Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Nov 21, 2011

A Better Life

The new (June 2011) 'OECD Health Data 2011' report shows the latest insights in health spending costs. Here are some results for the main OECD countries:

Health Costs

Total health spending accounted on average for 9.5% of the GDP for all OECD countries (main countries: 9.8%).

Public health is  a substantial  part  of  health  funding  in  all  OECD  countries.

Control Health Costs
Key question is: will relative 'big rising spenders' like The Netherlands and the U.S., be able to control their health costs in the near future?

Besides the fact that health costs undoubtedly rise sharply with age, the bulk of 'annual health spending growth' depends mainly on overall population growth, increases in the health prices and the introduction of new high-cost medical products and treatments used by all age groups. 

In controlling health costs, the most difficult an challenging question is in fact:

What are we trying to maximize
with the help of health investment costs?

Our first answer could be : Maximize Health.

In practice we (countries in the world) haven't explicitly defined what we try to maximize... Unfortunately discussing health costs without a clear goal, is an endless road, leading nowhere.... A Health Mission Impossible.....

On top of, 'Health'  is - at its best - a non defined subjective perception.....
Let's dive deeper on this theme of perception. Can we grasp it?

Health Perception
As in every corner of (your) life

Perception = Reality

Therefore let's take a look at how health is perceived by people in different countries. For a global 'health perception picture' we have to fall back on self-reported health status  figures of around 2006-2007:

As is clear Canada and the U.S. are clear 'feeling healthy' champions, with Japan as poorest performer.

Quality and Quantity of Life
To examine whether the self-reported health status indicator  (representing the quality of life) also indicates a 'longer life expectancy' (representing the quantity of life),  here is the 'life expectancy indicator'.

Surprisingly the results are - at first sight - counter intuitive:
  • Japan, with the poorest health perception, scores best in longevity
  • The U.S.,  with the almost best health perception, scores worst in longevity

'Good health' and  'life expectancy' 
It is known that elderly people report a less than average good healthy condition.

Unfortunately, as the next diagram indicates, there's no convincing direct relationship between 'perceived good health' and  'life expectancy' or 'median age' (as explaining variables) :

Reference: Japan Explained?
To find  out 'what drives a health perception', we may examine one of the rare underpinned studies : "The Surveys on the Japanese National Character".

First of all there's a relationship between Economy and Health:

Though declining, more than 50% of all respondents in this survey say that "people's health will get worse".

What's even of more concern, is that younger people are experiencing an increasing feeling of nervousness during the last decades.

This survey supports the idea that perceptions of 'health' and 'happiness' are more or less embedded in a nations' culture and not related to the investments in health.

Find out more on what's going on in Japan beneath the surface on:
Assessment of the Japanese Economy

It's all about Happiness

What remains is that it's all about happiness in life....
And of course happiness and good health are 'somewhat' and 'somehow' related

Maximizing or optimizing Health in on basis of 'health investments' (health costs) is tricky business. Although Happiness and Health Perception are related, they both don't relate to health investments.

The maximum price for 'good health' is subjective. Governments will have to border the maximum public financed costs of health on basis of objective goals of health condition (eg. max % obesity, BMI, etc) in relation to what's "bearable" in terms of costs in relation to the strength of their national economy.

Let's conclude with some positive news...

Your Better Life Index
I would like to invite you to take part in the Your Better Life Index.

'Your Better Life Index' was designed as s an interactive tool that allows you to see how countries perform according to the importance you give to each of 11 topics – like education, housing, environment, and so on – that contribute to well-being in OECD countries. Your Better Life Index allows you to put different weights on each of the topics, and thus to decide for yourself what contributes most to well-being.

It is a pioneering, interactive tool combining OECD substance with modern
technology in order to educate, promote dialogue and encourage consensus on the balance between societal and economic well-being. Your Better Life Index will be maintained on an ongoing basis.

Here's MY Better life index as an eample.

Live a healthy and - above all - happy life..... A Better life!

- OECD Health Data 2011 How Does the Netherlands Compare?
- OECD Health Data 2011 
- Health Self-Reported Health Status 
- Assessment of the Japanese Economy: A Continuing Downward Trend
- Why Does U.S. Health Care Cost So Much? ( An Aging Population Isn’t the Reason)
- The Surveys on the Japanese National Character

- Does Medicare Work Better Than Private Insurance?
- Balancing Affordability and Value: The Universal Challenge in Health Care Delivery

- Spreadsheet with all health data of this blog

Oct 17, 2009

Actuarial Sustainability Alarm

Recently the European Commission launched the 'Sustainability Report 2009", investigating the long-term (2010-2060)sustainability of public finances.

This report clearly shows the long-term economic effects of the aging society and the continuous increasing life expectancy.

Financing increasing pension and health costs in the next decades, will be a real challenge for almost all European countries. Even more, the current financial crisis and unsure financial outlook urge for severe short term measures in order to prevent much more unpleasant other measures in the next decades.

The report claims that the ability to meet public pensions liabilities is a higher long-term risk for governments than ever before and in most cases reform of member states’ pensions systems is 'must' and can no longer be delayed.

Although the report manly focuses on the increase (the so called delta) of the sustainability gap, I would like to take a look at the development of the aging costs in relation to the debt development of each country.

Development Aging costs
Let's start to take a look at the development of the public pensions liabilities (pension costs) and health costs from a slightly different angle as published in the report:

On average the total aging costs are increasing from 25% in 2010 to about 30% in 2060 on bases of a no-policy-change assumption.But there a countries (BE, EL, LU, SI) that grow way above this average to a level that's even above the current level of countries with high social standards, like Sweden and Finland.

To conquer this development, some member countries are trying to tackling the longevity issue by raising retirement ages.
Not only the pension costs increase, but also the projected long-term increase in healthcare spending is large and constitutes on its own a risk to sustainability.

Countries whose regimes are listed by the report as 'high-risk' in terms of sustainability are: The Czech Republic, Cyprus, Ireland, Greece Spain, Latvia, Lithuania, Malta, the Netherlands, Romania, Slovakia and the UK. In many countries the age-related expenditure is expected to climb quickly against existing financial imbalances.

Development gross debt ratio
As is clear from the next table, the mentioned next decades increase in health and pension costs, in combination with the unhealthy financial situation - due to the credit crisis - cumulates in a clear desperate debt situation for most of the European countries:

The table shows the government gross debt ratio in 2008 and 2009, and the projections for 2010, 2030 and 2060, once the costs of servicing debt and paying for age-related expenditure are taken into account.

As mentioned before, the long-term debt projections have been prepared under a no-policy-change assumption and in partial equilibrium. Given these assumptions, the projections are not robust forecasts and are not meant to be realistic scenarios of what may happen in the future.

The aim of the debt projections is to illustrate the long-term trends and the size of the required remedial action to avoid government debts to enter into an exponentially increasing spiral.

Actuary Involvement
It's clear that the debt and social costs developments are not heading in the right direction..... Actuary involvement to analyze, advice and create new social systems seems necessary.
Actuaries on the bridge, please!

- EC
- Sustainability Report 2009
- Report 2009
- Download: Maggid Excel tables Aging Costs and Debt Development

Oct 12, 2009

Health Leadership 2009

The Netherlands win the 2009 Euro Health Consumer Index (EHCI), for the second year in a row.

Nevertheless, Denmark keeps its runner-up position from last year. Besides The Netherlands and Denmark there are other strong performers like Iceland, Austria and Switzerland, leaving the UK in a disappointing 14th position....

Index performance criteria
The EHCI 2009 groups 38 indicators of quality into six categories: Patient rights and information, e-Health, Waiting time for treatment, Outcomes, Range and reach of services provided and Pharmaceuticals.
Each sub-discipline is weighted for importance to provide the overall Index score.

HCP research director, Dr. Arne Bjornberg, states: The Dutch might have found a successful approach that combines competition for funding and provision within a regulated framework.

Effective Health (Actuarial) Principles
In actuarial context, the success of the Dutch health system is based on a few very simple principles:
  • Risk Solidarity
  • Risk Equalization
  • No Risk Selection
  • Free choice of Care Providers & Health Insurer
  • Transparent ranking of Care Providers on bases of cost & quality
  • Worldwide cover

The Dutch Health Care System
An excellent summary of the Dutch Health Care System can be viewed on YouTube:

Health care In the Netherlands

Of course the Dutch system is no panacea, there are also many challenges and disadvantages.

Just to mention some....

Nevertheless, the Dutch system can be an inspiring example for countries like the US and the UK.

Let's conclude with an interesting development. In an 2009 article called A Strategy for Health Care Reform, Michael E. Porter presents the principles for a new health system, based on the idea that the central focus must be on increasing value for patients.

Related downloads/sources:

Jun 7, 2009

Happy Life Expectancy

As we know, Life Expectation can be measured in many ways. The three most common methods are:
  • LE = Life Expectation (standard), the average number of years that a newborn can expect to live.
  • HALE = Health Adjusted Life Expectation, the average number of years that a newborn can expect to live in "full health"
  • HLE = Healthy Life Expectation, the average number of years that a newborn can expect to live in "full perceived health"

As comparisons between LE an HALE show, 'living longer' doesn't necessarily mean 'living longer in good health'. However, it has become clear that a strong Healthy Working Life Expectancy at age 50 or higher is the best guarantee that people will be able to work longer as they live longer.

One step further. Living in "good (perceived) health" doesn't automatically mean that people are living a happy life.

Happiness is one of the most important lifestyle statistics. Optimizing the number of 'happy years' in our life is therefore an important issue.

Happy Life Expectancy
Here is where Prof.dr. Ruut Veenhoven (Publications), comes in.

Veenhoven defines a different HLE as:

In formula:

HLE = LE x Happiness-score/10

The Happiness-score (H) is the average happiness as expressed on a 0-10 scale.

Let's compare the HALE an HLE (Happy Life Expectancy) scores with each other for different (top-30 ranked) countries:

A full list and data is available at the World Database of Happiness.

It's clear that in most top-30 countries we spend about 90% of our life in healthy conditions and only about 70-80% in happy conditions. There room for improvement here! I'll leave the other conclusions up to yourself....

Let's conclude with two other correlated interesting findings:

1. Happy Life Expectancy Determination
What public policies are most conducive to happiness? This requires a view on the determinants of happiness in nations:

It turns out that six societal qualities (wealth, security, freedom, inequality, brotherhood and justice) explain 83% of the differences in Average happiness, 71% of the differences in Inequality of happiness and no less than 87% of the differences in Happy Life Years.
Enough for an interesting discussion between actuaries and politicians, I would say....

2. Wealth and happiness correlation
As expected wealth (expressed in GDP per capita) and happiness (e.g. highly satisfaction) are strongly correlated in clear distinguished regions.
Also the 'mean life satisfaction' turns out to be correlated to different age-groups and countries:

These graphics are food for thought on the relationship between mortality and wealth. More about that soon......

Dec 2, 2008

Netherlands Best EU Healthcare system 2008

The Netherlands are the overall winner in the Euro Health Consumer Index 2008, launched today in Brussels at a press conference hosted by the Health Consumer Powerhouse.

The Euro Health Consumer Index is the annual ranking of national European healthcare systems across six key areas: Patient rights and information, e-Health, Waiting time for treatment, Outcomes, Range and reach of services provided and Pharmaceuticals.