Transcript WPIX – Development of Scenarios for Health Expenditure in

WPIX – Development of Scenarios for
Health Expenditure in the Accession
Economies
POLAND - assumptions and results
Stanisława Golinowska, Ewa Kocot,
Agnieszka Sowa
I. Assuptions; variables, data
1. General projection assumptions
•
•
•
•
•
No policy changes
Base year: 2003
Projection period: 2003 – 2050
HE per capita increase = GDP per capita increase
Four scenarios:
I.
II.
III.
IV.
baseline,
death-related costs,
different LE improvement
different labour market indicators development
(IV scenario finished not yet)
2. Main model variables assumptions (base year data
and projection needed):
2003
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
TFR
1,22
1,26
1,35
1,43
1,51
1,58
1,64
1,69
1,73
1,75
1,76
LE-male
70,5
70,9
71,9
72,8
73,6
74,4
75,2
75,9
76,4
76,9
77,4
LE-female
78,9
79,2
80,0
80,7
81,2
81,7
82,2
82,7
83,1
83,5
83,9
Employment Rate
50%
51%
55%
59%
63%
66%
70%
71%
72%
73%
74%
Unemployment
Rate
20%
18%
14%
11%
10%
8%
7%
7%
7%
7%
7%
GDP growth
3,8%
5,3%
5,1%
4,8%
4,2%
3,7%
3,2%
2,6%
2,1%
1,5%
1,0%
Labour Productivity
growth
4,5%
3,0%
3,3%
4,4%
4,2%
3,4%
3,3%
3,2%
3,1%
3,0%
2,7%
DEMOGRAPHY
LABOUR MARKET
ECONOMY
Main projection sources: Convergence Program, National Development
Plan, national experts opinion
TFR – medium variant of UN projection,
LE – middle variant: ILO population module
10
10
96
96
92
92
88
88
84
84
80
80
76
76
72
72
68
68
64
64
60
60
56
56
52
Age
Age
Demographic variables development – change of
size (decreasing) and change of structure (ageing) (1)
48
52
48
44
44
40
40
36
36
32
32
28
28
24
24
20
20
16
16
12
12
8
8
4
4
0
400
0
300
200
100
0
Females
100
Males
year 2005
200
300
400
400
300
200
100
0
Females
100
Males
year 2050
200
300
400
Demographic variables development – change of
size and change of structure (2)
Size
Total
0 - 14
15 - 64
65+
2005
100%
100%
100%
100%
2050
87%
74%
69%
194%
Structure
2005
2050
16,2%
13,8%
70,5%
56,5%
13,3%
29,7%
• Total population - 13% decrease
• Young population – 26% decrease
• Active age population – 31% decrease
• Older population – nearly two times bigger (more than
two times from the structure perspective)
Labour market and economic variables:
Labour market (mln.)
50,00
45,00
40,00
35,00
30,00
25,00
20,00
15,00
10,00
5,00
0,00
2005
2010
2015
2020
2025
Total population 15-64
2030
Labour force
2035
2040
2045
2050
Employment
• Decreasing employment – despite increasing employment
rate, higher influence of adverse demographic tendency
3. Health care area - base year data
• Health Insurance Expenditures per capita by sex / 5-years
age groups for base year
(source: National Health Fund)
• Aggregate Heath Expenditures
(source: National Health Accounts, base year)
Additionally in Scenario II:
• Health Insurance Expenditures per capita by status :
deceased or survivor
(source: National Health Fund)
HE per capita was used instead of utilization per capita
because of data availability in Poland
typical J - curve
males
females
95 - 99
90 - 94
85 - 89
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0-4
BASELINE SCENARIO
Average health expenditures - base year
(as a share of GDP per capita)
12,00%
10,00%
8,00%
6,00%
4,00%
2,00%
0,00%
II. Modelling results
1. Revenues side
2. Expenditures side
3. Balance: surpluse/deficit
BASELINE SCENARIO
Results (1-2): public health care revenues and expenditures
as a share of GDP
8,00%
7,00%
6,00%
5,00%
4,00%
3,00%
2,00%
1,00%
0,00%
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
revenues
4,45%
4,66%
4,77%
4,96%
5,16%
5,20%
5,28%
5,40%
5,57%
5,80%
expenditures
4,63%
4,92%
5,22%
5,53%
5,88%
6,24%
6,56%
6,80%
6,96%
7,08%
Revenues - important dates:
• slower growth after 2008 (stabilizing of contribution rate (9%))
• about 2025 – still slower growth (lower productivity growth)
• about 2040 – faster growth (productivity growth higher than GDP growth)
BASELINE SCENARIO
Results (1-2): public health care revenues and expenditures
as a share of GDP
8,00%
7,00%
6,00%
5,00%
4,00%
3,00%
2,00%
1,00%
0,00%
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
revenues
4,45%
4,66%
4,77%
4,96%
5,16%
5,20%
5,28%
5,40%
5,57%
5,80%
expenditures
4,63%
4,92%
5,22%
5,53%
5,88%
6,24%
6,56%
6,80%
6,96%
7,08%
Expenditures
• lesser speed of growing in the last period (slower GDP growth)
BASELINE SCENARIO
Results (3): balance - deficit of the health budget as
a share of GDP
5,00%
4,50%
4,00%
3,50%
3,00%
2,50%
2,00%
1,50%
1,00%
0,50%
0,00%
deficit
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
0,18%
0,26%
0,44%
0,56%
0,72%
1,04%
1,28%
1,39%
1,39%
1,28%
Deficit
• after 2025 : faster deficit growth
• 2040-2045 : nearly stable deficit
• after 2045 : deficit decline
BASELINE SCENARIO
Results : contribution rate planned and needed to
close the gap between expenditures and revenues
14,00%
12,00%
10,00%
8,00%
6,00%
4,00%
2,00%
0,00%
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
planned
8,50%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
needed
8,90%
9,60%
10,03% 10,32% 10,67% 11,36% 11,86% 12,08% 12,01% 11,73%
• Planned contribution rate - on the stable level 9%
• Needed contribution rate - dependly on projected deficit is
growing up to about 12%, then is decreasing a little
35 000,0
30 000,0
25 000,0
20 000,0
15 000,0
10 000,0
5 000,0
2005
2025
95 - 99
90 - 94
85 - 89
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0,0
0-4
BASELINE SCENARIO
Projected total expenditures by age
2050
• Total expenditure by age is growing for each age group, but
definitely the largest growth is observed in the older age
(connection between demography changes and health
expenditures)
SCENARIO II – death-related costs
80,0%
75,0%
70,0%
65,0%
60,0%
50,0%
45,0%
40,0%
35,0%
30,0%
25,0%
20,0%
15,0%
10,0%
5,0%
males-deceased
females-deceased
males-survivors
95 - 99
90 - 94
85 - 89
80 - 84
75 - 79
70 - 74
65 - 69
60 - 64
55 - 59
50 - 54
45 - 49
40 - 44
35 - 39
30 - 34
25 - 29
20 - 24
15 - 19
10 - 14
5-9
0,0%
0-4
SCENARIO II
55,0%
females-survivors
• Population was divided into two groups: survivors and deceased
• Health care is definitely more expensive in the last year of life,
independently of age
• Difference in costs is decreasing in age
Results: expenditures with/without death-related costs
8,00%
SCENARIO II
7,00%
6,00%
5,00%
4,00%
3,00%
2,00%
1,00%
0,00%
2003
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
Scenario I
4,51%
4,63%
4,92%
5,22%
5,53%
5,88%
6,24%
6,56%
6,80%
6,96%
7,08%
Scenario II
4,51%
4,62%
4,88%
5,13%
5,41%
5,71%
6,03%
6,31%
6,51%
6,62%
6,70%
• The last year of life is shifting to the older age – lower
death-related costs: total expenditures decrease (0,38 p.p.
in 2050)
SCENARIO II
Results: deficit of the health budget with/without
death-related costs
8,00%
7,50%
7,00%
6,50%
6,00%
5,50%
5,00%
4,50%
4,00%
3,50%
3,00%
2,50%
2,00%
1,50%
1,00%
0,50%
0,00%
2003
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
Scenario I
0,29%
0,18%
0,26%
0,44%
0,56%
0,72%
1,04%
1,28%
1,39%
1,39%
1,28%
Scenario II
0,29%
0,17%
0,22%
0,36%
0,44%
0,55%
0,83%
1,03%
1,10%
1,05%
0,90%
Results: contribution rate needed with/without
death-related costs
SCENARIO II
14,00%
12,00%
10,00%
8,00%
6,00%
4,00%
2,00%
0,00%
2003
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
planned
8,00%
8,50%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
9,00%
Scenario I - needed
8,64%
8,90%
9,60%
10,03% 10,32% 10,67% 11,36% 11,86% 12,08% 12,01% 11,73%
Scenario II - needed
8,64%
8,87%
9,51%
9,87%
10,10% 10,37% 10,97% 11,39% 11,55% 11,42% 11,09%
• Contribution rate decreases – 0,64 p.p. in 2050
SCENARIO III: different LE improvement: slow,
middle, fast (demographic effect)
Different LE improvement scenarios: demographic effect
mln.
SCENARIO III
(s-slow, m-middle, f-fast)
40,0
35,0
30,0
25,0
20,0
15,0
10,0
5,0
0,0
s m f
2005
s m f
2010
s m f
2015
s m f
2020
0-14
s m f
s m f
2025
s m f
2030
15-64
2035
s m f
2040
s m f
2045
s m f
2050
65+
• Main difference in the size of the older group of population
• Slight effect on the active age group
Health revenues and expenditures – LE development
scenarios
8,00%
7,50%
7,00%
6,50%
6,00%
5,50%
5,00%
4,50%
4,00%
3,50%
3,00%
2005
2010
2015
2020
2025
2030
2035
2040
rev.-baseline
rev.-LE-slow
rev.-LE-f ast
exp.-baseline
exp.-LE-slow
exp.-LE-f ast
2045
2050
• slower LE development: lower revenues, lower expenditures
• faster LE development: higher revenues, higher expenditures
Deficit – LE development scenarios
5,00%
4,50%
4,00%
3,50%
3,00%
2,50%
2,00%
1,50%
1,00%
0,50%
0,00%
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
baseline scenario
0,18%
0,26%
0,44%
0,56%
0,72%
1,04%
1,28%
1,39%
1,39%
1,28%
LE-slow
0,18%
0,26%
0,44%
0,56%
0,71%
1,02%
1,24%
1,34%
1,32%
1,21%
LE-fast
0,18%
0,26%
0,44%
0,57%
0,73%
1,07%
1,32%
1,45%
1,45%
1,35%
• slight impact on the deficit (+ , - 0,07 percentage point) –
expenditures increase (decrease) a little „stronger” than
revenues increase (decrease)
Results: Scenario I, II and III
2005
Revenues
2025
2050
2005
Baseline
4,22%
5,16%
5,80%
4,51%
changes*
Scenario of deathrelated costs
100%
283%
561%
4,22%
5,16%
changes*
100%
slow
Scenario of
different changes*
increases of
fast
longevity
changes*
Scenario
Expenditures
2025
2050
2005
Deficit
2025
5,88%
7,08%
0,29%
0,72%
1,28%
100%
310%
657%
100%
967%
3030%
5,80%
4,51%
5,71%
6,70%
0,29%
0,55%
0,90%
283%
561%
100%
302%
623%
100%
797%
2270%
4,22%
5,13%
5,71%
4,51%
5,84%
6,92%
0,29%
0,71%
1,21%
100%
281%
551%
100%
308%
642%
100%
951%
2872%
4,22%
5,19%
5,91%
4,51%
5,92%
7,25%
0,29%
0,73%
1,35%
100%
284%
571%
100%
312%
673%
100%
986%
3191%
2050
• Deficit is growing in years – different speed of growth
• Death-related costs scenario: no influence to revenues, quite
significant influence to expenditures – lower deficit (compared to
baseline scenario)
• LE scenario: slight influence to revenues, expenditures and
deficit
Different scenarios sensitivity – changes (2050)
as a share of baseline scenario results
Scenario
Revenues
Expenditures
Deficit
Death-related cost
0,0%
-5,4%
-29,2%
slow
-1,6%
-2,3%
-5,4%
fast
1,9%
2,4%
5,4%
Scenario of
different
increases of
longevity
• with death-related costs: nearly 30% lower deficit
• with better (worse) LE development only 5,4% of change