HSAs within the social health insurance

Osobní zdravotní účty jako součást veřejného zdravotního pojištění HSAs within the social health insurance Tomáš Macháček, Jan Tesař (Klient PRO)

IHS, Prague, 7. 4. 2008

Health Reform.cz

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.

Reforma zdravotnictví-fórum.cz

Podíl plánů s vysokou spoluúčastí na trhu zdravotního pojištění v USA v r. 2006 U.S. employer sponsored health insurance market 2006 Conventional HMO PPO POS HDHP

3% 20% 60% 13% 4%

Obvyklé schema Common policy: Deductible: Employer contribution:

1000 – 2000USD cca 250 USD


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


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)


Pádné důvody pro účty zdravotního spoření: Main reasons for health savings accounts:

1)

2)

Významná spoluúčast High out-of-pocket payments + Systematické dlouhodobé zdravotně – sociální výdaje na konci života Systematic long term health spending in the end-life period


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 !


HealthReform.cz Model of HSA Detailed health care utilization data : 220 000 lives with roughly standard demographic distribution time period of 7 years (2000 – 2006) 8 milions of records


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 Reforma zdravotnictví-fórum.cz

STRUKTURA SPOLUÚČASTI: CO-PAYMENT STRUCTURE:

out-patient

:

50%, 500 Kč max

in-patient

:

Drugs

500 CZK per day ex critical and emergency first 30 Kč, then 30%

Devices:

50%, 1000 Kč max

Stop-loss

:

annual risk adjusted contribution plus 12 000 CZK

Co-payments thus counts for 32% of all BBP health care costs


DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB HEALTH CARE COSTS DISTRIBUTION 100,00%

90,00%

80,00%

70,00%

One year costs 60,00%

50,00%

40,00%

30,00%

20,00%

10,00%

0,00%


DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB HEALTH CARE COST DISTRIBUTION 100,00%

90,00%

80,00%

70,00%

Five year costs 60,00%

50,00%

40,00%

30,00%

20,00%

10,00%

0,00%



90,00%

80,00%

70,00%

60,00%

Insurance – copayment split 50,00%

41%

40,00%

30,00%

20,00%

10,00%

16%

0,00% Reforma zdravotnictví-fórum.cz


90,00%

HSA = stable cashflow for five years

80,00%

70,00%

60,00%

Copayment – five years

49%

50,00%

40,00%

30,00%

20,00%

10,00%

16%

0,00% Reforma zdravotnictví-fórum.cz

GINI KOEFICIENT wealth distribution : Denmark : Italy: Germany: UK: USA:

0,25 0,27 0,3 0,35 0,4

total equality = 0 total unequality = 1

DISTRIBUCE NÁKLADŮ ZDRAVOTNÍCH SLUŽEB: HEALTH CARE COST DISTRIBUTION: Insured costs – one year: Copayment costs – five years:

0,80 0,46


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: B) woman, 76 let, diabetes mellitus on insuline: C) man, 65 years, ischaemic heart disease (

woman, 56 years, malignity


2 000 CZK 12 000 CZK 13 900 CZK

128 000 CZK ??)

GROUP

Pharmacy-based cost groups

Risk index

Hypertension

1,19

Thyreoidal hormonal substitution

1,45

Glaukoma

1,53

Diabetes – typ II

2,22

Cystic fibrosis

2,95

Ischaemic heart disease

2,98

Astma, respiratory illneses

3,17

Parkinson disease

3,39

Depression and other

3,54

Rheumatic diseases, osteoartritis

3,62

Hyperlipidemia

3,78

Peptic acid disease

5,46

Crohn’s and ulcerative colitis

5,56

Epilepsia

5,91

Diabetes – typ I

7,53

Transplantation

22,32

HIV/AIDS

37,80 ??

Malignity

63,34 ??

Kidney failure

140,55 ?? Reforma zdravotnictví-fórum.cz

KROK 3: STEP 3:

JAK FUNGUJE ÚČET ZDRAVOTNÍHO SPOŘENÍ HSA AT WORK

RISK ADJUSTED CONTRIBUTIONS

COPAYMENT COSTS

+ 12 000 CZK BĚŽNÝ ÚČET CLEARING ACCOUNT (12 months balance)

- 12 000 CZK SPOŘÍCÍ ÚČET SAVING ACCOUNT

SAVINGS

Other HSA BALANCE

DEBT INSTALMENTS

EXTRA BENEFITS WITHDRAWAL up the limit Reforma zdravotnictví-fórum.cz

BILANCE PO ROCE ONE YEAR BALANCE 6,86 %

91,1% population

2,04%

2,00%

1,80%

1,60%

1,40%

-6 000 CZK

+6 000 CZK

1,20%

1,00%

0,80%

loosers

winners

0,60%

0,40%

0,20%

0,00%


BILANCE PO PĚTI LETECH FIVE YEARS BALANCE

1,00%

3,28 %

95,19% population

1,53%

0,90% 0,80% 0,70%

-6 000 CZK -per year

0,60%

+6 000 CZK -per year

0,50% 0,40% 0,30%

loosers

winners

0,20% 0,10% 0,00%

13% cop. costs

85% copayment costs Reforma zdravotnictví-fórum.cz

2% cop. costs

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%

-6 000 CZK -per year

0,60%

+6 000 CZK -per year

0,50% 0,40% 0,30%

loosers

winners

0,20% 0,10% 0,00%


SOUHRNNÝ VÝSLEDEK AGGREGATE RESULT Savings on Depts on HSAs HSAs (less than)

10,7%

Copayment rate

(less than)12,1%

System savings

33,3%

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


2,9%

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 !


Thank you for your attention. Děkujeme za pozornost

www.healthreform.cz

HSAs within the social health insurance

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