CHALLENGES FACING HEALTH INSURANCE IN A MULTI TRANSITION WORLD

financing of and access to healthcare services

J Cechin Jos C hi
jcechin@iess.org.br Geneva Association,28set2010 55113706.9747

Agenda ge d Transitions
demographic epidemiological nutritional ii l sedentary climate and global warming

Health insurance Financing and access

New products Health promotion and prevention
2

Demographic transition

Age pyramids
1980 2010 2050

Fecundity rate
Fecundity rate(%) 7,0 6,0 5,0 40 4,0 3,0 20 2,0 1,0 00 0,0

Source:IBGE

Gross birth and mortality rates

Birth rate (L) ( ) - TBN ( Taxa bruta deTBR natalidade (L) ) Taxa bruta de mortalidade Death rate TBM (L) - TBM (L) Populao (R) (R) Population
50 45 40 TBN N e TBM (taxas p por mil) 35 TBN 280 260 240

180 160 140

T Taxa de d crescimento i t natural t l

30 25 20 15 10 5 1900 1910 TBM

120 100 80 60 40 20 0 1920 1930 1940 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Fonte:IBGEeONU www.esa.um.org/unpp visitadoem18dejaneirode2006

Populao (em milhes)

* * * * * * * * *

220 200

Age structure
Youngsters (0 14) 14), working age (15 64) and elderly (65+) - %

EU Health expenditures by age

ource: Pellikaan e Westerhout, 2005 8

Epidemiological transition

Epidemiological Transition
Developing countries: global burden of disease mortality and incapacity 1990 2020

Communicable diseases

non-communicable diseases violence

10

Source: WHO Ageing and Life Course Programme

Epidemiological Transition
ProportionalMortalitybygroupofcauses
India China USA Japan Brazil Ni i Nigeria Ethiopia 0 20 40 60 80 Communicable,maternal,perinatalandnutritionalconditions Noncommunicablediseases Injuries 100

Source: WHOSIS

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Epidemiological Transition
InfectiousandcontagiousDiseases
Deaths among children under 5 years due to pneumonia (%)

20 16 12 8 4 0,6 0 France
Source:WHO2002

18,5 13,2

Brazil

India

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Epidemiological Transition
Chronicdiseases
Mortality rate for cancer (per 100 000 population) Mortality rate for cardiovascular diseases (per 100 000 population)

160 140 120 100 80 60 40 20 0

142

142 109

450 400 350 300 250 200 150 100 50 0

428 341

118

France

Brazil

India
Source:WHO2002

France

Brazil

India

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Nutritional transition

14

Nu Nutrition o Diet diversification

Green revolution Transport p facilities
improved nutrition reduced death rate and increased longevity

Caloric and fatty food

overweight and obesity

15

Nutritional Transition
O Overweight i ht
%

Male
50,1 2,7 times 41 4 41,4

Female
1,7 times 48,0 41,9

60 50 40 30 20 10 0 1974 1989 2002 2008

18 5 18,5 29,9

60 50
41 4 41,4

40 30 20 10 0 1974 1989 2002 2008

28,7

Source:IBGE

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Nutritional Transition
Ob it Obesity
%

Male
4,4 times 12,4 9,0 54 5,4 2,8

Female
2,1 times 13,2 13,5 16,9

18 16 14 12 10 8 6 4 2 0

18 16 14 12 10 8 6 4 2 0

8,0

1974

1989

2002

2008

1974

1989

2002

2008

Source:IBGE

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Nutritional Transition
Overweight g inchildrenunder10years y

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Sedentarism

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Sede Sedentarism s
From - predator and prey - walker - manual worker -p physically y y active leisure To - mechanized h i d work k - motorized transport - passive leisure in front of screens

From African savannas To air conditioned soft chairs furnished meeting saloons

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Transitions s o s and d health e Biological constitution out of pace with surrounding environment and life styles Allfourtransitionsleadtoobesityandchronic diseases ThenewglobalmenaceaccordingtoWEF
(WEF2008Report)
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Climate and global warming

22

Climate change
Different sorts of effects
frequency and intensity of natural disasters agricultural productivity populations p p geographical migration of diseases spread d of f tropical i l diseases di

23

Health insurance

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Health insurance and health plans

Impacts p c s of a changing c g g world w d
Aging, non-functional diets, sedentary life styles and epidemiology pid i l all ll contribute t ib t to t increase i the th prevalence p l of f chronic diseases, hence of healthcare expenditures Global warming brings its own challenges to insurance industry, particularly to health insurance
Revival and intensification of tropical diseases Spread p to newly y warmed geographical g g p areas

All this p points to g growing g healthcare expenditures p

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Health e insurance su ce structure s uc u e main numbers u be s

Brazil
Types Insurers HMO Cooperatives Selfmaintained Beneficent Operators 13 480 339 244 97

March/2010
Beneficiaries(%) , 11,9 37,0 35,5 12,2 3,4 Revenues(%) 20,3 , 30,9 34,2 12,3 2,3

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Revenues and Healthcare Expenditures

R$ billion Health Plans 2009
Medical

Revenues

Healthcare Expenditures

64.14 1.33 65.47

53.27 0.65 53.92

Odontological

Total

Source:ANS

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Health Expenditures by source

HealthExpenditures2009 Federal State p Municipal Publicsector Healthplans&insurance Outofpocket Medicines T lprivate Total i TotalBrazil

R$billion 58 34 35 127 64 24 55 143 270

% 22 13 13 47 24 9 20 53 100

%GDP 1 9 1.9 1.0 1.1 4.0 2.0 0.8 1.7 4 5 4.5 8.5
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Source:MSand ANS(GilsonCarvalho)

Financing and access

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Financing and access

Health insurance is expensive
Majority of wealthy people do have health insurance Access difficult for medium and low income classes Need to curb the growth of expenditures
Promotion of adequate life styles

Diversification of products - insurance and plans

Consumer driven health plans p
HSA High deductibles health plans
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Jos Cechin
INSTITUTO DE ESTUDOS DE SADE SUPLEMENTAR

jcechin@iess.org.br jcechin@iess org br www.iess.org.br 55 11 37069747

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Demographic Transition
1980
Female 80 + 70-79 60-69 60 69 50-59 40-49 30 39 30-39 20-29 10-19 09 0-9 40,0 20,0 0,0 20,0 40,0 Male 80 + 70-79 60-69 60 69 50-59 40-49 30 39 30-39 20-29 10-19 09 0-9 20,0 10,0 0,0 10,0 20,0

2009
Female Male 80 + 70-79 60 69 60-69 50-59 40-49 30 39 30-39 20-29 10-19 0-9

2050
Female e ae Male ae

20,0 10,0

0,0

10,0 20,0

Source:IBGEprojeopopulaoreviso2008

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Demographic Transition
Brazils Brazil s population by age group 160 140 120
Mill lion

100 80 60 40 20 0 1980 1990 2000 2010 2020 0-14 15-64 65 +

Source:IBGE

2030

2040

2050

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