1. Prevention policies as tool for NHS sustainability Vincenzo Atella Health Econometrics, Economics and Policy (HEEP)

2. Deaths - 1990 June 2013 2

3. Deaths - 2000 June 2013 3

4. Deaths - 2010 June 2013 4

5. Years of life with disability - 1990 June 2013 5

6. Years of life with disability - 2000 June 2013 6

7. Years of life with disability - 2010 June 2013 7

8. THE ROLE OF PREVENTION TO CONTAIN EXPENDITURE 8

9. Simulatuion of life expectancy at age 65 without pathologies - France 9 Fonte: Alai, Gaille e Sherris, 2013 - Australian School of Business Research Paper No. 2013ACTL08 Δ +3 anni Δ +5 anni

10. Simulations on the role of prevention in USA using the Future Elderly Model June 2013 10 Source: P.-C. Michaud et al. / Social Science & Medicine 73 (2011) 254-263 Health Differences between U.S. and SHARE-Europe Population Aged 50-53 2004

11. Simulations using the FEM June 2013 11 Fig. 5. Source: Authors’ own calculations using the microsimulation model. Health expenditures include Medicare and Medicaid. Social Security includes SSI, DI and OASI expenditures. Net Fiscal Impact is the revenue change minus the total expenditure change. All amounts in billions $2004 and refer to the difference between the European scenario and the status quo defined in Fig. 4. Source: P.-C. Michaud et al. / Social Science & Medicine 73 (2011) 254-263

12. Simulations using the FEM June 2013 12 Source: P.-C. Michaud et al. / Social Science & Medicine 73 (2011) 254-263

13. Simulating prevention role in Italy  The simulations produced are based on an econometric model developed within the Sissi project (Simulation of Healthcare Spending in Italy), a project born from the collaboration between Farmafactoring Foundation and SIMG, with the scientific collaboration of CEIS Tor Vergata and ISTAT  The Sissi Project collects information on the costs and needs in the healthcare sector, using information collected by GPs at patient level, supplemented with information on economic, political, socio-demographic and environmental level at municipal and provincial level (more than 200 variables ). 13

14. Il modello per la simulazione  Estimates are obtained from a sample of over 5 million observations, they are statistically reliable and consistent from the point of view of the economic interpretation.  From these estimates we obtained simulations that have allowed us to obtain information on the role of hypothetical prevention policies. 14

15. Trend in health care spending by age class – pure aging hp 15 Fonte: elaborazioni Fondazione Farmafactoring su dati HS - SiSSI

16. The simulation scenarios  The prevalence of the diseases most closely related to lifestyle (diabetes, hypertension, dyslipidemia, coronary heart disease, heart failure, stroke, COPD, colon cancer, breast cancer, stomach cancer):  will suffer a gradual decline, to arrive in 2050 to a - 40%;  will suffer a gradual delay, to reach in 2050 the postponement of 10 years (i.e., in 2050, after the policy, the prevalence of chronic diseases attributable to those in their 40s will shift in the cohort of those in their 50s);  undergo a gradual delay, arriving in 2050 at the deferral of 20 years. 16

17. Simulation results 17 Fonte: elaborazioni Fondazione Farmafactoring su dati HS - SiSSI Δ +8 mld

18. Simulation results  The previous figure shows the results of the simulations, which are compared with the trend obtained under the pure aging scenario.  As can be seen, the reduction in the prevalence of chronic conditions could lead to remarkable results in terms of cost savings:  in 2045, the spread between the scenario “pure aging” and the one which delays the onset of chronic diseases by 20 years is approximately EUR 8 billion in real terms, equivalent to a reduction of about 25% of health spending devoted health services;  Another interesting aspect to note is that the effects on health care costs of delaying the onset of disease by 10 years is equivalent to that which would gradually reduce them by 40%. 18

19. Conclusions  In the coming years the public resources for health are unlikely to be able to meet the growing health needs.  Policies aimed at cost containment and recovery of efficiency can not be considered the "solutions" to the problem.  Prevention should be seen as an important option to consider to ensure a structural change in the trend of health needs, without seeing impaired guarantees of equality in access and care on the part of all citizens. 19