Transcript Johan Polder, PhD | Professor in Health Eonomics

Johan Polder, PhD | Professor in Health Eonomics
Cost of illness - Framework & Data
“Measuring education and health volume output”
OECD - Paris, June 6th- 7th, 2007
An economist knows the price of
everything, but the value of nothing.
The value of health
Health Outcome: Dutch evidence
• Infectious diseases
- Disability adjusted life expextancy (DALE): +1.7
- Costs per DALY avoided: € 3400
• Cancer
- DALE: +0.31 (male); +0.85 (female)
- Costs per DALY avoided: € 15,500
• Cardiovascular diseases
- Life expectancy: +2.3 (male); +3.8 (female)
- Costs per DALY avoided: € 2000
• Generic efficiency of the health care system
- Meerding WJ, Polder JJ, et al., (forthcoming, september 2007)
Health output: Cost of illness
• Cost of illness (COI) analysis is the main method of
providing an overall view on the economic impact of a
disease.
• Such studies have been used to set priorities for health
care policy and describe resource allocations for various
diseases.
Cost of illness
- Approaches -
Top-Down Approach
• health expenditures from
National Health Accounts as
a fixed starting point
• complete disease
• no double counting
• comorbidity (partial)
• no longitudinal analysis
© Statistisches Bundesamt, VIII A3
Bottom-Up Approach
• direct evaluation of patient
specific data
• few special diseases
• double counting
• comorbidity
• longitudinal analysis
GENERAL Cost of illness (COI): What?
• Demographic and epidemiological view on health
expenditure
• Health expenditure by demand
- Direct medical costs only
• Break down of health expenditures to patient (or
demand) characteristics as:
- Disease (categories)
- Age
- Gender
- Function
- Financing
Cost of illness (COI): Why?
• Description
- Health expenditure by supply and demand
- All combinations
• Projection
- Forecasts of future health expenditure
- Ageing / changing disease patterns
• Comparison
- Over time: trends in health care costs
- Between countries: better understanding of cross-country
differences in health care systems and costs (for similar or
different demography / epidemiology)
General COI: How?
• Health care costs are known for each sector and actor
- Statistics Netherlands: 80 actors according HPclassification
• For each actor utilisation data is retrieved
- By diagnosis, age, gender, function, financing
- comprehensive registries and studies in the Netherlands
(most of them were used, ± 50 major data sources)
• Key variables represent equal health care use
- contacts, inpatient days, prescriptions, …
- some need weighing: hospital interventions, prescribed
medicine
• Costs are broken down using key variables
Accounting process
top-down method
step I:
step II:
step III:
step IV:
© Statistisches Bundesamt, VIII A3
health expenditures
providers
disease-based indicators
cost of illness
The Netherlands in the world
Share of health care costs in the GDP (%)
16,0
14,0
12,0
10,0
8,0
Belgium
Germany
6,0
Luxembourg
4,0
Netherlands
Sw eden
2,0
United Kingdom
United States
0,0
1980
1983
1986
1989
1992
1995
1998
2001
Key figures
• 16 million inhabitants
• Life expectancy
- About 75 for men
- About 81 for women
• Bismarck-based health care system
- Social health insurance
- Tax financed care plays a minor role
• GDP
- About € 30,000 per head of the population
- (€ 78,000 per worker)
• Health expenditure
- About € 3,500 per inhabitant (average)
Three perspectives
• Blue: Dutch health and
social care accounts
- € 60 billion
• Yellow: Budget Ministry of
Health
- € 44 billion
• Pink: OECD SHA
- € 45 billion
• quite different boundaries
Relations between perspectives
• Dutch health and social care accounts
- Standard: comprehensive; time series available; SHA-based
• Dutch Ministry of Health
- Minus: prevention, personal expenditures on e.g. over the counter
drugs, occupational health, social care
• OECD System of Health Accounts
- Minus: homes for the elderly, home care, care and provisions for
people with mental/intellectual disabilities
- Plus: investments
Dutch HA versus SHA / figures
SHA provider classification
Dutch
OECD Difference
HP.1
Hospitals
17,108
16,037
94%
HP.2
Nursing and residential care facilities
13,061
5,313
41%
HP.3
Providers of ambulatory care
12,538
9,980
80%
HP.4
Retail sale and other providers of medical goods
7,555
7,229
96%
HP.5
Provision and administration of public health
772
772
100%
HP.6
General health administration and insurance
1,837
1,837
100%
HP.7&9
Other
1,941
1,726
89%
outside SHA
2,717
Total current expenditure on health care
Capital formation of health care provider institutions
Total health expenditure
57,529
0%
42,893
2,220
45,113
75%
COI-2003: Costs by provider (€ mln)
<OECD definition of costs>
COI-2003: costs by disease (€ mln)
0
4.000
8.000
12.000
Mental and behavioural disorders
Not allocated / Not disease related
Diseases of the circulatory system
Diseases of the digestive system
Symptoms, signs and abnormal clinical and laboratory findings, not
elsew here classified
Diseases of the musculoskeletal system and connective tissue
Diseases of the nervous system
Neoplasms
Diseases of the respiratory system
Injury, poisoning and certain other consequences of external causes
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
SHA
Endocrine,nutritional and metabolic diseases
Infectious and parasitic diseases
Diseases of the skin and subcutaneous tissue
Certain conditions originating in the perinatal period
Congenital malformations
Diseases of the blood and blood-forming organs
Dutch HA
COI-2003: per capita costs by age & gender (€)
50.000
50.000
Dutch HA - w omen
Dutch HA - men
45.000
SHA - men
45.000
40.000
40.000
35.000
35.000
30.000
30.000
25.000
25.000
20.000
20.000
15.000
15.000
10.000
10.000
5.000
5.000
0
0
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
SHA = w omen
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
COI-2003: population costs by age & gender
COI-2003: Gender difference explained (€ mln)
pregnancy and
gender specific
diseases
280
demography
(number of persons
per age group)
Intensity of health
care use
160
40
w omen higher costs
men higher costs
-80
0
5
15
25
35
45
55
65
75
85
95
COI-2003: by age and diagnosis
Distribution ICD-9 chapters (%)
0%
20%
40%
60%
80%
100%
Infectious and parasitic diseases
Neoplasms
Endocrine,nutritional and metabolic diseases
Diseases of the blood and blood-forming organs
Mental and behavioural disorders
Diseases of the nervous system
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Diseases of the skin and subcutaneous tissue
Diseases of the musculoskeletal system and connective tissue
Congenital malformations
Certain conditions originating in the perinatal period
Symptoms, signs and abnormal clinical and laboratory findings, not
elsew here classified
Injury, poisoning and certain other consequences of external causes
Not allocated / Not disease related
0
1-14
15-24
25-44
45-64
65-74
75-84
85+
All results: www.costofillness.nl
Drugs: results by diagnosis
Drugs: results by age & gender
Mental health care: Results by age & gender
International comparisons
(Report by Heijink R, Polder JJ, et al., 2006)
Curative care: overall picture comparable
Long term care: large differences
Comparability by age
Conclusions
• Cost of illness studies
- value health output
- allow for detailed analyses of health expenditure by
aspects of supply & demand
- can be used for projections & comparisons
• Cross-national comparisons should focus on cure
• COI-studies reveal the societal value of health care
• (Health) economists have learned a lot about value
(rather than price), but can learn even more…..