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New Models of Care
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1Primary Care Conference, November 2012 1Primary Care Conference, November 2012
New Models of Care
November 2012Fergus Clancy
2Primary Care Conference, November 2012 2
Agenda
• Supply
• Demand
• New model of care required
3Primary Care Conference, November 2012 3
Demand
2010 2020 2030 2040 20500
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
Population Projections >65yrs
65-80yrs >80yrsSource: CSO, Eurostat
4Primary Care Conference, November 2012 4
Demand
0- 17 18-29 30-39 40-49 50-59 60-69 70-79 80+
€164€224
€409€469
€793
€1,469
€2,442
€3,333
Claims Cost per Insured Person 2011
5Primary Care Conference, November 2012 5
Demand
18-24 25-34 35-44 45-54 55-64 65-69 70+
2.4
2.7 2.6
3
3.7
4
5.4
GP consultations by age group
Source: CSO (Q3 2010)
6Primary Care Conference, November 2012
Demand
Source: DOHC
Jan 2010 Mar 2011 Mar 2012
1,479
1,649
1,759
Medical Cards (000's)
19% increase in number of medical cards issued since 2009 – at its
highest for 40 years
7Primary Care Conference, November 2012 7
Supply (Public)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 e 2014 e 2015 e 2016 e 2017 e0
2000
4000
6000
8000
10000
12000
14000
16000
18000Total Health Public Expenditure (incl CAPEX)
Source of 2002-2011 data: Health in Ireland, Key Trends 2011, DOHC. 2013 - 2017 based on 5% cut in first 3 years.
8Primary Care Conference, November 2012 8
Supply (Public)
2006 2007 2008 2009 2010 2011
12,110 12,12311,847
11,538
11,159
10,807
Public In-patient Beds
Source: In-patient & Day Case Activity Data: Hospital In-Patient Enquiry (HIPE), ESRI
9Primary Care Conference, November 2012 9
Supply
Austra
lia
Fran
ce
Canad
a
Portu
gal
Kore
a
Belgi
um
Mex
ico
Austri
a
Finl
and
New Z
eala
nd
Turk
ey
Unite
d Ki
ngdo
m
Luxe
mbo
urg
OECD
Esto
nia
Nethe
rland
sIta
ly
Slov
enia
Israe
l
Norway
Czech
Rep
ublic
Denm
ark
Germ
any
Swed
en
Icel
and
Switz
erla
nd
Slov
ak R
epub
lic
Irela
nd
Unite
d St
ates
Hunga
ry
Pola
nd
Greec
e0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
49.8
49.0
47.4
46.0
41.9
38.9
36.7
33.2
33.1
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
15.9
15.8
13.8
13.5
12.3
11.7
9.5
4.5
GPs as a share of total doctors, 2009
GPs OtherSource: OECD Health at a glance 2011
10Primary Care Conference, November 2012 10
New Model of Care
Hospital Setting Primary Care Setting
High unit price and low access caps activity
Low unit price and high access drives activity
€100 x 1,000= €100,000
€50 x 3,000= €150,000
Quality
Critical mass and multi-disciplinary care
Unit Price
Volume
The Sweet Spot Selected
Procedures in Sufficient Volumes
Agreed Treatment Guidelines
Clinical Leadership &
Less Bureaucracy
11Primary Care Conference, November 2012 11
New Model of Care
The Sweet Spot
Larger Primary Care
Centres
Selected procedures in
sufficient volumes
ICT & MDT linkages
Agreed treatment guidelines
Clinical leadership an
less bureaucracy
Proper financial
incentives
12Primary Care Conference, November 2012
Summary
The whole is other than the sum of its parts
Gestalt Theorist: Kurt Koffka
The Sweet Spot
• Stronger clinical leadership
• Better patient experience
• More efficient use of scarce resources