1. New Models of Care
November 2012
Fergus Clancy
Primary Care Conference, November 2012 1
2. Agenda
• Supply
• Demand
• New model of care required
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3. Demand
Population Projections >65yrs
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
2010 2020 2030 2040 2050
65-80yrs >80yrs
Source: CSO, Eurostat
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4. Demand
Claims Cost per Insured Person 2011
€3,333
€2,442
€1,469
€793
€469
€409
€224
€164
0- 17 18-29 30-39 40-49 50-59 60-69 70-79 80+
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5. Demand
GP consultations by age group
5.4
4
3.7
3
2.7
2.6
2.4
18-24 25-34 35-44 45-54 55-64 65-69 70+
Source: CSO (Q3 2010)
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6. Demand
Medical Cards (000's)
1,759
1,649
19% increase in number of
medical cards issued since 2009 –
at its highest for 40 years
1,479
Jan 2010 Mar 2011 Mar 2012
Source: DOHC
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7. Supply (Public)
Total Health Public Expenditure (incl CAPEX)
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 e 2014 e 2015 e 2016 e 2017 e
Source of 2002-2011 data: Health in Ireland, Key Trends 2011, DOHC. 2013 - 2017 based on 5% cut in first 3 years.
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8. Supply (Public)
Public In-patient Beds
12,110 12,123
11,847
11,538
11,159
10,807
2006 2007 2008 2009 2010 2011
Source: In-patient & Day Case Activity Data: Hospital In-Patient Enquiry (HIPE), ESRI
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9. Supply
GPs as a share of total doctors, 2009
100%
90%
80%
70%
60%
50%
40%
30%
49.8
49.0
47.4
46.0
41.9
38.9
20%
36.7
33.1
33.2
32.0
32.0
29.8
29.3
25.9
25.1
24.9
22.7
20.7
20.3
20.1
19.7
19.6
18.0
16.7
10%
15.9
15.8
13.8
13.5
12.3
11.7
9.5
4.5
0%
GPs Other
Source: OECD Health at a glance 2011
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10. New Model of Care
Hospital Setting Quality Primary Care Setting
Critical mass and
multi-disciplinary care
Selected
Procedures
in Sufficient
High unit price and Volumes
low access caps activity
€100 x 1,000
The
Unit
= €100,000 Sweet
Price Spot
Clinical
Leadership
& Less
Bureaucracy
Low unit price and high
access drives activity
Agreed
Treatment €50 x 3,000
= €150,000
Guidelines
Volume
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11. New Model of Care
Larger
Primary
Care Centres
Selected
Proper
procedures
financial
in sufficient
incentives
volumes
The
Sweet
Spot
Clinical
leadership ICT & MDT
an less linkages
bureaucracy
Agreed
treatment
guidelines
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12. Summary
The whole is other than the
sum of its parts
The Sweet Spot
• Stronger clinical leadership
• Better patient experience
• More efficient use of scarce
resources
Gestalt Theorist: Kurt Koffka
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