3 questions to... Nicolas Sirven, on the occasion of the publication of Issues in Health Economics (216), March 2016: "Ageing, Frailty and Health Care Expenditures", realised in collaboration with Thomas Rapp

1/ What are the issues and contributions of the concept of frailty in terms of health economics?

First, we use Fried's approach of frailty which defines frail individuals by the presence of at least three criteria contributing to the loss of autonomy process: unintentional weight loss, reported fatigue, low physical activity, slow walking speed and muscle weakness. The frailty phenotype allows to better understand the physical health of the elderly and complements conventional health status measures in population surveys. The concept of frailty notably enables to anticipate negative consequences such as loss of autonomy, entering a nursing home or hospital use. The measure of frailty is quite simple and can improve predictions of health expenditure models.

2/ Your study is testing whether frailty and health costs are related: what are the main results?

The frailty phenotype is associated with a higher consumption of care regardless of other health measures effect. While the average amount of outpatient expenses of people aged 65 and over was 2,600€ per person in 2012, the additional cost associated with frailty is about 1,200€ for outpatient care, per year and per person aged 65 or more, and about 550 € for pre-frail individuals.

3/ What are the lessons learned from your study in terms of public policy and what are the developments you are thinking on this issue?

This study is taking part in the previous work showing that age is not a good indicator of spending: the demographic argument loses its influence in favor of health status. The increase in health spending is not inevitable; social and health policies that target frailty could be considered to optimize the consumption of care and improve the lives of seniors. Our current work analyzes the role of frailty in the recourse to the hospital through an international comparison between France and Quebec.

Interview by Anne Evans

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