Ageing, Health Status and Determinants of Health Expenditure Data availability and comparability –...
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Transcript of Ageing, Health Status and Determinants of Health Expenditure Data availability and comparability –...
Ageing, Health Status and Determinants of Health Expenditure
Data availability and comparability – challenges and possible solutions – (WPVIA)
Dr. Erika Schulz
Erika Schulz28.06.2007
Determinants of health expenditure
Population Health size, age-structure Use of insurance
Life health Health Prices, schemesexpectancy Morbidity/ care expenditure costs
Acut services Supply/health status access
Medical/ Socio-economic General frameworktechnological determinants/ conditionsprogress healthy behavior/ (policies, rules,
genetic conditions assets, economy)
Erika Schulz28.06.2007
Erika Schulz28.06.2007
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 Schulz28.06.2007
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, medical-technological progress (one result of a study for Germany was that technology is the main driver of health expenditure (Breyer 1999))
Erika Schulz28.06.2007
Health Care Expenditure
– 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
Erika Schulz28.06.2007
Demand Factors I– 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
Erika Schulz28.06.2007
Demand Factors II
– 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 Schulz28.06.2007
Supply Factors
– 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
Erika Schulz28.06.2007
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 Schulz28.06.2007
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 Schulz28.06.2007
Health Care System III
– 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
Erika Schulz28.06.2007
Framework conditions
– Gross domestic product per capita, US$ PPP– female labour force participation – unemployment rate in % of labour force
Erika Schulz28.06.2007
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• Life expectancies at birth, and at age 65, crude death rates, heath behaviour
(alcohol, tobacco), nursing and elderly home beds
– EUROSTAT• Population
– ILO• Harmonized unemployment rates
– Health Care Systems in Transition reports, MISSOC, MISSCEEC• Institutional variables
Erika Schulz28.06.2007
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 Schulz28.06.2007
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 Schulz28.06.2007
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• 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 Schulz28.06.2007
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 Schulz28.06.2007
Development of health care expenditure per capita US$ PPP 1980-2003 EU 15
0
500
1000
1500
2000
2500
3000
3500
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Austria Belgium Denmark Finland France
Germany Greece Ireland Italy Luxembourg
Netherlands Portugal Spain Sweden United Kingdom
Erika Schulz28.06.2007
Health care expenditure per capita and share of people aged 65+ in 2001
4
6
8
10
12
14
16
18
20
0 500 1000 1500 2000 2500 3000 3500
HCE
Pro
port
ion
65+
TR
IT
GEBE
SWGR
ES
PTFRUK
A
DKFIHUETLA
SV
LI LUNECZRO
MTPL
IRECYSK
Erika Schulz28.06.2007
Changes in HCE per capita and changes in the share of people aged 65+ between 1980 and 2002 in selected countries
0
1
2
3
4
5
6
0 1 2 3 4 5 6
Changes in the share of people aged 65+
Cha
nges
in H
CE
per c
apita
PT
SPGR
FI
BE
NL
UK
SW
IRE
DK
LU
AU
Erika Schulz28.06.2007
Health care expenditure and GDP per capita in 2002
0
10 000
20 000
30 000
40 000
50 000
60 000
0 500 1000 1500 2000 2500 3000 3500
HCE per capita US$ PPP
GD
P p
er c
apit
a U
S$
PP
P
LU
IREDK NL
A FRUK BE
SV GEFI
ITES
GRSLCY
PT
MT
CZHUSK
EE
PLLV
LT
TRRO
Erika Schulz28.06.2007
Health care expenditure of % of GDP
0
2
4
6
8
10
12
1992 2002