november 30, 2004 dr. glen roberts director, health programs roberts@conferenceboard
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November 30, 2004 Dr. Glen Roberts Director, Health Programs [email protected]. IRPP: CAREFUL CONSIDERATION: DECISION-MAKING IN THE HEALTH CARE SYSTEM. The Fiscal Implications of What is in and out of the Medicare Basket. The Conference Board of Canada-Who We Are - PowerPoint PPT PresentationTRANSCRIPT
November 30, 2004Dr. Glen Roberts
Director, Health [email protected]
The Fiscal Implications of What is in and out of the Medicare Basket
IRPP: CAREFUL CONSIDERATION: DECISION-MAKING IN THE HEALTH CARE SYSTEM
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Presentation Overview
The Conference Board of Canada-Who We Are Synthesis of Conference Board of Canada
Literature Key Findings from Canada Policy Principles Questions
The Conference Board of CanadaWho We Are
OUR MISSION…
The Conference Board builds leadership capacity for a better Canada by creating and sharing insights on economic trends, public policy, and organizational performance.
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Conference Board Literature Used…
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List of Ranked Indicators Used (By Category)
Health Status Non-Medical Factors Health Outcomes
Life expectancymales / females
Body weight Lung cancer mortality ratesmales / females
Disability-free life expectancymales / females
Tobacco consumption Immunization for influenzamales / females
Self-reported health status Alcohol consumption Stroke mortality ratesmales / females
Infant mortality rate Road Traffic Accidents *PYLL suicide – (males)
Low birth weight Sulphur oxide emissions PYLL lung cancer males / females
Immunization – DTP PYLL breast cancer males / females
Immunization for influenza
*Potential Years of Life Lost
Overall Performance Results (Weighted Medal Count)
0
5
10
15
20
25
30
35
40
Canad
a
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Source: CBoC; OECD
Drivers of Productivity
Phys
ical
cap
ital
Hu
man
Ca
pit
al Innovation
Source: Performance and Potential 2003-04
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Federal and Provincial Government Budgetary Balance($ billions)
-20
0
20
40
60
80
100
2001/02 2003/04 2005/06 2007/08 2009/10 2011/12 2013/14 2015/16 2017/18 2019/20
Federal Provincial/territorial
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Source: CBoC
Federal and Provincial Government Budgetary Balance($ billions)
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Source: CBoC
7 7
2
9 76 7
1013
1519
22
27
31
-2-5
-2
-8-9 -9 -9 -8
-6 -5 -5 -4 -40
-20
0
20
40
20
01
/02
20
02
/03
20
03
/04
20
04
/05
20
05
/06
20
06
/07
20
07
/08
20
08
/09
20
09
/10
20
10
/11
20
11
/12
20
12
/13
20
13
/14
20
14
/15
Federal GovernmentProvinces & Territories
Thinking of the issues presently confronting Canada , which one do you feel should receive the greatest attention from Canada's leaders? (Open-Ended, N=1000)
Canadian Priority Issues
47%
22%
11%8%
0%
10%
20%
30%
40%
50%
Jul'95 Jul'96 Jul'97 Jul'98 Jul'99 Jul'00 Jul'01 July'02 Sep'02 Nov'02 Jan'03 Apr'03 May'03 Jun'03 Sep'03 Nov'03
Healthcare Education
Economy (general) International Issues
Defence/Military Environment/Kyoto
Unemployment/Jobs
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Estimated Impact of Determinants of Health on the Health Status of the Population (%)
Source: Canadian Institute for Advanced Research
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Biology and genetic
endowment15%
Physical environment
10%
Social and economic
environment50%
Health care system
25%
Key Cost Drivers and Escalators
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COST DRIVERSo Demographicso Consumer and Provider Expectationso Chronic Diseaseso Inflation
COST ESCALATORSo Pharmaceuticalso Home Careo Health Human Resourceso New Technologies
EMERGING COST ESCALATORSo Access Issueso Patient Safetyo Environmental Issues
700
750
800
850
900
950
1,000
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care SpendingHospitals—1981–2020 ($1997 per person)
Source: Canadian Institute for Health Information; CBoC.
400
420
440
460
480
500
520
Real Per Capita Provincial Health Care Spending Hospitals—1981–2020 ($ 1997 per person)
Age 0-64
Source: Canadian Institute for Health Information ; CBoC.
3,000
3,200
3,400
3,600
3,800
4,000
4,200
1981 1985 1990 1995 2000 2005 2010 2015 2020
Real Per Capita Provincial Health Care Spending Hospitals—1981–2020 ($ 1997 per person)
65+
Source: Canadian Institute for Health Information ; CBoC.
250
275
300
325
350
375
400
425
450
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care Spending Physicians—1981–2020 ($1997 per person)
Source: Canadian Institute for Health Information ; CBoC.
10
30
50
70
90
110
130
150
170
190
210
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care Spending Home Care—1981–2020 ($1997 per person)
Source: Canadian Institute for Health Information ; CBoC.
2575
125175225275325375425475525
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care Spending Prescription Drugs—1981–2020 ($1997 per person)
Source: Canadian Institute for Health Information ; CBoC.
150
160
170
180
190
200
210
220
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care Spending Other Institutions—1981–2020 ($1997 per person)
Source: Canadian Institute for Health Information ; CBoC.
100
150
200
250
300
350
400
450
500
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care Spending Other Expenditures—1981–2020
($1997 per person)
Source: Canadian Institute for Health Information ; CBoC.
15
20
25
30
35
40
81 85 90 95 00 05 10 15 20
Real Per Capita Provincial Health Care Spending Other Professionals—1981–2020 ($1997 per
person)
Source: Canadian Institute for Health Information ; CBoC.
40
45
50
55
60
65
70
75
80
1981 1985 1990 1995 2000 2005 2010 2015 2020
Real Per Capita Provincial Health Care Spending Other Professionals—1981–2020 ($ 1997 per
person) 85+
Source: Canadian Institute for Health Information ; CBoC.
Total Share of Nominal Provincial Spending by Component, 2001 (2020)
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Source: CBoC; Health Canada; Canadian Institute for Health Information
Other professionals
1% (1%)
Home care4% (8%)
Prescription drugs7% (15%)
Other health expenditures14% (15%)
Hospitals44% (36%)
Other institutions10% (9%)
Physicians20% (16%)
28
30
32
34
36
38
40
42
44
46
89 95 00 02 05 10 15 20
Total Provincial Spending on Health Care as per cent of Revenue 1989 - 2020
Source: Canadian Institute for Health Information; CBoC.
Cost Driver and Escalator Breakdowns
ComponentNominal
Increases (%)Approximate Annual Increase ($ billions)
Overall 5.3 5.0
Inflation 2.7 2.0
Demand 0.9 0.8
Aging 0.8 0.8
Population Growth 0.9 0.8
Drugs 9.3 0.5
Homecare 8.7 0.2
CBoC
Drivers of Rising Health Benefits Costs(in descending order of impact)
1. Drug costs2. Dental Care3. Hospital and medical services4. Vision care5. Out-of-country medical coverage6. Short- and long-term disability claims7. Paramedical coverage (massage, chiropractic, etc.)8. Increased utilization
Source: Unpublished data from The Conference Board of Canada’s 2003 compensation planning survey.
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Health Expenditure Growth Rate
Source: OECD.
0
1
2
3
4
5
6
7
8
9
Australia Canada France New Zealand Spain Sw eden Sw itzerland
1970-1980
1980-1990
1990-2000Average
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Key Findings for Canada Money alone is not the answer.
Canada must do more to control escalating pharmaceutical costs.
Creating and maintaining a satisfied workforce is vital for a high-performing health care system .
Canada needs to focus more on health promotion, prevention and appropriate investments in the broad determinants of health as strategies to control health costs over the long term.
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Key Findings for Canada The “greying” of Canada’s population does not have to result in a
more expensive health care system.
Countries that have invested strategically in health related information and communications technologies (ICT) and provided training and skills development are better integrated and have a more productive workforce.
User fees/cost-sharing methods work well to control costs under certain circumstances, but may have consequences.
A publicly funded health care system with zero or low user fees needs to ensure that it has adequate surgical capacity if it wants to avoid long wait times.
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7 Key Policy Principles for Defining the Medicare Basket:
Assuming that re-defining the Medicare basket is worth the trouble…..
Get it right the first time. Recognize current health care utilization patterns and plan based on the
future needs of Canadians. Align services with patient/client expectations. Process used must be transparent. Services must be necessary, effective and cost-effective. Provide equitable funding and access. Use International experience with technology assessment. Canada needs a
NICE.
Questions?
“The Tortoises Are Gearing Up To Run”Duncan Sinclair, Chair HSRC
“I learned a lot about delisting and while I’m not sure I learned how to do it, I sure learned how not to do it.”Dorothy Pringle, U of T
“If you do not know where you are going, any road will take you”Alice in Wonderland
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