The Impact of Chronic Disease on a Future NHI National Health Insurance Policy Brief 3 The Impact of Chronic Disease on a Future NHI 27 June 2009

Rate of Chronic Disease in Medical Schemes 2009 The 25 Chronic Disease List (CDL) diseases must be covered by medical schemes as part of the Prescribed Minimum Benefit (PMB) package. Strong pattern by age for chronic disease and multiple chronic disease. Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Diabetes Mellitus Type 2 Diagnosis and Treated More prevalent in males than females. Diagnosed cases requires ICD-10 diagnosis by healthcare practitioner. About two-thirds meet “treated patient” criteria. Need to prove regular supply of appropriate drugs paid from risk pool (not personal medical savings accounts). Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Comparison Medical Schemes and SADHS 2003: Diabetes Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology. Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review 2007. Durban: Health Systems Trust; 2007. URL: http://www.hst.org.za/uploads/files/chap15_07.pdf Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Comparison Medical Schemes and SADHS 2003: Asthma Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology. Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review 2007. Durban: Health Systems Trust; 2007. URL: http://www.hst.org.za/uploads/files/chap15_07.pdf Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Comparison Medical Schemes & SADHS 2003: Hyperlipidaemia Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology. Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review 2007. Durban: Health Systems Trust; 2007. URL: http://www.hst.org.za/uploads/files/chap15_07.pdf Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Comparison Medical Schemes and SADHS 2003: Hypertension Comparison of Demographic and Health Survey results to REF Study 2005 results. First comparison of public and private prevalence but see report for reservations in SADHS methodology. Day C, Gray A. Health and Related Indicators. In: Harrison S, Bhana R, Ntuli A, eds. South African Health Review 2007. Durban: Health Systems Trust; 2007. URL: http://www.hst.org.za/uploads/files/chap15_07.pdf Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Needing Treatment for CDL Chronic Diseases 1985 to 2025 Shows sensitivity to higher and lower rates of chronic disease by age and gender. The aging and growth of the population mean a substantial increase in the numbers needing treatment from 2.99 million in 1994 to 5.13 million by 2025 (172% increase). Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Estimated Numbers Needing Treatment under Future NHI Assumes public prevalence, diagnosis and treatment rates are the same as in medical schemes. Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Implications for NHI Despite some reservations, a first estimate of the burden of chronic disease (excluding HIV) for the country as a whole can be made. This shows that a National Health Insurance system would be facing a growing burden of chronic disease, simply due to the growth in the population and the aging of that population.  This concern is echoed by the MRC: “Demographic change in South Africa has produced a rapidly ageing population that is expected to continue ageing at a rapid rate for at least the short- to medium-term future. ... it currently seems that the serious consequences of population ageing are not adequately planned for and responded to by government. ....”. “The demographic projections pose clear challenges to the health sector. Not only is there a need to plan for the increase in the numbers in older persons but there is also the need to recognise and plan for an expected increase in chronic morbidity and disability.” Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Multiple CDL Diseases in Medical Schemes, excl. HIV At older ages, nearly half the beneficiaries on medical schemes with chronic disease have more than one chronic disease. REF Study 2005 showed people being diagnosed for up to eleven simultaneous conditions and treated for up to nine simultaneous conditions. Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Common Combinations of Chronic Conditions, excl. HIV Data from REF Study 2005 in medical schemes. Analysis excludes HIV as epidemic is progressing each year. Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Numbers with Combinations of Chronic Conditions 2009 This analysis restricted to medical scheme population and excludes HIV (dealt with in Policy Brief 4). Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Managing Chronic Disease There are several ways a future NHI can tackle this problem other than simply increasing the budget for healthcare. Example of Western Cape Department of Health: attempts to intervene in the “up-stream” causes of disease. Germany implemented disease management programmes in their national system in 2002. Other countries to introduce chronic disease management programmes include Singapore, Australia, Japan, Brazil, Argentina, France, Canada, Spain and India. Medical schemes in South Africa have developed wellness programmes, disease management programmes and high-cost patient programmes. South African medical schemes and managed care organisations are amongst the leaders worldwide in this field.   Disease management and wellness programmes are areas where the private sector can add significant value to a future National Health Insurance system, no matter the details of the funding design. Source: IMSA NHI Policy Brief 3: Chronic Disease and Future NHI

Innovative Medicines South Africa (IMSA) is a pharmaceutical industry association promoting the value of medicine innovation in healthcare. IMSA and its member companies are working towards the development of a National Health Insurance system with universal coverage and sustainable access to innovative research-based healthcare.   Contact details: Val Beaumont (Executive Director) Tel: +2711 880 4644 Fax: +2711 880 5987 Innovative Medicines SA (IMSA) Cell: 082 828 3256 PO Box 2008, Houghton, 2041. South Africa val@imsa.org.za www.imsa.org.za

Professor Heather McLeod Material produced for IMSA by Professor Heather McLeod hmcleod@iafrica.com www.hmcleod.moonfruit.com