compas health micro-simulation model québec, canada pierre-carl michaud, esg uqam
TRANSCRIPT
![Page 1: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/1.jpg)
COMPASHealth micro-simulation model
Québec, Canada
Pierre-Carl Michaud, ESG UQAM
![Page 2: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/2.jpg)
Québec context• Population is aging (second after Japan)• 5.33 people of working age per 65+ in 2011• 2.91 people of working age per 65+ in 2031
• Evolution of disease prevalence 2000-2005• heart disease, diabetes and high blood pressure• types of cancer and cardiac diseases
• Health care cost on rise, close to 50% of spending• Why create a model for Quebec only? • Financing of healthcare at provincial level (cost data)
2
![Page 3: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/3.jpg)
COMPAS• Microsimulation model using data from Statistics Canada• Heavily based on the U.S. Future Elderly Model• Projects health status of individuals between 2010 and
2050• Each year: calculates healthcare resources used • Doctor visits• Hospital stays (number of nights)• Home care• Prescriptions• Long-term care
3
![Page 4: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/4.jpg)
Data• National Population Health Survey (NPHS)• Longitudinal survey • Biennial from 1994 to 2011• 17,276 individuals in 1994• Covers Canadian population of all ages
• Canadian Community Health Survey (CCHS)• Cross sectional survey• 2010 (available multiple years)• 11,000 individuals in Quebec • Covers Quebec population of all ages
• Definition of health states are similar in both surveys4
![Page 5: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/5.jpg)
Dynamics of the model
5
![Page 6: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/6.jpg)
Modules• Initialization module• Creates the initial population of the model• CCHS
• Representative of Quebec population• At age 30
• Individuals have different characteristics• Social and demographic characteristics• Diseases• Risk factors• Functional status
6
![Page 7: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/7.jpg)
Modules (2)• Transition module• Estimates probabilities of a change in individual health status
and behaviour (7 diseases, functional status, BMI and smoking)
• Transitions are estimated over a 2 year period• Example: calculates the probability a 48 year old man who
has diabetes and a BMI over 30 will develop a heart disease in 2 years
• NPHS 1994-2010
7
![Page 8: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/8.jpg)
Modules (3)• Renewal module• Entry of individuals aged 30 • Differ from past cohorts in some aspects• Immigration and emigration• From CCHS, multivariate model with correlation structure
• Health care module• Predicts quantity of resources used every year• Hospital Stays• Generalist and specialist visits• Drugs• Home care and nursing homes• As a function of disease, socio-demographic• NPHS
8
![Page 9: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/9.jpg)
Baseline scenario• Based on the demographic assumptions of the Régie des
rentes du Québec (RRQ)• Includes exogenous mortality improvement• Net Immigration• Size of new cohorts
• Trends in health status and demographics based on extrapolation of trends observed since 2001 for the composition of new cohorts
• Situation between 2010 and 2050 in the absence of changes in • Structure of transition probabilities
9
![Page 10: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/10.jpg)
Quebec is aging…
10
![Page 11: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/11.jpg)
Likely with more diseases …
11
![Page 12: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/12.jpg)
but likely living longer…
12
![Page 13: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/13.jpg)
and using more resources…
13
![Page 14: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/14.jpg)
14
![Page 15: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/15.jpg)
Applications• Proportion of healthcare resources attributable to obesity
between 2010 et 2050
• Effects of trends in health status (mortality and diseases) on a DB pension plan’s solvency between 2010 and 2050
15
![Page 16: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/16.jpg)
Obesity• Compare resources used in 2 scenarios• Baseline scenario• Scenario without obesity
• Second scenario implies• No obesity in initial population• No obesity in entering cohorts• Transitions towards obesity are not allowed
16
![Page 17: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/17.jpg)
Relative disease prevalence
17
![Page 18: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/18.jpg)
Relative use of resources
18
![Page 19: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/19.jpg)
On average, each year• Obesity is responsible for• 514 195 general practioner visits (5.5%)• 173 398 specialist visits (4.6%)• 1 013 519 hospital stays -number of nights (8.4%)
• Obesity increases by 504 the number of individuals in long term care facilities (0.6%)
19
![Page 20: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/20.jpg)
Pension Plan• Dynamic of a pension plan is very complex • We seek to isolate longevity risk• Set
• Retirement at age 65
• Eliminate• Rate of return risk • Productivity risk• Wages are constant and normalized to 1• Wages are identical for all individuals
• Standard DB pension plan (factor * years worked * salary), prefunded in 2010.
• Discounting rate = 3% 20
![Page 21: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/21.jpg)
Exploring alternative scenarios
• Disease prevention• Diabetes• High blood pressure• Heart disease• Lung disease
• Total prevention• All diseases, obesity and smoking
• Mortality improvement• 50 % reduction in mortality rates
21
![Page 22: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/22.jpg)
Effects on the Pension Plan:All Scenarios
22
![Page 23: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/23.jpg)
Contribution Rates
23
![Page 24: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/24.jpg)
Adding costs to COMPAS• Difficulties• Universal healthcare system• No private insurers (government is unique payer)• Cost data is spread throughout several databases• Access to these databases is complicated
• How we proceed• Find an average cost for a single use of each resource as a
function of disease, sex and age • Multiply the average cost by predicted use of each resource
24
![Page 25: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/25.jpg)
Data sources
25
![Page 26: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/26.jpg)
Collaborators• David Boisclair (ESG UQAM)• Aurélie Côté-Sergent (ESG UQAM)• Jean-Yves Duclos (U Laval)• Alexandre Lekina (ESG UQAM)• Steeve Marchand (U Laval)
• Visit us at www.cedia.ca
26
![Page 27: COMPAS Health micro-simulation model Québec, Canada Pierre-Carl Michaud, ESG UQAM](https://reader035.vdocuments.us/reader035/viewer/2022062714/56649d1f5503460f949f38bc/html5/thumbnails/27.jpg)
Partners• Industrielle Alliance (http://www.inalco.com)• Régie des rentes du Québec(http://www.rrq.gouv.qc.ca)• Ministère des finances du Québec (http://www.finances.gouv.qc.ca)• Centre interuniversitaire de recherche en analyse des
organisations (http://www.cirano.qc.ca/)• Fonds de recherche du Québec – Société et culture(http://www.frqsc.gouv.qc.ca)
27