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DEPARTMENT OF HEALTH Republic of South Africa Presentation to SANAC Technical Task Team: Treatment, Care & Support Health Sector Impacts of HIV/AIDS: Key Issues for Planning Martin Hensher Directorate: Health Financing & Economics
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Presentation to SANAC Technical Task Team: Treatment, Care & Support Health Sector Impacts of HIV/AIDS: Key Issues for Planning Martin Hensher Directorate: Health Financing & Economics. DEPARTMENT OF HEALTH Republic of South Africa. Presentation Objectives. - PowerPoint PPT Presentation
Transcript of DEPARTMENT OF HEALTH Republic of South Africa
DEPARTMENT OF HEALTHRepublic of South Africa
Presentation to SANAC Technical Task Team: Treatment, Care & Support
Health Sector Impacts of HIV/AIDS:Key Issues for Planning
Martin HensherDirectorate: Health Financing & Economics
DEPARTMENT OF HEALTHRepublic of South Africa
Presentation Objectives
• To summarise key results of the recent Abt Associates Health Sector Impact Study
• To discuss strengths and limitations of the study
• To identify key resource issues of relevance to the workshop discussion
DEPARTMENT OF HEALTHRepublic of South Africa
Impact Study - Background
• Abt Associates commissioned by DoH with World Bank funding
• Project overseen by DoH Steering Committee
• Report “The Impact of the HIV Epidemic on the Health Sector in South Africa” delivered in November 2000
DEPARTMENT OF HEALTHRepublic of South Africa
Status of Report
• Presented at various DoH fora• Considerable internal discussion• Not yet a public document• Presentation contents should not be
regarded as reflecting official DoH policy
DEPARTMENT OF HEALTHRepublic of South Africa
Study Methods - Overview
• Synthesises multiple data sources to develop several models
• Core provided by Doyle model of epidemic
• No primary data collection, all estimates generated from existing sources
DEPARTMENT OF HEALTHRepublic of South Africa
Main Limitations
• Heavy reliance on a few data points, especially for costs of care – some of which are open to question
• Heavy use of (strong) assumptions• Projection forwards of “current practice”
is not sustainable or realistic – but gives an outer limit to cost projections
DEPARTMENT OF HEALTHRepublic of South Africa
Main Strengths
• Successfully assembled more relevant data in one place in a workable form than anyone else to date
• Based on a generally respected epidemiological model
• The only show in town until we have much stronger primary research
ObjectivesProject the likely course of the epidemic, and
its impact on the South African population, divided into populations depending on public and private health care services.
Estimate the likely increase in health service utilisation, and the costs associated with this.
Estimate total expenditure requirements until 2010
Estimate the impact that the epidemic will have on employees in the public health sector.
Epidemic Projection Assumptions
Most up to date Doyle simulation model Model has been extensively used for other
impact assessments in South Africa Base populations for public and private
sectors taken from 1995 October Household Survey and projected until 2010
Assumes that there will be little cross-over between public and private sector membership and mid case scenario
The Doyle model produces conservative estimates of the course of the epidemic
HIV PREVALENCE: ADULTS 20-64
0%
5%
10%
15%
20%
25%
30%
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
BestCase
MiddleCase
WorstCase
ADULT HIV PREVALENCE BY MEDICAL AID STATUS (Mid Case)
0%
5%
10%
15%
20%
25%
30%
NoMedicalAid
MedicalAid
AIDS CASES 1995-2010 (Best and Worst Scenarios)
0100,000200,000300,000400,000500,000600,000700,000800,000900,000
1,000,000
Best Case Worst Case
AIDS AND NON-AIDS DEATHS IN ADULTS
050,000
100,000150,000200,000250,000300,000350,000400,000450,000500,000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Non AIDS DeathsAIDS Deaths
CUMULATIVE AIDS DEATHS IN ADULTS
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Cumulative AIDS deaths
Public Sector Utilisation data– Chris Hani Baragwanath Hospital and three
mine hospitals (average taken)– Extracted by approximate WHO clinical stage
of disease– Removed chronic TB care, and all
occupationally compensatable TB care – Utilisation measured in terms of acute inpatient
days, ambulatory visits, and full courses of TB therapy
– Calculated separately for children and adults
No data on HIV-related utilisation in the private sector
Used Johannesburg Hospital data (1989-1996) as best available proxy
Same units of utilisation used as for public sector data
Private Sector Utilisation Data
Expected number of HIV-related admissions by year and age category
0
500000
1000000
1500000
2000000
2500000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Adm
issi
ons
Children
Adults
HIV related acute bed-days, ambulatory attendances and days of DOTS required in the public sector by year.
0
5000000
10000000
15000000
20000000
25000000
30000000
35000000
40000000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Bed-days
Ambulatory att.
Days of DOTS
Public Sector HIV Expenditure
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Expe
nditu
re (R
mill
)
Inpatient adult Ambulatory adultChronic TB adult Children
Total Public Expenditure
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Cos
ts R
' mill
HIV-associated diseaseNon-HIV associated illness
Total Private Expenditure
0
5000
10000
15000
20000
25000
30000
35000C
osts
R'm
ill
HIV associated diseasenon-HIV associated illness
Impact of substitutes for in and outpatient hospital care on HIV-related expenditure requirements.
4000
6000
8000
10000
12000
14000
16000
18000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
HIV
-rel
ated
exp
(R m
ill)
Base* 50% hospice
PHC clinic Home based care
Price Reductions for HAART
* Base case is without HAART
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Exp
endi
ture
(R m
ill)
Base* 100% 75%50% 25% 10%
0
1000
2000
3000
4000
5000
6000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Ran
d (M
illio
ns)
$600 ppa$350 ppa
Costs of Generic HAART – Current Offer
Predicted annual costs of MTCT prevention, INH and cotrimoxazole prophylaxis.
-100
0
100
200
300
400
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
R m
ill
Cotrim
INHMTCT
MTCT net
Conclusions (1) Largest impact will be on acute public hospital
inpatient facilities under current mode of care Projected impacts on the private sector are
significant, but no reason to predict the demise of the industry. If anything they support the Government view that this sector can and should bear its share of the weight of the epidemic.
Tuberculosis is the largest cause of admission, and uses a disproportionate number of acute bed days – Rationalising and improving the effectiveness of TB
care will be critical to reducing the impact of HIV
•
Conclusions (2) Regarding antiretrovirals:
– Vertical transmission prevention strategies warrant introduction because they are cost effective, not because they would have massive impact reduction potential
– HAART may be cost-effective in certain contexts, but affordability problems are likely to prevent it being introduced to the public sector. Affordability would not seem to be a significant problem in the private sector assuming they have access to discounts.
Conclusions (3) Equity implications
– The already strained public sector (and its users) will bear most of the health sector impact of HIV/AIDS. This is likely to increase
– Private/public sector differential spending on health care will increase from 4 to 6 fold
– Battle is to maintain status quo, let alone righting the balance
– Equity between provinces may be affected
Conclusions (4) Rationing of care to HIV infected individuals is
inevitable Critical to direct rationing imperatives towards
more cost-effective and appropriate forms of care This will require an extensive capital investment
programme in terms of facilities and training of health care workers willing to undertake this task
Projected HIV infection levels in the Health Sector
0%
5%
10%
15%
20%
25%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Best case Mid caseWorst case
Projected HIV infection levels in the Health Sector by Job Category (middle scenario)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Dentists
Doctors
Therapists
ProfNurses
StudentNurses
NursingAssistantsStaffNurses
Pharms
CUMULATIVE AIDS DEATHS AMONG HEALTH SECTOR EMPLOYEES (mid case)
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Cumulative AIDS Deaths
STAFF IMPACT Conclusions (1)
– The HIV epidemic will be the biggest challenge facing HR management in the health sector over the next decade.
– The DPSA is planning around general labour issues, including benefits, BUT:
– The Department needs to plan programmes at a provincial, district and institutional level.
– All managers will need to become proficient in HR issues
STAFF IMPACT Conclusions (2)
– Aggregated data may hide devastating impacts at a local level.
– Vulnerable institutions and work processes should be identified for special attention.
– The Department needs to make staff aware of their risk outside the wards, as well as inside.
– An environment needs to be created where PLWHA (patients AND staff) are treated with respect and care.
Treasury Projected Real Public Health Spending vs. Abt Model Projections
0.0
10.0
20.0
30.0
40.0
50.0
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10
Ran
d (B
illio
ns)
Calculated Real Health ABT Associates Projections
