The “Double Expansion of Morbidity” Hypothesis: Evidence from Italy

The last few decades have been characterized by an increase in the number of years lived in bad health, lending support to the “Expansion of Morbidity” hypothesis. In this paper we propose the “Double Expansion of Morbidity” (DEM) hypothesis, arguing that not only life expectancy gains have been transformed into years lived in “bad health”, but also, due to an earlier onset of chronic diseases, the number of years spent in “good health” is actually reduced. Limited to the Italian case, we present and discuss a set of empirical evidence confirming the DEM hypothesis. In particular, we find that from 2004 to 2014 the average number of years spent with chronic conditions in Italy increased by 7.2 years 2.3 years of which are due to an increase in life expectancy and 4.9 years due to a reduction in the age of onset of chronic conditions. Compared with 2004, in 2014, this phenomenon generated extra public health expenditure of nearly 6.3 billion euros. We discuss the policy implications of these findings.