Transcript Health care in an ageing society

Ageing, Health Status and
Determinants of Health Expenditure
Data availability and comparability – challenges
and possible solutions – (WPVIA)
Dr. Erika Schulz
Determinants of health expenditure
Population
size, age-structure
Life
expectancy
Morbidity/
Acut
health status
Medical/
technological
progress
Erika Schulz
28.06.2007
Use of
health
care
services
Health
expenditure
Socio-economic
determinants/
healthy behavior/
genetic conditions
Prices,
costs
Health
insurance
schemes
Supply/
access
General framework
conditions
(policies, rules,
assets, economy)
Erika Schulz
28.06.2007
Aims of WP VI
– WP VI focuses on the determinants fo health
spending taking into account of a combination of
demand and supply factors.
– It aims at making predictions of changes in
aggregate expenditure due to marginal changes in
age composition by taking supply factors into
account.
– The analyses include economic, institutional,
demographic and social factors.
Erika Schulz
28.06.2007
Determinants mentioned in previous studies
– As demand factors were mostly performed: age, sex,
health status, income, marital status, household
composition, activity status and dependency
– As supply factors were mostly performed: hospital beds,
staff in hospitals, number of physicians, political
decisions, general economic development, medicaltechnological progress (one result of a study for
Germany was that technology is the main driver of
health expenditure (Breyer 1999))
Erika Schulz
28.06.2007
Health Care Expenditure
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Erika Schulz
28.06.2007
HCE US$ PPP (in million)
HCE US$ PPP per capita
Public expenditure US$ PPP (in million)
Public expenditure US$ PPP per capita
Public expenditure as % of total HCE (US$ PPP per
capita)
Private payment as % of total HCE
Out-of-pocket payments (household) as % of total HCE
Private insurance as % of total HCE
All other privat funds as % of total HCE
Demand Factors I
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Erika Schulz
28.06.2007
Population
total population at 1. January
age-composition as share of total
0-5,6-19,20-34,35-49,50-64,65-74,75-84,85+
life expectancy at birth
male
female
life expectancy at 65
male
female
total fertility rate
migration per 1000 inhabitants
crude death rate per 1000 population
Demand Factors II
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health status (share of people in bad health)
health behaviour: alcohol consumption
health behaviour: tobacco consumption
education level - attainment ISCED 0/1/2
education level - attainment ISCED 3/4
education level - attainment ISCED 5B
education level - attainment ISCED 5A/6
– Utilisation of health care services
– doctor's consultation per capita
– Acute care occupancy rate in % of available beds
Erika Schulz
28.06.2007
Supply Factors
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Erika Schulz
28.06.2007
physicians per 1 000 inhabitants
physicians per 100 hospital beds
acute care beds per 1 000 inhabitants
nursing and elderly home beds per 100 000 inhabitants
MRI (and CT scanners) per million inhabitants
(MRI and) CT scanners per million inhabitants
dialyses per 100 000 inhabitants
Health Care System I
– Organisational structure
– Health care system (public contract, public integrated,
mixed)
– Gatekeeper to non-acute hospital treatment or
specialist
– Free choice GP or family doctor
– Free choice of specialists
– Free choice of hospitals
– Free choice of dentists
– Waiting lists for specialist care
– waiting lists for surgeries in hospitals
Erika Schulz
28.06.2007
Health Care System II
– Financing the health care system
– Population covered by public health system % of total
population
– Multiple or single source financing system
– population covered by privates health insurance
– Co-payment in connection with GP visits
– Co-payment in connection with specialists visits
– Co-payment in connection with hospital admission
– Co-payments in connection with dentist care
– Co.payments for pharmaceuticals
Erika Schulz
28.06.2007
Health Care System III
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Erika Schulz
28.06.2007
Reimbursement of hospitals
(global budget, fee-for-service, per diem, per discharge)
Reimbursement of physicians in hospitals
(fee-for-service, fixed salary)
Reimbursement of general practitioner
(fee-for-service, salary, capitation)
Reimbursement of specialists
(fee-for-service, salary, capitation)
Reimbursement of dentists
(fee-for-service, salary, capitation)
Overall ceiling of hospital expenditure
Framework conditions
– Gross domestic product per capita, US$ PPP
– female labour force participation
– unemployment rate in % of labour force
Erika Schulz
28.06.2007
Data sources
– OECD Health Data Version 2004
•
Health care expenditure, education, docotrs consultation, supply of health care
services, acute care occupancy rate, population covered by public health care
systrem. GDP per capita, share of female labour force in total labour force
– WHO Health For All database
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Life expectancies at birth, and at age 65, crude death rates, heath behaviour
(alcohol, tobacco), nursing and elderly home beds
– EUROSTAT
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Population
– ILO
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Harmonized unemployment rates
– Health Care Systems in Transition reports, MISSOC, MISSCEEC
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Erika Schulz
28.06.2007
Institutional variables
Data comparability
– OECD Health Data Version 2004
• The OECD has the principle to ensure that the data presented
in their database are as comparable as possible across
countries and over time.
• For example: A System of Health Accounts was published with
guidelines for reporting health care expenditure. Countries can
be grouped in four categories: I (close to SHA): Denmark,
France, Germany, Hungary, Netherlands, United Kingdom,
Spain and Turkey. II (near by SHA): Finland and Poland. III
(problems in international comparison): Greece, Portugal. IV
(OECD estimates): Belgium.
Erika Schulz
28.06.2007
Data comparability II
– The OECD data base is the most comparable data
set, but nevertheless, in some cases the
specification of HCE was not really clear
(sometimes a part of HCE was included in other
parts of the social budget)
– The different data sources show for the same
variable different figures. Therrefore we decided to
use as a main data base the OECD (combined
with WHO data if possible) and for the population
EUROSTAT.
Erika Schulz
28.06.2007
Data included in the model estimating HCE
- Demographic variables:
• AGE0-5, AGE65-74 and AGE75+(share of population aged .. in total
population)
• AVELE65 (life expectancy at age 65)
• MORTALITY (Crude death rate)
– Behavioural variables:
• ALCCON (pur alcohol in litres per capita 15+ per year)
– Supply variables:
• BEDS (acute care beds per 1000 inhabitants)
– Institutional variables
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Reimbursement (SALARYGP, CAPGP, GLOBALHO, CASEHO)
Copayments (COPAYGP, COPAYHO)
Free choice (FREEGP, FREEHO)
PUSHES (share of public HCE in total HCE)
– Economic variables
• GDP in US$ PPP per capita, UNEMPL
Erika Schulz
28.06.2007
Conclusion
– The used data for the model are the most comparable data
• Demographic variable stem from EUROSTAT and are comparable
• Demand and supply factors stem from OECD and are most
comparable
• Institutional variables are created by ourselfs and therefore
comparable
• Only the definition of health care expenditure may be in some cases
not fully comparable, but OECD Health Data provided the most
comparable data
Erika Schulz
28.06.2007
Development of health care expenditure per capita US$ PPP 1980-2003 EU 15
3500
3000
2500
2000
1500
1000
500
0
1980
1981
1982
1983
1984
Austria
Germany
Netherlands
Erika Schulz
28.06.2007
1985
1986
1987
Belgium
Greece
Portugal
1988
1989
1990
1991
Denmark
Ireland
Spain
1992
1993
1994
1995
Finland
Italy
Sweden
1996
1997
1998
1999
2000
France
Luxembourg
United Kingdom
2001
2002
Health care expenditure per capita and share of people aged 65+ in 2001
20
IT
18
ES
GE
PT
16
UK
LA
Proportion 65+
SW
BE
GR
ET
HU
FR
A
FI
DK
SV
14
RO
LI
CZ
PL
12
NE
LU
MT
SK
CY
IRE
10
8
6
TR
4
0
500
1000
1500
2000
HCE
Erika Schulz
28.06.2007
2500
3000
3500
Changes in HCE per capita and changes in the share of people aged 65+ between 1980 and
2002 in selected countries
6
PT
Changes in HCE per capita
5
IRE
GR
SP
4
LU
UK
BE
3
NL
AU
FI
DK
2
SW
1
0
0
1
2
3
Changes in the share of people aged 65+
Erika Schulz
28.06.2007
4
5
6
Health care expenditure and GDP per capita in 2002
60 000
50 000
GDP per capita US$ PPP
LU
40 000
IRE
30 000
UK
FI
A
IT
DK NL
BE
SV
FR
GE
ES
20 000
MT
CY
SL
GR
PT
CZ
EE
SK
LV
10 000
LT
RO
HU
PL
TR
0
0
500
1000
1500
2000
HCE per capita US$ PPP
Erika Schulz
28.06.2007
2500
3000
3500
er
m
an
y
G
re
ec
Fr e
an
ce
M
Ne
th alta
er
la
n
Po ds
r tu
g
Sw al
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Be en
lg
iu
m
EU
De 15
nm
ar
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e
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ng
Un
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ite
ng
d
K i ary
ng
do
m
Au
st
ria
Sp
ai
Cz
n
e c Ir e
la
h
Re nd
pu
b
Fi lic
nl
an
Tu d
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NM
Cy S
Lu
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m
bo
u
Sl
ov
Po rg
ak
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Re nd
pu
Li bli c
th
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n
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to
ni
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La
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m
an
Bu ia
lg
ar
ia
G
Health care expenditure of % of GDP
12
10
8
6
4
2
0
1992
Erika Schulz
28.06.2007
2002