other funds equals the ratio in the latest national health care budget.

In 2015, health expenditure for women was 9.9 billion euros higher than for men. By 2040 this difference will amount to 30 billion euros. This increase in the difference in health expenditure is due to the high number of older women compared to older men. This difference will remain to exist. In the Trend scenario, the number of men increases by 5.9 percent; the number of women by 6.8 percent. Since older people have higher health care expenses than other age groups, the difference between men and women will continue to increase.

Of all the health care sectors, expenditure on care for the elderly will increase the fastest in the Trend Scenario, from 20 percent of total health care expenditure in 2015 to 25 percent in 2040. This corresponds to an average expenditure growth of 3.8 percent per year. Around three quarters of this growth can be attributed to demographic developments. Because of the ageing of the population, expenditure on elderly care will rise faster than total health care expenditure. In 2040, total health care expenditure will have doubled compared with 2015; for health care for the elderly the growth factor is 2.6. Health care for the elderly includes all providers of health care for the elderly. ‘Other health care’ includes primary health care, drugs and therapeutic resources, oral health care and curative mental healthcare. Other health care expenditure, including health care for the disabled, is included in the group ‘other sectors’.

In the Trend Scenario, expenditure on the treatment of cancer will be a factor of 4.3 times higher in 2040 than in 2015. This corresponds to an average annual growth of 6 percent. A sixth of this can be attributed to demographic developments. Five sixths of the growth is attributable to other developments, such as medical technology and income growth. Of all the disease groups, health care expenditure on cancer will rise the fastest; the share of this diagnosis group of total health care expenditures will increase from 6.5 percent in 2015 to 14percent in 2040. This will make it the second most expensive disease group, after mental disorders. Expenditure on mental disorders includes expenditure on dementia and intellectual disabilities.