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
Jan 03, 2016
Johan Polder, PhD | Professor in Health Eonomics
Cost of illness - Framework & Data“Measuring education and health volume output”
OECD - Paris, June 6th- 7th, 2007
An economist knows the price of
everything, but the value of nothing.
The value of health
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)
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.
© Statistisches Bundesamt, VIII A3
Cost of illness- Approaches -
Cost of illness- Approaches -
Top-Down ApproachTop-Down Approach Bottom-Up ApproachBottom-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
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
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)
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
© Statistisches Bundesamt, VIII A3
Accounting process
health expenditures health expenditures
providers providers
disease-based indicatorsdisease-based indicators
step I:step I:
step II:step II:
step III:step III:
step IV:step IV: cost of illness cost of illness
top-down method top-down method
The Netherlands in the worldShare of health care costs in the GDP (%)
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
16,0
1980 1983 1986 1989 1992 1995 1998 2001
Belgium
Germany
Luxembourg
Netherlands
Sw eden
United Kingdom
United States
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)
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
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
Dutch HA versus SHA / figures
Dutch OECD Difference
HP.1 Hospitals 17,108 16,037 94%
HP.2 Nursing and residential care facilities 13,061 5,313 41%
HP.3 Providers of ambulatory care 12,538 9,980 80%
HP.4 Retail sale and other providers of medical goods 7,555 7,229 96%
HP.5 Provision and administration of public health 772 772 100%
HP.6 General health administration and insurance 1,837 1,837 100%
HP.7&9 Other 1,941 1,726 89%
outside SHA 2,717 0%
57,529 42,893 75%
Capital formation of health care provider institutions 2,220
45,113
SHA provider classification
Total current expenditure on health care
Total health expenditure
COI-2003: Costs by provider (€ mln) <OECD definition of costs>
COI-2003: costs by disease (€ mln)0 4.000 8.000 12.000
Mental and behavioural disorders
Not allocated / Not disease related
Diseases of the circulatory system
Diseases of the digestive systemSymptoms, signs and abnormal clinical and laboratory f indings, not
elsew here classif ied
Diseases of the musculoskeletal system and connective tissue
Diseases of the nervous system
Neoplasms
Diseases of the respiratory system
Injury, poisoning and certain other consequences of external causes
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Endocrine,nutritional and metabolic diseases
Infectious and parasitic diseases
Diseases of the skin and subcutaneous tissue
Certain conditions originating in the perinatal period
Congenital malformations
Diseases of the blood and blood-forming organs
SHA
Dutch HA
COI-2003: per capita costs by age & gender (€)
0
5.000
10.000
15.000
20.000
25.000
30.000
35.000
40.000
45.000
50.000
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
Dutch HA - men
SHA - men
0
5.000
10.000
15.000
20.000
25.000
30.000
35.000
40.000
45.000
50.000
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
Dutch HA - w omen
SHA = w omen
COI-2003: population costs by age & gender
COI-2003: Gender difference explained (€ mln)
-80
40
160
280
0 5 15 25 35 45 55 65 75 85 95
pregnancy andgender specificdiseases
demography(number of personsper age group)
Intensity of healthcare use
w omen higher costs
men higher costs
COI-2003: by age and diagnosisDistribution ICD-9 chapters (%) 0% 20% 40% 60% 80% 100%
Infectious and parasitic diseases
Neoplasms
Endocrine,nutritional and metabolic diseases
Diseases of the blood and blood-forming organs
Mental and behavioural disorders
Diseases of the nervous system
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Diseases of the skin and subcutaneous tissue
Diseases of the musculoskeletal system and connective tissue
Congenital malformations
Certain conditions originating in the perinatal periodSymptoms, signs and abnormal clinical and laboratory f indings, not
elsew here classif iedInjury, poisoning and certain other consequences of external causes
Not allocated / Not disease related
0
1-14
15-24
25-44
45-64
65-74
75-84
85+
Drugs: results by diagnosis
Drugs: results by age & gender
Mental health care: Results by age & gender
International comparisons(Report by Heijink R, Polder JJ, et al., 2006)
Curative care: overall picture comparable
Long term care: large differences
Comparability by age
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…..