a) Scenarios for the impact of immigration on longevity and dependency of the elderly in the Spanish population
The composition of the Spanish population has recently changed due to immigration. We find a bound for the change in magnitude of healthy life expectancy and life expectancy in disability when the population of foreign residents is taken into account. For this population there is no information about the mortality experience and the disability prevalence. With data from the Survey on Disabilities, Handicaps and Health Status from 1999, we can estimate healthy life expectancy and life expectancy in disability using the Sullivan method. Data come are taken from the Spanish Statistical Institute (INE) and the WHO. We adapt Sullivan's method to the case of two different populations and we establish possible scenarios. The differences between the mortality table that has been estimated for the foreign resident population and the Spanish mortality table are apparent and they are more evident for women. At 65 year of age in the worst scenario, which occurs when all the members of the foreign resident population are disabled, life expectancy in disability would be 2 more years for men and 3 more years for women than when the foreign population is not considered. Our scenarios reveal that the impact on the calculation of in life expectancy and life expectancy in disability is of moderate size.
b) Health Indicators and the use of medical services on the foreign-born population resident in Catalonia.
This paper examines health differences in Catalonia for those individuals who were born in another country compared to the native population, in seven health districts. Data come from the Survey of Health in Catalonia 2006 for people aged 15 or above. Logistic regression is used to examine the effect of foreign origin on health indicators and the use of medical services, controlled by sex, age, level of education, presence of chronic diseases and social status. No significant differences in the presence of chronic diseases, smoking behaviour and overweight are found. We observe that residents who were born in another country have a lower health perception that those born in Spain. They also have less private health insurance coverage; they are more prone to use emergency services and tend to visit the usual primary care physician than their native analogues. No evidence is found of differences between the two populations when considering visits to any primary physician. The comparative behaviour of the foreign born population when compared to the native population is analogous, when using controls. The higher likelihood to visit the usual primary physician by the foreign born population could be explained by a lower private insurance coverage for this group.
c) Health of Immigrants in European countries
The health of older immigrants can have important consequences for needed social support and demands placed on health systems. This paper examines health differences between immigrants and the native-born populations aged 50 years and older in 11 European countries. We examine differences in functional ability, disability, disease presence and behavioural risk factors, for immigrants and non-immigrants using data from the Survey of Health, Aging and Retirement in Europe (SHARE) database. Among the 11 European countries, migrants generally have worse health than the native population. In these countries, there is a little evidence of the "healthy migrant" at ages 50 years and over. In general, it appears that growing numbers of immigrants may portend more health problems in the population in subsequent years.
d) Gender Differences in Health in 11 European Countries: Results from SHARE
We examine gender differences in health in 11 European countries. It is not clear if differences between men and women in multiple dimensions of health are the same across countries. We use the Survey of Health, Aging and Retirement (SHARE) with a sample of 27,444 persons (ages 50+) across the 11 countries. We examine how health behaviours, the presence of functioning problems, disease prevalence, self-rated health, and health care utilization, differ for men and women in multiple countries. We also examine how gender differences in self-rated health are mediated by differences in functioning and disease. There are similarities in gender differences in health across these countries. Men are more likely than women to be overweight and to be current smokers; while women are more likely to report having recently seen or talked to a doctor. Functioning problems and IADL difficulties are more prevalent among women across all countries; the presence of ADL difficulties does not differ by gender in many countries. Hypertension and arthritis are also more common among women; while heart disease is more common among men. Other diseases do not consistently differ by gender. While subjective assessment of health is poorer among women, part of this difference is due to women being older and having more functioning problems. While women have worse functioning and more disability than men; we cannot generalize that women's health is worse than men's. Some diseases are more prevalent among men. Gender differences in health depend on the dimensions studied.
KEYWORDS: Immigration, Health economics, Life expectancy, Health care usage, Count data models
L'objectiu de la tesi doctoral era examinar tendències en l'impacte de la salut, la utilització dels serveis sanitaris, la longevitat i les cures de llarga durada de la población adulta d'Europa i d'Espanya, en particular. En general, s'estudien les diferències en diverses dimensions de salut per gènere, i també les diferències en salut i ús de serveis mèdics entre immigrants i no immigrants adults en onze països europeus. Per últim, s'estudien els possibles canvis en l'esperança de vida i la dependència deguts a l'impacte de la immigració dels últims anys a Espanya.
L'envelliment és un fenomen conegut en moltes societats, i dia rere dia es fa més evident, ja que és palpable un increment en la proporció de població adulta en les últimes dècades, especialment a Europa, on el percentatge d'aquest col·lectiu és generalment més gran que a la resta del món, i on els increments de la població adulta en relació amb la població activa són notables. Les principals causes de l'envelliment de la població es poden englobar en tres parts: una esperança de vida més llarga, un decreixement del nombre de naixements i el fenomen de la immigració. Aquesta tesi doctoral es centra en el paper de la immigració i la població adulta que viu a Espanya i en 11 països europeus:
(1) Analitza les diferències de gènere en salut dels individus de 50 i més anys en 11 països d'Europa, explicant com els comportaments de salut, la presència de problemes funcionals, la prevalença de malalties, l'autopercepció de la salut, i la utilització de serveis mèdics difereixen entre homes i dones en múltiples països;
(2) S'examinen les diferències de salut entre immigrants i no immigrants de 50 i més anys d'edat en 11 països europeus. Les diferències en salut examinades són les habilitats funcionals, discapacitats, la presència de malalties i el comportament de factors de risc.
(3) S'analitza la utilització dels serveis mèdics dels immigrants i es compara amb la població nativa de 50 i més anys d'edat i en múltiples països europeus. Particularment, s'explica com difereix el nombre esperat de visites al metge, al metge de capçalera o les visites a l'hospital entre els dos grups; i per últim
(4) S'estudia l'efecte de l'entrada massiva d'estrangers residents a Espanya en els últims anys en el càlcul de l'esperança de vida lliure de discapacitat i l'esperança de vida en discapacitat.
