Understanding the age pattern of medical spending and changes therein – the purpose of this paper – is essential in an ageing society. We started by combining several data sources to create a comprehensive time-based data series of hospital spending by age group, gender and disease category for The Netherlands in the period 1994-2010. Subsequently, this time series enabled us to disentangle changes in the age pattern of hospital spending to various disease categories. Finally, we investigated to what extent trends in hospital spending by age and disease differed under the different hospital payment schemes – first global and fee-for-service budgeting and then patient-based budgeting – that were in place in The Netherlands between 1994 and 2010. Our results show that while hospital spending increased for all age groups, it grew most for the non-elderly aged. The greatest hospital spending growth for this age group related to the treatment of cardiovascular diseases and cancer. Furthermore, compared to global budget in 1990s, overall hospital spending grew considerably under fee-for-service and patient-based payment schemes, although this effect appears to be disease-specific.