Healthy aging versus demographic trends: the French case, estimated by markovian microsimulation methods

The Objective of this paper is to test the consequences of changes in health status of future cohorts of French elderly on healthcare expenditures. We value the precise effect of epidemiological and life expectancy changes on health expenditures for 2025 by using a markovian microsimulation model for a representative database of the contemporary cohorts in France. The originality of these simulations holds in the use of an aggregate indicator of morbidity-mortality, capturing a vital risk and making possible to adapt the quantification of the life expectancies by taking into account of a life without incapacity and/or of the presence of severe pathologies. We forecast a reliable range for future national health spending, under different epidemiological scenarios of morbidity: benchmark case (BM), healthy aging (HA), healthy aging and medical progress (AM). We obtain an evaluation of the annual growth rates in health expenditure accounted for solely by aging: +1.18%; +0.95%; +1.38% according to the scenarios BM; HA; AM. In short, the effective decreases in morbidity rates are not sufficient enough to compensate the massive arrival of baby-boomers at elderly age in France for the period 2010- 2025.