Is old age something worth striving for, Stefan Felder?
Text: Stefan Felder, health economist
Everyone hopes to live a long life. But how do we stay fit and healthy for as long as possible? What new questions arise as life expectancy increases? Answers from health economics.
Achieving old age is undoubtedly something to wish for — and is also increasingly achievable. In Switzerland, the probability of reaching the age of 90 has doubled from 15 to 30 percent for men and has risen from 30 to 46 percent for women since 2000. These days, almost a third of men and half of women will live to see at least their 90th year.
This is generally considered a positive thing. Our research has shown that an additional year of life in perfect health is worth around CHF 200,000 to Swiss people. Living longer, however, involves additional costs both for the person themselves and for the state. The state portion is largely covered by the younger generations.
The Swiss pension scheme, OAHI (old-age and survivors’ insurance), for example, is primarily funded by salary contributions: If someone lives for an extra five years — the average number of years gained by women and men since 2000 — they will receive between CHF 75,000 (minimum pension) and CHF 150,000 (maximum pension) during this time. The 13th-month pension payment, which will be introduced in 2026, will add between CHF 37,500 and CHF 75,000 more. All of these benefits will be mainly funded via salary contributions, and so responsibility falls to the young.
It isn’t just that people are dying later and later; frailty also sets in later and later in life. Mortality and morbidity are both being pushed back to an ever-increasing age. As a result, the cost of health insurance is in large part immune to an aging demographic.
Only in long-term care do costs rise as life expectancy increases — for example, the supplementary benefits to OASI, which have rocketed in recent years. What is required is long-term care insurance whereby people build up a capital reserve before receiving benefits. This is similar to occupational provisions, the second pillar of the Swiss social security system. In this way, baby boomers would cover the costs of future long-term care themselves. If, however, this care continues to be funded through health insurance premiums and taxes, then the younger generations will again foot the bill.
What treatments at the end of life?
The extra costs — private and state — of a long life have implications for decisions on which services are covered by statutory health insurance. With medication that increases life expectancy, these additional costs should be included in the price. If not, services that improve quality of life, rather than extending life, would be at a disadvantage. Therefore, health economists advise prioritizing end-of-life care treatments and foregoing treatments that extend life by just a few months at great expense.
Stefan Felder is Professor of Health Economics at the University of Basel and co-founder of the Basel Center for Health Economics. His research interests include regulation of health insurance and healthcare markets.
More articles in this issue of UNI NOVA (November 2025).