An Ageing Australia: Implications for Health Expenditure and Private Health Insurance

Allan McLean MD PhD FRACP MBA

Issues Requested for Consideration

•The Biology of Ageing•Consequences of Ageing and its Social Accompaniments•Cause, Prevention and Cure of Disease•Lessons for Health Insurers

The Dubbo Study and Life Outcomes for Older PeopleProfessor John McCallum and colleagues have made a major contribution through their studies of the Dubbo population.

John McCallum, Leon Simons, Judith Simons, Paul Sadler and Joanne Wilson. The continuum of care for older people. Australian Health Review. 1995; 18:40-55

““Not Sick”Not Sick” ““Sick” with Sick” with HospitalisationHospitalisation

Population2805

Not hospitalisedN = 1261

45%

HospitalisedN = 1544

55%

HomeN = 1208

95.8%

HostelN = 30.2%

Nursing HomeN = 10.08%

DeadN = 342.7%

HomeN = 1293

84%

HostelN = 80.5%

Nursing HomeN = 46

3%

DeadN = 197

13%

AliveN = 563%

DeadN = 337%

AliveN = 2452%

DeadN = 2248%

AliveN = 1230

95%

DeadN = 63

5%

Lost toFollow-up

N = 151.22%

Patterns of service use in an elderly cohort over 50 monthsPatterns of service use in an elderly cohort over 50 months

The Dubbo Study and Outcomes for Older People

Dubbo Study - Outcomes if Not Sick

Not hospitalisedN = 1261

45%

HomeN = 1208

95.8%

HostelN = 30.2%

Nursing HomeN = 10.08%

DeadN = 342.7%

Lost toFollow-up

N = 151.22%

Dubbo Study - Outcomes if Sick and Hospitalised

HospitalisedN = 1544

55%

HomeN = 1293

84%

HostelN = 80.5%

Nursing HomeN = 46

3%

DeadN = 197

13%

Dubbo Study - Hostel and Nursing Home Outcomes

Nursing HomeN = 46

3%

AliveN = 2452%

Dead*N = 2248%

HostelN = 80.5%

AliveN = 563%

DeadN = 337%

* - the valued outcome for a nursing home resident

““Not Sick”Not Sick” ““Sick” with Sick” with HospitalisationHospitalisation

Population2805

Not hospitalisedN = 1261

45%

HospitalisedN = 1544

55%

HomeN = 1208

95.8%

HostelN = 30.2%

Nursing HomeN = 10.08%

DeadN = 342.7%

HomeN = 1293

84%

HostelN = 80.5%

Nursing HomeN = 46

3%

DeadN = 197

13%

AliveN = 563%

DeadN = 337%

AliveN = 2452%

DeadN = 2248%

AliveN = 1230

95%

DeadN = 63

5%

Lost toFollow-up

N = 151.22%

Patterns of service use in an elderly cohort over 50 monthsPatterns of service use in an elderly cohort over 50 months

The Dubbo Study and Outcomes for Older People

POPULATION CHANGE (GROWTH RATE) BY AGE GROUP,ACT AND AUSTRALIA 1998/99

-2.0

-1.0

0.0

1.0

2.03.0

4.0

5.0

6.0

7.0

8.0

9.0

Grow

th ra

te (%

)

ACT

Australia

0-4 5-14

15-2425-54

55-64

65-74

75+

Total

Australian Hospital Usage 1995-1996

Separations (per 103 population) Patient bed days (per 103 population) Males 65-69 640 3060 85+ 1058 11668 Females 65-69 508 2617 85+ 813 11157

Productivity in Australian Health Care Services

Source – IBISWorld Top 1000 Enterprises (2000-01) Published in The Australian

Falls as a National Issue

In 1995, falls were the most frequent cause of most recent injury, affecting 188,700 people with a current injury of injury-related condition (1.0% of the population). Similar numbers of males and females were injured in falls (94,000 and 95,000 respectively).

Falls accounted for 32% of all people having a recent injury, being the most frequent cause of injury among females (39%) and the second most common cause among males (27%). Persons aged less than 15 years and those 65 years and over had the highest prevalence of injury from falls.

Falls 120,660

Transportation 51,488

Hospital separations due to injury and poisoning, Australia 1999–00

Research Centre for Injury Studies, AIHW

Australian Institute of Health and Welfare, 2002

Drugs recommended by WHO as requiring care due to adverse drug reactions

BenzodiazepinesCarbemazepineHaloperidolLevodopaMetoclopramideBenzhexolChlopropamide

ChlorpromazineIndomethacinMefenamic acidIsoniazidMethyldopaNitrofurantoinTetracycline

Quality of Life for Older People – Values are Known

Self determination and personal autonomy are the

values.

Our perspectives on the priorities for the health dollar if research is driven by the values of older people

• Get older people well and home (efficient

and effective acute and sub-acute care)

• Priority prevention of existing disease and

disability (known as “secondary

prevention”)

• Primary prevention of disease

• Promotion of healthy ageing (prevention of

primary ageing)

Efficient and Effective Acute & Sub-Acute Health Care Services to the Elderly

Patients admitted to the acute care of the elderly (ACE) unit at Canberra Hospital (1993/4-2001/2) comparing patients within the home ward ( ) with patients housed outside the ACE unit ward ( ).Allan McLean. The Future of Aged Care. Internal Medicine Journal. 2003; 33 (in press).

247390

525 507 496 484 506

17966 117 140

0

100

200

300

400

500

600

700

800

1993/94 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02

Reducing heart attack in people with heart disease

Intervention Risk reduction Mediterranean diet 72% Fish oil 35% Quit smoking advice 32% Statins 25% Antihypertensives 21% Aspirin 18%

Source: de Lorgirel et al, The final report of the Lyon Diet Heart Study: Circulation.

Cost per life year gained

(£ sterling)

50

66

290

5634

8240

Treatment

Aspirin

Thiazide (antihypertensive)

Mediterranean Diet

ACE Inhibitor (antihypertensive)

Simvastatin (cholesterol lowering)

Cost-effectiveness of prevention for heart disease

Source: Ebrahim S, Davey-Smith G, McCabe C, Payne N, Pickin M, Sheldon TA et al. What role for statins? A review and Economic model. Health Technol Assess 1999;3:No (19)