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The Costing of the Chronic Disease List

This study provides data on the costing of chronic diseases, including cluster analysis and the applicability of the Chronic Disease List. It covers data from the Medscheme Data Warehouse for the year 2001. The study explores distinct clusters with different benefit utilization, costs, and disease profiles, and also examines provider behavior within these clusters. The study includes information on chronic registrations, prevalence of CDL conditions, co-morbidity, average cost per case, and more.

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The Costing of the Chronic Disease List

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  1. The Costing of the Chronic Disease List January 2003

  2. CDL Study Data • Data from Medscheme Data Warehouse • Data covers 2001 calendar year, extracted in August 2002 • Data fully run-off, no adjustment for IBNR • 46 options • 27 schemes • 16.103 million beneficiary months of data • Average exposure of 1,341,892 beneficiaries

  3. Cluster Analysis and Applicability

  4. Cluster Analysis • Distinct clusters: • High contains options with older, 'whiter' members with high utilisation; • Medium-older contains options with medium utilisation and older members; • Medium-younger contains options with medium utilisation and younger members; and • Low contains options with younger, 'blacker' members with low utilisation. • Additional not present in PMB study. Single large scheme where the ethnicity is predominantly so-called “Coloured”

  5. Cluster Analysis • Different clusters experience different benefit utilisation, costs and disease profiles. Provider behaviour differs by cluster, even within the same hospital facility. • Study contains more Low cluster beneficiaries than the industry. • For industry comparisons, useWeighted industry price. • This uses 50% of the costs of the Low cluster and 100% of the other clusters. • Low clusteris more relevant to the emerging low-cost option environment.

  6. Centre for Actuarial Research Beneficiaries by Cluster

  7. Centre for Actuarial Research Age Profile by Cluster

  8. Proportion of Options Covering the CDL

  9. Industry Benefit Study 2001 Source : CARE Monograph

  10. Proportion of Beneficiaries Covered for CDL

  11. Chronic Registrations by Cluster Q1 2002 data

  12. Cluster Average 29.7% Chronic Registrations High Cluster Q1 2002 data

  13. Cluster Average 16.9% Centre for Actuarial Research Chronic Registrations Medium-older Cluster Q1 2002 data

  14. Cluster Average 9.3% Chronic Registrations Medium-Younger Cluster Q1 2002 data

  15. Cluster Average 11.4% Centre for Actuarial Research Chronic Registrations Low Cluster Q1 2002 data

  16. Chronic Registrations Scheme H Q1 2002 data

  17. Prevalence of CDL Conditions from Registrations

  18. Registration of Beneficiaries for Chronic Medicine Other Chronic Conditions 22.9% CDL Conditions 77.1%

  19. Centre for Actuarial Research Prevalence of CDL Registrations

  20. Single Disease 40.6% As Co-morbidity 59.4% Centre for Actuarial Research Co-morbidity in Registrations

  21. Centre for Actuarial Research Co-morbidity in Registrations

  22. Centre for Actuarial Research Co-morbidity in Registrations

  23. Beneficiaries Registered for CDL Conditions

  24. Single Disease Analysis

  25. Centre for Actuarial Research Registered Beneficiaries Claiming Single diseases only

  26. Centre for Actuarial Research Proportion of Total Drug Claims Single diseases only

  27. Centre for Actuarial Research Proportion of Total Drug Cost Single diseases only

  28. Centre for Actuarial Research Centre for Actuarial Research Average Cost per Case Single diseases only

  29. Centre for Actuarial Research Centre for Actuarial Research Average Cost per Case Single diseases only

  30. Multiple Disease Analysis

  31. Registered Beneficiaries

  32. Centre for Actuarial Research Registered Beneficiaries Claiming Multiple diseases

  33. Centre for Actuarial Research Proportion of Total Drug Claims Multiple diseases

  34. Centre for Actuarial Research Proportion of Total Drug Cost Multiple diseases

  35. Centre for Actuarial Research Average Cost per Case Multiple diseases

  36. Centre for Actuarial Research Average Cost per Case vs. Sum of Single Diseases Multiple diseases

  37. Prevalence All Diseases

  38. CDL Package by Age

  39. 14% 12% 10% 8% Proportion of beneficiaries 6% 4% 2% 0% 0 1-4 5-9 85+ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 Centre for Actuarial Research Age of Exposed Beneficiaries

  40. Age of Claiming Beneficiaries

  41. 14% 12% 10% 8% Proportion of Claiming Beneficiaries 6% 4% 2% 0% 0-1 1-4 5-9 85+ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 Age of Claiming Beneficiaries

  42. Centre for Actuarial Research Age of Claiming Beneficiariesfor Selected Diseases

  43. Centre for Actuarial Research Age of Claiming Beneficiariesfor Selected Diseases

  44. CDL Prevalence by Age

  45. CDL Prevalence by Age

  46. 600 500 400 300 Prevalence per 1000 beneficiaries 200 100 0 0-1 1-4 5-9 85+ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 All ages CDL Prevalence by Age

  47. Average Cost by Age

  48. 5,000 4,500 4,000 3,500 3,000 2,500 Average Cost per case pa 2,000 1,500 1,000 500 0 0 1-4 5-9 85+ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 All Ages Average Cost of CDL by Age

  49. Centre for Actuarial Research Raw Price of CDL by Age

  50. 2,500 2,250 2,000 1,750 1,500 Price per beneficiary pa 1,250 1,000 750 500 250 0 0 1-4 5-9 85+ 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 All Ages Raw Price of CDL by Age

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