National Health Insurance
Conclusions and Implications for NHI
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Studies of healthcare costs to do pricing for a future NHI would usually be done using historic data. If the historic data is not analysed by age and gender, then applying it to today would already be too low as the population has changed shape this decade. Applying the historic cost to the future, without considering age and gender, will likewise produce an estimate that is too low. Studies are also typically done on a small part of the population. If these results are not produced by age and gender, then the cost of healthcare may be very different when the whole population is enrolled. This policy brief has shown how important it is to work by at least age and gender in any costings and when working with the population.
This policy brief has also shown how different the age and gender profiles are for each province. Any allocation of funds to the provinces should take into account at least the differences in age and gender, but preferably also the disease burden of each province. This begins to hint at the need for risk-adjusted payments to the provinces or any other pools in a future NHI. The issue is the same one encountered in the multiple pools in medical schemes: pools have very different structures by age and gender and risk-adjusted payments need to be made on at least an age and gender basis in order to charge everyone the same community rate for the minimum benefit package.
The policy brief has also demonstrated the future age and gender profiles that have been projected through to 2025. It is important to look further forward than just a typically five year planning horizon to see some of the longer term demographic changes that might be expected. The implication of the aging of the population is that there will be greater future demand for both chronic medicine and for hospitalisation, as both these are strongly related to age. There are distinctive curves for females and males, as commonly found in other countries, and work needs to be done by both age and gender.
There is much research effort needed to produce reliable curves of the cost of healthcare in the public sector by age and gender. Work is also expected to be underway soon with a new costing of PMBs and possibly expansions of the PMB package. This work too must be done by age and gender. The costing of care for the low income market (LIMS) 12 did not produce tables by age and gender, making it difficult to determine the cost when the package is applied to the whole potential LIMS population. Researchers are strongly urged to take this into account in preparing future costings of healthcare in any setting: work by age and gender.
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