HSAs within the social health insurance

Transkript

1 Osobní zdravotní účty jako součást veřejného zdravotního pojištění HSAs within the social health insurance Tomáš Macháček, Jan Tesař (Klient PRO) IHS, Prague, Health Reform.cz

2 1992 John C. Goodman, Gerald L. Musgrave PATIENT POWER: Solving America s health care crisis. Zdravotní péče může být zadarmo nebo snadno dostupná. NIKOLI OBOJÍ. Health care can be free or easily accessible. BUT NOT BOTH.

3 Podíl plánů s vysokou spoluúčastí na trhu zdravotního pojištění v USA v r U.S. employer sponsored health insurance market 2006 Conventional 3% HMO 20% PPO 60% POS 13% HDHP 4% Obvyklé schema Common policy: Deductible: Employer contribution: USD cca 250 USD

4 PRVNÍ ZKUŠENOSTI JSOU NADĚJNÉ: First evidence is promissing: (Mc Kinsey&Co. survey 2006) More value-conscious utilization decisions Increasing consumer engagement : greater ownership of their health Reduce utilization Engagement in overall health and wellness On the other hand they feel : Lack of proper information price differences Less satisfaction

5 PRVNÍ ZKUŠENOSTI JSOU NADĚJNÉ: First evidence is promissing: (Mc Kinsey&Co. survey 2006) 50% more likely to ask about cost 33% likely to independently identify treatment alternatives 3x more likely to have chosen a less extensive (expensive) treatment 25% more likely to engage in healthy behaviors 20% more likely to follow treatment regimens for chronic conditions very carefully Twice as likely to inquire about drug costs (with the same levels of drug coverage)

6 Pádné důvody pro účty zdravotního spoření: Main reasons for health savings accounts: 1) Významná spoluúčast High out-of-pocket payments + 2) Systematické dlouhodobé zdravotně sociální výdaje na konci života Systematic long term health spending in the end-life period

7 JAK KONCEPT HSA IMPLEMENTOVAT? How should we implement the HSA concept? JAK IMPLEMENTOVAT KONCEPT OSOBNÍCH ZDRAVOTNÍCH ÚČTŮ DOSTUPNÝCH PRO VŠECHNY! How should we implement concept of HSAs accessible for all!

8 HealthReform.cz Model of HSA Detailed health care utilization data : lives with roughly standard demographic distribution time period of 7 years ( ) 8 milions of records

9 KROK 1: STRUKTURA SPOLUÚČASTI STEP 1: CO-PAYMENT STRUCTURE 1) SIMPLE DEDUCTIBLE DOESN T WORK all in cash for 80% insured, but almost no impact on seriously ill people drug underusage risk structural problems (access) 2) MUST REFLECT COST DITRIBUTIONS AND PROBABILITY frequent and cheap v.s. rare and expensive 3) MUST BE SIMPLE FOR ADMINISTRATION

10 STRUKTURA SPOLUÚČASTI: CO-PAYMENT STRUCTURE: out-patient : 50%, 500 Kč max in-patient : 500 CZK per day ex critical and emergency Drugs first 30 Kč, then 30% Devices: 50%, 1000 Kč max Stop-loss : annual risk adjusted contribution plus CZK Co-payments thus counts for 32% of all BBP health care costs

11 DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB HEALTH CARE COSTS DISTRIBUTION 100,00% 90,00% 80,00% 70,00% 60,00% One year costs 50,00% 40,00% 30,00% 20,00% 10,00% 0,00%

12 DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB HEALTH CARE COST DISTRIBUTION 100,00% 90,00% 80,00% 70,00% 60,00% Five year costs 50,00% 40,00% 30,00% 20,00% 10,00% 0,00%

13 DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB HEALTH CARE COSTS DISTRIBUTION 100,00% 90,00% 80,00% 70,00% 60,00% 50,00% 40,00% Insurance copayment split 41% 30,00% 20,00% 10,00% 16% 0,00%

14 DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB HEALTH CARE COSTS DISTRIBUTION 100,00% 90,00% HSA = stable cashflow for five years 80,00% 70,00% 60,00% 50,00% Copayment five years 49% 40,00% 30,00% 20,00% 10,00% 16% 0,00%

15 GINI KOEFICIENT wealth distribution : Denmark : 0,25 total equality = 0 Italy: 0,27 total unequality = 1 Germany: 0,3 UK: 0,35 USA: 0,4 DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB: HEALTH CARE COST DISTRIBUTION: Insured costs one year: 0,80 Copayment costs five years: 0,46

16 KROK 2: RIZIKOVĚ OCENĚNÉ PŘÍSPĚVKY STEP 2: RISK ADJUSTED CONTRIBUTIONS - In total are equal to total copayments costs (redistribution) - Risk factors: age, sex, health status (PCG) Examples: A) man, 18 years, no chronic disease: CZK B) woman, 76 let, diabetes mellitus on insuline: CZK C) man, 65 years, ischaemic heart disease CZK ( woman, 56 years, malignity CZK??)

17 GROUP Pharmacy-based cost groups Hypertension Thyreoidal hormonal substitution Glaukoma Diabetes typ II Cystic fibrosis Ischaemic heart disease Astma, respiratory illneses Parkinson disease Depression and other Rheumatic diseases, osteoartritis Hyperlipidemia Peptic acid disease Crohn s and ulcerative colitis Epilepsia Diabetes typ I Transplantation HIV/AIDS Malignity Kidney failure Risk index 1,19 1,45 1,53 2,22 2,95 2,98 3,17 3,39 3,54 3,62 3,78 5,46 5,56 5,91 7,53 22,32 37,80?? 63,34?? 140,55??

18 KROK 3: STEP 3: JAK FUNGUJE ÚČET ZDRAVOTNÍHO SPOŘENÍ HSA AT WORK RISK ADJUSTED CONTRIBUTIONS COPAYMENT COSTS CZK CZK BĚŽNÝ ÚČET CLEARING ACCOUNT (12 months balance) SPOŘÍCÍ ÚČET SAVING ACCOUNT SAVINGS DEBT INSTALMENTS Other HSA BALANCE EXTRA BENEFITS WITHDRAWAL up the limit

19 BILANCE PO ROCE ONE YEAR BALANCE 2,00% 6,86 % 91,1% population 2,04% 1,80% 1,60% 1,40% CZK CZK 1,20% 1,00% 0,80% 0,60% loosers winners 0,40% 0,20% 0,00%

20 BILANCE PO PĚTI LETECH FIVE YEARS BALANCE 1,00% 3,28 % 95,19% population 1,53% 0,90% 0,80% 0,70% 0,60% 0,50% CZK -per year CZK -per year 0,40% 0,30% loosers winners 0,20% 0,10% 0,00% 13% cop. costs 85% copayment costs 2% cop. costs

21 BILANCE PO PĚTI LETECH 5% úspora FIVE YEARS BALANCE - 5% savings 1,00% 2,88 % 95,43% population 1,69% 0,90% 0,80% 0,70% 0,60% 0,50% CZK -per year CZK -per year 0,40% 0,30% loosers winners 0,20% 0,10% 0,00%

22 SOUHRNNÝ VÝSLEDEK AGGREGATE RESULT Depts on HSAs Savings on HSAs Copayment rate System savings (less than) 10,7% (less than)12,1% 33,3% 2,9% Increased effectiveness, more value for money, better allocation of sources, less moral hazard More sources in total (cca + 5%)!! (including savings) Capitalized individual sources for future spending

23 IMPLEMENTATION - OPT OUT alternative, at least two years of membership - Typ of health plan = risk factor for risk redistribution system (risk selection envisaged) - Very slow growth foreseen (?) nearly no impact on the system performance - Progress along with increasing nominal premiums of standard health plans - Generation change We have time for refining!

24 Thank you for your attention. Děkujeme za pozornost