1Primary Care Conference, November 2012 1Primary Care Conference, November 2012

New Models of Care

November 2012Fergus Clancy

2Primary Care Conference, November 2012 2

Agenda

• Supply

• Demand

• New model of care required

3Primary Care Conference, November 2012 3

Demand

2010 2020 2030 2040 20500

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

Population Projections >65yrs

65-80yrs >80yrsSource: CSO, Eurostat

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Demand

0- 17 18-29 30-39 40-49 50-59 60-69 70-79 80+

€164€224

€409€469

€793

€1,469

€2,442

€3,333

Claims Cost per Insured Person 2011

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Demand

18-24 25-34 35-44 45-54 55-64 65-69 70+

2.4

2.7 2.6

3

3.7

4

5.4

GP consultations by age group

Source: CSO (Q3 2010)

6Primary Care Conference, November 2012

Demand

Source: DOHC

Jan 2010 Mar 2011 Mar 2012

1,479

1,649

1,759

Medical Cards (000's)

19% increase in number of medical cards issued since 2009 – at its

highest for 40 years

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Supply (Public)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 e 2014 e 2015 e 2016 e 2017 e0

2000

4000

6000

8000

10000

12000

14000

16000

18000Total Health Public Expenditure (incl CAPEX)

Source of 2002-2011 data: Health in Ireland, Key Trends 2011, DOHC. 2013 - 2017 based on 5% cut in first 3 years.

8Primary Care Conference, November 2012 8

Supply (Public)

2006 2007 2008 2009 2010 2011

12,110 12,12311,847

11,538

11,159

10,807

Public In-patient Beds

Source: In-patient & Day Case Activity Data: Hospital In-Patient Enquiry (HIPE), ESRI

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Supply

Austra

lia

Fran

ce

Canad

a

Portu

gal

Kore

a

Belgi

um

Mex

ico

Austri

a

Finl

and

New Z

eala

nd

Turk

ey

Unite

d Ki

ngdo

m

Luxe

mbo

urg

OECD

Esto

nia

Nethe

rland

sIta

ly

Slov

enia

Israe

l

Norway

Czech

Rep

ublic

Denm

ark

Germ

any

Swed

en

Icel

and

Switz

erla

nd

Slov

ak R

epub

lic

Irela

nd

Unite

d St

ates

Hunga

ry

Pola

nd

Greec

e0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

49.8

49.0

47.4

46.0

41.9

38.9

36.7

33.2

33.1

32.0

32.0

29.8

29.3

25.9

25.1

24.9

22.7

20.7

20.3

20.1

19.7

19.6

18.0

16.7

15.9

15.8

13.8

13.5

12.3

11.7

9.5

4.5

GPs as a share of total doctors, 2009

GPs OtherSource: OECD Health at a glance 2011

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New Model of Care

Hospital Setting Primary Care Setting

High unit price and low access caps activity

Low unit price and high access drives activity

€100 x 1,000= €100,000

€50 x 3,000= €150,000

Quality

Critical mass and multi-disciplinary care

Unit Price

Volume

The Sweet Spot Selected

Procedures in Sufficient Volumes

Agreed Treatment Guidelines

Clinical Leadership &

Less Bureaucracy

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New Model of Care

The Sweet Spot

Larger Primary Care

Centres

Selected procedures in

sufficient volumes

ICT & MDT linkages

Agreed treatment guidelines

Clinical leadership an

less bureaucracy

Proper financial

incentives

12Primary Care Conference, November 2012

Summary

The whole is other than the sum of its parts

Gestalt Theorist: Kurt Koffka

The Sweet Spot

• Stronger clinical leadership

• Better patient experience

• More efficient use of scarce resources