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Johan Polder, PhD | Professor in Health Eonomics Cost of illness - Framework & Data Measuring education and health volume output OECD - Paris, June 6 th.

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Presentation on theme: "Johan Polder, PhD | Professor in Health Eonomics Cost of illness - Framework & Data Measuring education and health volume output OECD - Paris, June 6 th."— Presentation transcript:

1 Johan Polder, PhD | Professor in Health Eonomics Cost of illness - Framework & Data Measuring education and health volume output OECD - Paris, June 6 th - 7 th, 2007

2 An economist knows the price of everything, but the value of nothing.

3 The value of health

4

5 Health Outcome: Dutch evidence Infectious diseases -Disability adjusted life expextancy (DALE): +1.7 -Costs per DALY avoided: 3400 Cancer -DALE: +0.31 (male); +0.85 (female) -Costs per DALY avoided: 15,500 Cardiovascular diseases -Life expectancy: +2.3 (male); +3.8 (female) -Costs per DALY avoided: 2000 Generic efficiency of the health care system -Meerding WJ, Polder JJ, et al., (forthcoming, september 2007)

6 Health 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.

7 © Statistisches Bundesamt, VIII A3 Cost of illness - Approaches - Cost of illness - Approaches - Top-Down Approach Bottom-Up Approach health expenditures from National Health Accounts as a fixed starting point complete disease no double counting comorbidity (partial) no longitudinal analysis direct evaluation of patient specific data few special diseases double counting comorbidity longitudinal analysis

8 GENERAL Cost of illness (COI): What? Demographic and epidemiological view on health expenditure Health expenditure by demand -Direct medical costs only Break down of health expenditures to patient (or demand) characteristics as: -Disease (categories) -Age -Gender -Function -Financing

9 Cost of illness (COI): Why? Description -Health expenditure by supply and demand -All combinations Projection -Forecasts of future health expenditure -Ageing / changing disease patterns Comparison -Over time: trends in health care costs -Between countries: better understanding of cross-country differences in health care systems and costs (for similar or different demography / epidemiology)

10 General COI: How? Health care costs are known for each sector and actor -Statistics Netherlands: 80 actors according HP- classification For each actor utilisation data is retrieved -By diagnosis, age, gender, function, financing -comprehensive registries and studies in the Netherlands (most of them were used, ± 50 major data sources) Key variables represent equal health care use -contacts, inpatient days, prescriptions, … -some need weighing: hospital interventions, prescribed medicine Costs are broken down using key variables

11 © Statistisches Bundesamt, VIII A3 Accounting process health expenditures providers disease-based indicators step I: step II: step III: step IV: cost of illness top-down method

12 The Netherlands in the world Share of health care costs in the GDP (%)

13 Key figures 16 million inhabitants Life expectancy -About 75 for men -About 81 for women Bismarck-based health care system -Social health insurance -Tax financed care plays a minor role GDP -About 30,000 per head of the population -( 78,000 per worker) Health expenditure -About 3,500 per inhabitant (average)

14 Three perspectives Blue: Dutch health and social care accounts - 60 billion Yellow: Budget Ministry of Health - 44 billion Pink: OECD SHA - 45 billion quite different boundaries

15 Relations between perspectives Dutch health and social care accounts -Standard: comprehensive; time series available; SHA-based Dutch Ministry of Health -Minus: prevention, personal expenditures on e.g. over the counter drugs, occupational health, social care OECD System of Health Accounts -Minus: homes for the elderly, home care, care and provisions for people with mental/intellectual disabilities -Plus: investments

16 Dutch HA versus SHA / figures

17 COI-2003: Costs by provider ( mln)

18 COI-2003: costs by disease ( mln)

19 COI-2003: per capita costs by age & gender ()

20 COI-2003: population costs by age & gender

21 COI-2003: Gender difference explained ( mln)

22 COI-2003: by age and diagnosis Distribution ICD-9 chapters (%)

23 All results: www.costofillness.nlwww.costofillness.nl

24 Drugs: results by diagnosis

25 Drugs: results by age & gender

26 Mental health care: Results by age & gender

27 International comparisons (Report by Heijink R, Polder JJ, et al., 2006)

28 Curative care: overall picture comparable

29 Long term care: large differences

30 Comparability by age

31 Conclusions Cost of illness studies -value health output -allow for detailed analyses of health expenditure by aspects of supply & demand -can be used for projections & comparisons Cross-national comparisons should focus on cure COI-studies reveal the societal value of health care (Health) economists have learned a lot about value (rather than price), but can learn even more…..


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