5Health Outcome: Dutch evidence Infectious diseasesDisability adjusted life expextancy (DALE): +1.7Costs per DALY avoided: € 3400CancerDALE: (male); (female)Costs per DALY avoided: € 15,500Cardiovascular diseasesLife expectancy: +2.3 (male); +3.8 (female)Costs per DALY avoided: € 2000Generic efficiency of the health care systemMeerding WJ, Polder JJ, et al., (forthcoming, september 2007)
6Health output: Cost of illness Cost of illness (COI) analysis is the main method of providing an overall view on the economic impact of a disease.Such studies have been used to set priorities for health care policy and describe resource allocations for various diseases.
7Cost of illness - Approaches - Top-Down Approach Bottom-Up Approach health expenditures fromNational Health Accounts asa fixed starting pointcomplete diseaseno double countingcomorbidity (partial)no longitudinal analysisdirect evaluation of patientspecific datafew special diseasesdouble countingcomorbiditylongitudinal analysis
8GENERAL Cost of illness (COI): What? Demographic and epidemiological view on health expenditureHealth expenditure by demandDirect medical costs onlyBreak down of health expenditures to patient (or demand) characteristics as:Disease (categories)AgeGenderFunctionFinancing
9Cost of illness (COI): Why? DescriptionHealth expenditure by supply and demandAll combinationsProjectionForecasts of future health expenditureAgeing / changing disease patternsComparisonOver time: trends in health care costsBetween countries: better understanding of cross-country differences in health care systems and costs (for similar or different demography / epidemiology)
10General COI: How?Health care costs are known for each sector and actorStatistics Netherlands: 80 actors according HP-classificationFor each actor utilisation data is retrievedBy diagnosis, age, gender, function, financingcomprehensive registries and studies in the Netherlands (most of them were used, ± 50 major data sources)Key variables represent equal health care usecontacts, inpatient days, prescriptions, …some need weighing: hospital interventions, prescribed medicineCosts are broken down using key variables
12The Netherlands in the world Share of health care costs in the GDP (%) Figure 2.36 shows thecontribution of health care to a number of countries’ gross domestic product since 1975.The countries have been selected so that the graph shows the entire bandwidth for all OECD countries and also includes the countries surrounding the Netherlands. The United States has the greatest contribution of health care to GDP, at approximately 13%.Luxembourg’s contribution of more than 6% is not even half as large. The Netherlands is in the middle of the spectrum.
13Key figures 16 million inhabitants Life expectancy About 75 for menAbout 81 for womenBismarck-based health care systemSocial health insuranceTax financed care plays a minor roleGDPAbout € 30,000 per head of the population(€ 78,000 per worker)Health expenditureAbout € 3,500 per inhabitant (average)
14Three perspectives Blue: Dutch health and social care accounts € 60 billionYellow: Budget Ministry of Health€ 44 billionPink: OECD SHA€ 45 billionquite different boundaries
15Relations between perspectives Dutch health and social care accountsStandard: comprehensive; time series available; SHA-basedDutch Ministry of HealthMinus: prevention, personal expenditures on e.g. over the counter drugs, occupational health, social careOECD System of Health AccountsMinus: homes for the elderly, home care, care and provisions for people with mental/intellectual disabilitiesPlus: investments
22COI-2003: by age and diagnosis Distribution ICD-9 chapters (%) Diagnosis and ageThe costs of diseases are strongly interrelated with age. Within nearly all ICD-chaptersmost care was used by elderly people (see figure 3). For pregnancy, congenital malformationsand for perinatal complications a different pattern emerged, of course. Pregnancyrelated costs for 0-year olds pertain to hospital costs for healthy babies. Similarly,the costs of infectious diseases have been attributed for a substantial part to theyoungest age groups, among others because of the costs of the National VaccinationProgramme. For diseases of the digestive system, the share of children and adults isrelatively high because of the costs for dental care. For adults this disease categoryalso includes the costs of acid reducing pharmaceuticals.
31Conclusions Cost of illness studies value health outputallow for detailed analyses of health expenditure by aspects of supply & demandcan be used for projections & comparisonsCross-national comparisons should focus on cureCOI-studies reveal the societal value of health care(Health) economists have learned a lot about value (rather than price), but can learn even more…..