ageing, Europe, health care, Labor market, social policy and social services, Research

Ageing, Health Status and Determinants of Health Expenditure - AHEAD


On 1 February 2004 a CEPS-led consortium with 18 partners, most of which are members of ENEPRI, started the implementation of a three-year research project on the future evolution of health expenditure in the enlarged European Union. This project is financed under the 6th Research Framework Programme.

General Objectives

With the general goal of "Investigating into different key factors driving health care expenditures and in particular their interaction with particular reference to ageing", the Strategic Objectives of AHEAD are:

  • An assessment of pressures on health spending in the existing EU and in selected candidate countries, looking both at those arising directly from ageing and at those affected by changing incomes, social change and methods of expenditure control.
  • The development of models embedded in EXCEL spreadsheets for projecting future health spending.
  • Estimation of confidence limits for these projections.

Expenditure on medical treatment has tended to rise as a proportion of national income throughout the European Union. There has been an element of uplift to the mean as countries with low proportions of spending, such as the United Kingdom, have faced political pressure to spend at least the average EU proportion of their national income on the provision of health services, medical treatment and long-term care. A particular concern is that, with an ageing population and therefore the prospect of more old people around, the pressures for expenditure on health care will increase further. This issue is of concern both in its own terms and because of its fiscal implications. Rising health expenditures put pressure on the targets of the Stability and Growth Pact. They also raise the question whether budgetary targets should be tightened ahead of projected growth in public expenditures, so as to "save up" for future spending and keep expected future tax rates reasonably constant.

Project Structure and Involvement of CASE

Two of nine sub-themes of the project were coordinated by CASE. Stanisława Golinowska directed the work of the CASE team, which concentrated on the current state of health in Eastern Europe and analyzing the factors determining an individual's state of health. Preliminary results of the project were presented at a conference in Brussels on October 10 - CASE's presentation focused on "Health Status and Health Care Systems in Central and Eastern European Countries: Bulgaria, Estonia, Poland, Slovakia and Hungary"

Project Output

This project will refine existing estimates of the links between reported states of health and use of medical services. As well as looking at the effects of ageing on health care the research will take account of the link between health expenditure and fertility rates and the demands on health services made by non-native populations. Particular attention is paid to costs of care near death. A study will be made of factors other than demand (such as methods of financial control) which may influence health spending. An important aspect of this research is that the work is carried out so as to be able to provide not only the familiar projections and scenarios but also standard deviations and confidence limits for predictions of key variables such as healthy life expectancy and demand-driven expenditure levels. These will allow policy-makers to judge not only possible outcomes but also the risks surrounding them and to assess their implications.

For further information on the AHEAD project and the research reports please visit ENEPRI network site


European Commission, 6th Framework Programme


Centre for European Policy Studies, CEPS, BE (leader)
National Institute for Economic and Social Research, NIESR, UK
Netherlands Bureau for Economic Policy Analysis, CPB NL
Deutsches Institut für Wirtschahftsforschung, DIW, DE
Economic and Social Research Institute, ESRI, IRL
Research Institute of the Finnish Economy, ETLA, SF
Federal Planning Bureau, FPB, BE
Istituto di Studi e Analisi Economica ISAE, IT
Institute for Advanced Studies, HIS, AT
Institute for Public Health, IPH, DK
Laboratoire d'Economie et de Gestion des Organisations de Santé , LEGOS, FR
Personal Social Services Research Unit, PSSRU, UK
Fundación de Estudios de Economía Aplicada, FEDEA, ES
Institute of Slovak and World Economy, ISWE, SK
Institute of Economics at the Bulgarian Academy of Sciences , IE-BAS, BG
Social Research Centre, TARKI, HU
Department of Public Health, University of Tartu, UniTartu, EE