WPIX Development of Scenarios for Health Expenditure in the Accession Economies POLAND assumptions a

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WPIX Development of Scenarios for Health
Expenditure in the Accession EconomiesPOLAND -
assumptions and results

• Stanislawa Golinowska, Ewa Kocot,
• Agnieszka Sowa

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1. General projection assumptions
I. Assuptions variables, data

• No policy changes
• Base year 2003
• Projection period 2003 2050
• HE per capita increase GDP per capita increase
• Four scenarios
• baseline,
• death-related costs,
• different LE improvement
• different labour market indicators development
• (IV scenario finished not yet)

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2. Main model variables assumptions (base year
value and projection necessary)

• Demography Total Fertility Rate, Life
  Expectancy,
• Labour Force employment rate, unemployment rate,
• Economy real GDP growth, labour productivity
  growth

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2. Main model variables assumptions (base year
data and projection needed)
Main projection sources Convergence Program,
National Development Plan, national experts
opinion TFR medium variant of UN projection,
LE middle variant ILO population module
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Demographic variables development change of
size (decreasing) and change of structure
(ageing) (1)
year 2050
year 2005
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Demographic variables development change of
size and change of structure (2)

• 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)

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Labour market and economic variables

• Decreasing employment despite increasing
  employment rate, higher influence of adverse
  demographic tendency

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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

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Average health expenditures - base year (as a
share of GDP per capita)
BASELINE SCENARIO
typical J - curve
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II. Modelling results

• Revenues side
• Expenditures side
• 3. Balance surpluse/deficit

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Results (1-2) public health care revenues and
expenditures as a share of GDP
BASELINE SCENARIO

• 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)

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Results (1-2) public health care revenues and
expenditures as a share of GDP
BASELINE SCENARIO

• Expenditures
• lesser speed of growing in the last period
  (slower GDP growth)

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Results (3) balance - deficit of the health
budget as a share of GDP
BASELINE SCENARIO

• Deficit
• after 2025 faster deficit growth
• 2040-2045 nearly stable deficit
• after 2045 deficit decline

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Results contribution rate planned and needed to
close the gap between expenditures and revenues
BASELINE SCENARIO

• 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

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Projected total expenditures by age
BASELINE SCENARIO

• 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)

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SCENARIO II death-related costs
SCENARIO II

• 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

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k indicator
a age sex male/female AE average
expenditures d - deceased s - survivor
SCENARIO II
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Results expenditures with/without death-related
costs
SCENARIO II

• The last year of life is shifting to the older
  age lower death-related costs total
  expenditures decrease (0,38 p.p. in 2050)

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Results deficit of the health budget
with/without death-related costs
SCENARIO II
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Results contribution rate needed with/without
death-related costs
SCENARIO II

• Contribution rate decreases 0,64 p.p. in 2050

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SCENARIO III different LE improvement slow,
middle, fast (demographic effect)
SCENARIO III

• Main difference in the size of the older group of
  population
• Slight effect on the active age group

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Health revenues and expenditures LE development
scenarios

• slower LE development lower revenues, lower
  expenditures
• faster LE development higher revenues, higher
  expenditures

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Deficit LE development scenarios

• slight impact on the deficit ( , - 0,07
  percentage point) expenditures increase
  (decrease) a little stronger than revenues
  increase (decrease)

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Results Scenario I, II and III

• 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

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Different scenarios sensitivity changes (2050)
as a share of baseline scenario results

• with death-related costs nearly 30 lower
  deficit
• with better (worse) LE development only 5,4 of
  change