Trends in Australian health care

Transcription

1 Trends in Australian health care Lynne Pezzullo Lead Partner, Health Economics and Social Policy, Deloitte Access Economics Office Managing Partner, Canberra, Deloitte Touche Tohmatsu 30 July 2014

2 Overview of trends The Australian population continues to age, with associated increases in dependency rates, chronic disease prevalence, health service and informal care needs Technology has enabled supply of services to keep pace with needs, but only with growing health & aged care costs, which will continue to rise as a % GDP This is not fiscally sustainable, so costs are being shifted increasingly to the private sector and individuals Budget MBS and PBS co-payment announcements are part of this major trend. Rationalisation is also occurring through hospital funding reductions, downsizing the regional tier and reducing administrative overheads Traditional infrastructure, workforce and capacity models of health care will be strained, leading to greater use of technologies such as telehealth & RPM Although a focus on preventive health has commenced, much more needs to be done in this area going forward There could be a role for community pharmacy to take on many new roles that align with these trends. 2 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

3 An ageing population Fertility and mortality rates are decreasing Average life expectancy has increased 8 years for males and females over the past 40 years % -5.0% 0.0% 5.0% 10.0% Females Males Females Males % -5.0% 0.0% 5.0% 10.0% Females Males Females Males % -5.0% 0.0% 5.0% 10.0% Females Males Females Males Source: ABS Australian Demographic Statistic and ABS Population Projections, Australia 3 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

4 The dependency ratio (Census) 65+ share of population - 8% in 1971, 13% in 2011, 20% in 2040, 25% by % 19% 17% 15% 13% 11% 9% 7% 5% Actuals Forecasts Source: ABS Australian Demographic Statistic and ABS Population Projections, Australia

5 < Separations per 100 population Hospital service utilisation 75+yo rate is 3-4 times that of 45-54yo; by 2040, need 50% more services (ageing effect only) Women less on average! Males Females Age group Source: AIHW ICD-10-AM Data Cube and ABS Australian Demographic Statistic

6 Persons aged 65+ in the community ('000) Ratio (%) Demand growth will exceed supply growth of informal (family) care The carer ratio, of informal primary carers to older people with a disability, is projected to fall from 57% now to under 40% by mid-century, placing added pressure on the formal health and aged care systems 1, , , Has a primary carer Requires a carer Carer Ratio

7 Chronic disease is growing High and growing prevalence of chronic disease in Australia our 3 rd epidemiological transition in a century Drivers of growth are lifestyle factors and population ageing Chronic disease currently 70% of total disease burden in Australia and set to hit 80% by 2020 (NSW DoH, 2008). cancers (19% of the total), cardiovascular diseases (16% of the total), mental disorders (13% of the total) and diabetes (6.6% of the total). Disease burden is measured in DALYs (disability adjusted life years) by AIHW (Australian Institute of Health and Welfare), comprised of: YLD years of healthy life lost due to disability; and YLL years of life lost due to premature death. 7 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

8 % of M/F population Cardiovascular disease trends 1 in 6 prevalence today will increase to 1 in 4 by mid-century Assumes no change to CVD risk factors 30% 25% 20% 15% 10% Males Females 5% 0% Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

9 People ('000) Diabetes trends 1,800 1,600 1,400 1,200 1, GDM Type 1 DM Type 2 DM 9 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

10 Cancer incidence is also correlated with age E.g. colorectal (bowel) cancer (data from the NBCSP) Cancer screening interventions are reducing incidence of later stage cancers, lowering mortality from cancer, and have been shown to be cost effective in particular age/target groups, depending on the screening tool (e.g. FOBT c.f. colonoscopy) Other screening/prevention interventions are BreastScreen Australia, the national PapSmear register, and the Gardasil vaccination program Risk of diagnosis (any cancer, M+F) to 75 years = 1 in 3, to 85 years = 1 in 2 10 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

11 Incidence trends in cancer Males highest incidence is prostate (top 5 account for 61% of incidence M&F). Stabilisation due to declines in smoking, screening programs (offsetting increasing risk from higher levels of obesity & physical inactivity). Other risk factors: alcohol abuse, diet, hormonal factors in females, chronic infections, sunlight, radiation, occupational exposure, pollution, genetics Source: AIHW, Cancer in Australia, Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

12 Cancer mortality trends Cancer still accounts for 3 in every 10 deaths (AIHW, Cancer in Australia, 2010), around 40,000 deaths p.a. (males 57%, females 43%). Mortality is steadily declining notably for lung cancer in males (not females), bowel cancer (M+F), breast & prostrate cancers, 12 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

13 Dementia trends Will become Australia s largest source of disability burden by 2016 Fourfold prevalence increase by ,000, , , , , , , , , , Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

14 Some regions will be more affected by future chronic disease trends South Western Sydney, Nepean Blue Mountains and North Coast are NSW regions facing challenging future planning 14 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

15 Data from 15 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

16 Technology enables supply to keep pace with demand but at higher cost Tailored cancer therapies and other pharmaceuticals (e.g. large molecule drugs) Medical devices and prostheses New surgery techniques, imaging and models of care (can reduce ALOS/cost) Telehealth and e-health Technology also now disseminates information more effectively, which fuels growing patient expectations for care as well as indemnity claims Health R&D returns around 3:1 (the value of wellbeing gains attributable to Australian health R&D), with most of the returns in the second half of last century being from CVD and cancer R&D (e.g. statins, antihypertensives, cancer therapies); underpins Medical Research Future Fund 16 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

17 Growth trends in health expenditure In Australia spent 9.5% of Gross Domestic Product or $140.2 billion with government accounting for 69.7% of funding Expenditure has grown from ~4½% of GDP in 1970 to nearly 10% now 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% Other Individuals Health insurance funds State and local Australian Government Injury Compensation Insurers Source: AIHW data cube, Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

18 IGR projections IGR 2010 projects health spending by the Australian government will increase from 3.7% in to 6.9% by Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

19 IGR Federal Government budget position fiscally unsustainable IGR 2010 projects health spending by the Australian government will increase from 3.7% in to 6.9% by Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

20 Drivers of growth Demographic ageing, epidemiological change, technology and expectations Income elasticity of demand Higher incomes higher real GDP per capita changes consumer preferences to leisure, outsourced services and health (Access Economics, The Silver Market Goes Platinum) IED = (% change in quantity demanded) / (% change in income) Health IED estimated to be around 2, relative to all other goods and services Prof Robert Hall (US) estimates increase in the health sector in the US to 60% of the economy by % 60% 50% 40% 30% 20% 10% 0% 20 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

21 Jun-71 Jun-72 Jun-73 Jun-74 Jun-75 Jun-76 Jun-77 Jun-78 Jun-79 Jun-80 Jun-81 Jun-82 Jun-83 Jun-84 Jun-85 Jun-86 Jun-87 Jun-88 Jun-89 Jun-90 Jun-91 Jun-92 Jun-93 Jun-94 Jun-95 Jun-96 Jun-97 Jun-98 Jun-99 Jun-00 Jun-01 Jun-02 Jun-03 Jun-04 Jun-05 Jun-06 Jun-07 Jun-08 Jun-09 Jun-10 Jun-11 Private hospital treatment coverage: the swinging pendulum PC Report suggests private hospitals more efficient... Hospital Treatment Coverage (insured persons as % of population) 90.00% 80.00% 70.00% 60.00% Commonwealth medical benefits at 30% flat rate restricted to those with at least basic medical cover from September 1981 Introduction of Medicare from 1 February 1984 Introduction of Life Time Health Cover from 1 July 2000 Higher rebates for older persons from 1 April % 40.00% 30.00% 20.00% 10.00% Medibank began on 1 July A program of universal, non contributory, health insurance it replaced a system of government subsidised voluntary health insurance. 1 July A Medicare Levy Surcharge (MLS) of 1% of taxable income is introduced for higher income earners who do not take out private health insurance. 31 October Increase in MLS income thresholds, subject to annual adjustment. Introduction of 30% Rebate from 1 January % Source: Private Health Insurance Administration Council, 2011

22 Implications for policy reforms Fiscal sustainability and health/aged care funding concern led to the Productivity Commission report in 2011 & in 2012 the Living Longer Living Better reforms in aged care (trend = greater means testing and choice-based market solutions) Budget 13 May 2014 introduced $10bn of cost-shifting measures in health: Hospital funding agreements negotiated with the states and territories under Rudd will be wound back from 2017 saving $50bn over 8 years ($1.8bn over 4 years). Ceasing the NPA on Improving Public Hospital Services will save $201m. $7 co-payment on MBS GP, pathology & imaging items (also chargeable for GPequivalent ED visits to hospitals); concession card holders and children <16 only pay the co-payment for first 10 visits pa ($3.5bn). Simplifying MBS safety nets saves $267m. PBS medicines will also attract an extra $5 copayment (to $42.70), 80c for those on concession cards (to $6.90). Safety nets will increase too ($1.3bn). Medicare rebate for optometry will be reduced and caps removed ($90m) Adult public dental program deferred ($390m), dental grants program ceased ($229m) The national partnership agreement on preventive health ceased ($370m) Pausing MBS indexation for 2 years from July, and income thresholds for MLS and PHI rebate ($1.7bn over 5 years) Replace Medicare Locals with Primary Health Networks from 1 July 2015, with Clinical Councils for GP presence, and local Consumer Advisory Committees aligned to LHNs Moving Health Workforce Australia (HWA) into DOH ($142m) 22 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

23 Traditional infrastructure, workforce and capacity models of health care will be strained, leading to greater use of technologies such as telehealth Telehealth is a subset of e-health that involves using information and communication technologies (ICT) to support off-site clinical healthcare. Real-time telehealth Store & Forward Remote patient monitoring Tele-education Teleconsultations performed across a wide range of specialties, often via video link. Asynchronous transmission of medical data for remote diagnosis e.g. echocardiograms (ECGs), photographs of skin lesions, blood glucose levels and x- rays. For example, the transmission of medical data for disease and injury management and prevention, remote foetal monitoring or support and care for elderly people with chronic conditions. The transmission of medical information either for training health professionals or to assist the public to manage their health. 23 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

24 Preventive health healthy ageing Individual and population health outcomes are influenced by biological and behavioural factors as well as social, cultural, economic and political factors Potentially avoidable conditions account for around 20% of Australian total health care expenditure (Australia s Health 2010) 14 risk factors including tobacco smoking, high blood pressure, alcohol harm, physical inactivity and obesity account for almost 1 third of Australia s total burden of disease (Australia s Health 2010) Reduction in risk taking behaviour and the resulting burden of disease represents significant savings Significant gains in promoting health, preventing disease and reducing health inequities require a whole of government commitment at Commonwealth and state levels The private sector also plays a significant and constructive role in health promotion 24 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

25 Historical approach to preventive health The historical approach to preventive health was characterised by silos with different agents and levels of government advocating for individual causes In the 7 years to , public health expenditure was unchanged at around 2.7%-2.8% of recurrent government health expenditure ($1.47 billion in 05-06). Federal government funded $797 million (54.3%) of this, of which ~40% was provided to jurisdictions in Specific Purpose Payments (much through Public Health Outcome Funding Agreements). Prevention activities include: primary prevention i.e. limiting risk factor exposure (immunisation, schoolbased health promotion programs, education and control activities in relation to substance misuse) secondary prevention i.e. early detection and intervention (cancer screening programs, detection and treatment of sexually transmissible infections) and tertiary prevention i.e. reducing complications of disease (e.g. controlling blood sugar levels of people with diabetes, the MedsCheck Pilot to protect people with multiple medications from potential adverse events) Source: Russell LM, Rubin GL, Leeder SR (2008) Preventive health reform: what does it mean for public health, Med J Aust; 188 (12): Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

26 Preventive health In July 2008 the National Partnership Agreement on Preventive Health (NPAPH) was agreed by COAG, committing $872.1m over six years (from ) to a comprehensive range of prevention and health promotion measures Key initiatives: The Healthy Workers Initiative ($289.4 million) and the Healthy Children Initiative ($325.5 million) i.e. settings-based approaches and social marketing campaigns focused on tobacco and obesity. January 2011 the new Australian National Preventive Health Agency (ANPHA) was launched to reduce the burden of potentially avoidable disease. This was abolished in the May 2014 Budget, with various functions rolled back into the Dept of Health (and possibly others into the Health Productivity and Performance Commission). The NPAPH was also terminated in the Budget. 26 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

27 Opportunities for community pharmacy PBS reforms since 2007 have reduced medicine prices; other commercial pressures have also adversely impacted community pharmacy sustainability 5,350 pharmacies Australia-wide, however, have existing infrastructure ready for providing convenient and high quality access to a broad range of services Such service provision may also enhance Government efforts to seek savings 6 examples services that may be delivered to the public on behalf of the Commonwealth and engender efficiency and convenience are: 1. personally controlled ehealth record (PCEHR); 2. health promotion and preventive health; 3. assessment, management and provision of home based aged care services; 4. supply of equipment and aids for the National Disability Insurance Scheme (NDIS); 5. health coaching and medication management under Partners In Recovery; and 6. provision of Medicare services. 27 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

28 1. PCEHR Currently, a low number of people are registered on the PCEHR system and a large majority of these were achieved using a temporary recruitment drive that may not provide a sustainable solution to the problem. Furthermore, unless registrants actively maintain their records, the records will not be useful to healthcare providers. Community pharmacies could play a role in assisting patients to register on the PCEHR system and act as authorised agents on behalf of patients to help them manage their record on an ongoing basis. Community pharmacies could also play a central role in promoting awareness about the PCEHR initiative in the community. 2. Public health marketing There has been an increased interest in broadening the role of community pharmacies in public health in Australia and overseas. Community pharmacies could provide spaces for displaying and communicating public health messages for the national health promotion campaigns, and provide professional advice to individuals when requested. 28 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

29 3. Assistance with access to home based aged care services The potential role for community pharmacy in this area is two-fold: Assisting older Australians navigate the aged care system by helping them use MyAgedCare, and linking customers with suitable home care services. Providing goods and equipment covered by the HACC and HCP programs. 4. Supply of equipment and aids for the NDIS Participants/carers or an NDIA planner must currently go through a list of suppliers and identify appropriate ones. Some participants do not have internet or are not technologically savvy, making information access difficult. Community pharmacy could be listed on the NDIS website as a single point of contact or information hub for supply of equipment and aids. Pharmacies could provide price information to NDIS participants, with information built into existing dispensing/point of sale software. Pharmacies could liaise with suppliers on behalf of patients for the delivery of equipment. Community pharmacy could supply some of the equipment directly. Community pharmacy could also play a role enabling awareness of NDIS eligibility requirements to facilitate appropriate participation, choice and control and offer support to people participating in the Scheme and their families/carers. 29 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

30 5. Health coaching and medication management under Partners In Recovery DoH has engaged 48 PIR Organisations but none include representation from community pharmacy, despite the role it plays in the supply and management of medicines for the target client group. Community pharmacies could participate in PIR by: Providing health coaching to PIR participants to manage health conditions common in individuals living with mental illness e.g. diabetes & weight gain. Participating in a PIR Organisation as a representative to proactively manage the clients medication plan, especially prior to & following hospital admission. 6. Provision of Medicare services From May 2014, 93 of the 380 Medicare Service Centres stopped providing services on Saturday mornings, reducing service coverage and responsiveness, particularly to individuals who do not have internet access or Smartphone, or those who require services not covered by alternative options. The well distributed network of community pharmacies is in a position to assist DHS in increasing points of access to Medicare services for extended service hours. 30 Trends in Australian health care 2014 Deloitte Access Economics Pty Ltd

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