Projections of Demand for Healthcare in Ireland, 2015-2030

Projections of Demand for Healthcare
in Ireland, 2015 - 2030
ESRI Research Report Number 67
Publication on October 26th 2017
Authors: Maev-Ann Wren, Conor Keegan, Brendan Walsh,
Adele Bergin, James Eighan, Aoife Brick, Sheelah Connolly,
Dorothy Watson, Joanne Banks
PUBLICATION EMBARGO, 00.01 AM THURSDAY OCTOBER 26TH 2017

PUBLICATION EMBARGO, 00.01 AM THURSDAY OCTOBER 26th 2017
Introduction
ESRI research report, “Projections of Demand for
Healthcare in Ireland 2015-2030”, published
tomorrow (26 October 2017)
Programme of research funded by Department of
Health since 2014
First output from new ESRI Hippocrates model
Important step to help decision-making and planning

Introduction
Most comprehensive mapping of public and private
activity in the Irish healthcare system to have
been published.
Annual projections of demand for wide range of
health and social care services to 2030
Based on new ESRI population projections, first
published based on 2016 Census

Objectives: answer important questions in
Irish health policy
This report:
– How much care is used now?
– How much unmet need is there?
– How much demand for care will there be in future?
Future research and applications of model:
– What capacity will system need to meet future demand?
– How much spending will be needed?
– How much does Ireland spend relative to other countries?
– What are the drivers of Irish healthcare spending?
– If reform to change eligibility e.g. further extension free GP
care – how much additional demand?

Methods and scope of this report
• Scope: wide range of services (hospital,
primary, community, long-term)
• Scope: public and private demand
• Base year and time horizon: 2015 –2030
• Base case (pure population growth)
• Preferred projection range varies assumptions
about population, health status and unmet
demand
• Assume no change to models of care

The Hippocrates Model
Method: macro-simulation, single year of age, M/F

Determinants of Future Healthcare
Demand
• Population Growth
– The increase in the number in the population will impact overall
demand for care.
• Change in Population Age Structure
– The age structure of the population will also drive the demand for
healthcare;
• Healthy Ageing
– Although population ageing is often associated with increased
healthcare utilisation, the relationship of health to ageing is unclear
• Unmet Need
– When added to current use, increases projected demand

Main Findings
Demand for care across all health and social care
sectors projected to increase substantially in years to
2030
Driven by
Rapid growth and ageing of population
Plus unmet needs
Although we take an optimistic view of health as life
extends

Presentation Outline
• Demographic projections
• Approach to healthy ageing evidence
• Approach to unmet need
• Detailed findings and projections
• Conclusions and policy implications

DETERMINANTS OF DEMAND:
1: POPULATION GROWTH & AGEING

Demographic Context
• Ireland’s demographic profile is unusual in an EU context
– Rapid population growth, 1996-2016: 31%; 6% in EU-28
– Have a younger population structure, e.g. 2016: 13% of
population aged 65+; 19% in EU-28
• However…
– Relatively young demographic masks increases at older ages, e.g.
1996-2016: 64% increase in population aged 80+
Population is ageing

Demographic Modelling
• Population projections: combine assumptions on average number
of children per woman (fertility), life expectancy and migration
– Migration is a key driver of population change in Ireland, very
sensitive to economic conditions, link with our macro-model COSMO
• Three different population scenarios (Central, High and Low)
• Central scenario assumptions:
– Life expectancy at birth is assumed to increase from 78.4 to 82.9
years for males and from 82.9 to 86.5 years for females by 2030
– Total fertility rate unchanged from 2015 rate of 1.94
– Net immigration averaging 9,000 p.a. to 2021 and 13,000 p.a.
thereafter

Summary of Population Projections
• Population to increase to between 5.35 to 5.79mn by 2030 in
Central and High scenarios
– This is an overall increase of between 14 to 23% on 2015 or an
annual increase of between 42 and 70 thousand per year
– Migration is key driver of differences in Central and High scenarios
• The number of older persons is set to increase
– Population aged 65+: 1 in 8 now by 2030 1 in 6
• Central scenario growth between 2015 and 2030:
– Total: 14%; aged 65+: 60%; aged 80+: 89%
• High scenario growth between 2015 and 2030:
– Total: 23%; aged 65+: 63%; aged 80+: 94%

2: AGEING AND HEALTH

Healthy Ageing
• The relationship between population ageing and healthcare
demand is nuanced
• The approach adopted in this report to understand this relationship
reflects synthesis of national and international evidence
• There are three main Healthy Ageing assumptions:
– Expansion of Morbidity
– Dynamic Equilibrium
– Compression of Morbidity
15

How Healthy Ageing Scenarios Impact
Projected Demand
• Expansion of Morbidity
– As the population ages, additional years of life are spent in bad health
(morbidity/disability)
• Dynamic Equilibrium
– As the population ages, the number of years in bad health remains fixed
• Compression of Morbidity
– As the population ages, the number of years in bad health reduces
• Moderate Healthy Ageing
– Intermediate point, halfway between Expansion of Morbidity and
Dynamic Equilibrium
• The healthy ageing assumptions applied in this report differ between
sectors
16

3: UNMET NEED AND DEMAND

Unmet Need/Demand
• Unmet need for care generally understood to refer to a need for
care not being met
– Unmet demand refers to unmet need where care has been sought
(e.g. hospital waiting lists)
• Three key factors contribute to unmet need
– Access e.g. cost
– Availability
– Acceptability
• In international reviews, Ireland scores quite badly on levels of
unmet need for healthcare, particularly due to access (Koolman,
2007)
18

Unmet Need/Demand
• The model calculates the volume of unmet need/demand in
2015 and applies this to our baseline activity rate
• Survey data (e.g. GP visits, PHN visits)
• Self-reported levels of unmet need converted into measure of
activity
• Administrative waiting list data (e.g. public hospital outpatient
and inpatient care, residential LTC places, home help)
– Unmet demand measured at end of the year and converted to
activity
– Avoids double-counting
– For hospital care, we apply national and international time
thresholds
19

Unmet Demand in Acute Public Hospitals
• Outpatient
– Low Volume: 365 days (HSE (2016) target for 85 per cent of first
time appointments to occur within 52 weeks)
– Medium Volume: 180 days (New Zealand)
– High Volume: 70 days (Sláintecare Report)
• Inpatient/Daycase
– Low Volume: 140 days [child], 240 days [adult] (HSE (2016))
– Medium Volume: 30 days [urgent], 120 days [routine] (Australia’s
urgent threshold, 120 days threshold is used for reporting by the
Commonwealth Fund)
– High Volume: 15 days [urgent], 84 days [routine] (Norway’s and
Portugal’s urgent threshold, Sláintecare Report)
20

EVIDENCE FOR FUTURE DEMAND:
CURRENT HEALTHCARE USE

Irish health and social care activity in 2015
Hospital care
• Estimated 4.2 million inpatient bed days
– 15% (613,000) delivered in private hospitals
• Estimated 1.5 million daypatient cases
– 31% (459,000) delivered in private hospitals
• Over 1.1 million public hospital ED
attendances
• Nearly 3.3 million public hospital outpatient
visits

Long-term and home care
• Nearly 10.6 million long-term care bed days
• 29,000 residents in nursing homes/other
facilities
• Over 14.3 million home help hours
– 27% (3.9m) home help hours privately purchased
• Over 15,000 Home Care Package recipients

Community care
• Over 17.5 million GP visits and nearly 6 million
practice nurse visits
• Over 73 million public prescription items
• Over 1.3 million public health and community
nurse visits
• Over 1 million visits to public physiotherapists,
occupational therapists and speech and language
therapists combined

PROJECTIONS OF HEALTHCARE
DEMAND 2015-2030

Public Hospitals
Projected demand increase 2015 - 2030
Inpatient bed days: 32-37% demand increase
Up to 1.2 million extra bed days in 2030
Daypatient cases: 23-28% demand increase
Up to 300,000 extra cases in 2030
ED attendances: 16-26% demand increase
Up to 292,000 extra attendances in 2030
Outpatient visits: 21-30% demand increase
Up to 1.0 million extra attendances in 2030

Private Hospitals
Inpatient bed days: 28-32% demand increase
Up to 197,000 extra bed days in 2030
Day patient cases: 24-28% demand increase
Up to 131,000 extra cases in 2030

Long-term and Home Care
Nursing home places: 40-54% demand increase
Up to 15,600 extra places in 2030
Home help hours: 38-54% demand increase
Up to 7.7 million extra hours in 2030
Home care packages: 44-66% demand increase
Up to 10,000 extra packages in 2030

GP Care and Medicines
GP visits: 20-27% demand increase
Up to 4.8 million extra visits in 2030
Practice nurse visits:26-32% demand increase
Up to 1.9 million extra visits in 2030
Publicly-funded medicines: 34-37% demand
increase
Up to 27.4 million extra prescription items in 2030

Public community therapists and nursing
Public health nursing : 26-35% demand increase
Up to 478,000 extra visits in 2030
Physiotherapy: 24-30% demand increase
Occupational therapy: 33-38% demand increase

Roles of population growth, ageing and
unmet demand in projected demand growth
Public acute hospital inpatient bed days
DE: Dynamic
Equilibrium

Residential long-term and intermediate care places
DE: Dynamic
Equilibrium;
CM: Compression
of Morbidity

GP visits
EM: Expansion of
Morbidity;
MHA: Moderate
Healthy Ageing

CONCLUSIONS AND POLICY
IMPLICATIONS

Conclusions
• Ireland is unusual in recent and projected rapid
population growth
• Population growth is a major driver of demand
• Population growth in older age cohorts will be a
major driver of demand even if optimistic healthy
ageing assumptions prove correct

Conclusions
• Demand for health and social care projected to increase
across all sectors
• Greatest increases for services for older people
• Up to 54 per cent projected demand increase for home
help care, residential and intermediate care places
• Up to 37 per cent projected demand increase for inpatient
bed days in public hospitals
• Up to 30 per cent projected demand increase for inpatient
cases in public hospitals
• Up to 27 per cent projected demand increase for GP visits

Policy implications
• Demand projections have major implications for
capacity planning, capital investment, workforce
planning and training
• Demand will need to be met in most if not all
settings to avoid increased unmet demand
• The healthcare system is currently within this
projection period and experiencing these pressures

Projections of Demand for Healthcare in Ireland, 2015-2030

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