michael abbott [email protected] population aging and the north american health care workforce scott...
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Michael Abbott [email protected]
Population Aging and the
North American Health Care Workforce
Scott Otteman
Senior Editor/Researcher
Commission for Labor Cooperation
Mexico City, Mexico
November 13th, 2006
Michael Abbott [email protected]
North America: Comparative Health Spending Ratios 2003Mexico USA Canada
Total Health Spending as % of GDP 6.2 15.2 9.9General Govt. Health Spending as % of Total Health Spending 46.6 44.6 69.9Private Health Spending as % of Total Health Spending 53.6 55.4 30.1General Govt. Health Spending as % of Total Govt. Spending 11.7 18.5 16.7
External Resources for Health as % of Total Health Spending 0.4 0 0Social Security Health Spending as % of General Govt. Health Spending 66.9 28.4 2.1Out-of-Pocket Spending as % if Private Health Spending 94.2 24.3 49.6
Private Prepaid Plans as % of Private Health Spending 5.8 65.9 42.3Source: WHO, The World Health Report 2006,Statistical Annexes
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Note: The reference population for these data is the civilian noninstitutionalized population
Source: McNeil, 2001, Table 1
U.S. - Percent of People Aged 15 and Over Needing Assistance With Everyday Activities by
Age and Sex: 1997
11.6 1320.9
3441.8 45.5
53.4
68.2
9.8 13.7
24.2
37.2
47.5 47.4
60.7
76.7
15 to 24 25 to 44 45 to 54 55 to 64 65 to 69 70 to 74 75 to 79 80 andover
Men Women
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Note: The reference population for these data is the civilian noninstitutionalized population.Source: McNeil, 2001, Table 1
U.S. - Percent of People Aged 15 and Over Needing Assistance With Everyday Activities by Age and Race:
1997
0.7
0.5
1.2
2.8
4.7
2.7
20.7
24.8
15.4
Hispanic (anyrace)
Black
Non-HispanicWhite
65 and over
25 to 64
15 to 24
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U.S. - Percent of People Aged 65 and Over With Chronic Disability: 1982 to 1999
4.2
2.9
3.5
6
3.2
19.7
5.7
3
3.4
6.1
4.4
22.5
6.1
3
3.7
6.7
4.8
24.4
6.6
3.4
3.1
7
6.2
26.2
6.8
3.7
3
6.9
5.7
26.2
Institutionalizedand disabled
5 or 6 ADLs **
3 or 4 ADLs **
1 or 2 ADLs **
IADL only*
Total Disabled
1982
1984
1989
1994
1999
*Instrumental activities of daily living** Activities of daily livingNote: The reference population of these data is the Medicare enrollees aged 65 and older Source: Manton and Gu, 2001, Table 1
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10.4
2.6
6.8
4.2
5.4
22
18.6
18.5
15.9
13.8
45.5
73.2
11.4
38.4
25.4
31.2
110.8
117.8
10.7
42.5
48.6
82.5
170.9
193.1
Mental Illness
Diabetes
Fractures/Joint Injury
Vision/Hearing
Heart/OtherCirculatory
Arthritis/ OtherMusculoskeletal
75 and over
65 to 74
45 to 64
18 to 44
U.S. - Selected Chronic Health Conditions Causing Limitation of Activity
Among Adults by Age: 1998 to 2000 (Number of people with limitation of activity caused by selected chronic health conditions per 1,000 population)
Note: The reference population for these data is the civilian noninstitutionalized population.
Source: National Center fro Health Statistics, 2002a, Figure 17
Michael Abbott [email protected]
Mexico - Proportional Mortality by Selected Causes, 1976-2005
20051976
% of Total Deaths % of Total Deaths Source: IMSS
05101520 0 5 10 15 20
Chronic Kidney Disease
Hypertension
Breast Cancer
Cerebrovascular Disease
Ischemic Heart Disease
Diabetes Mellitus (Type II)
Tuberculosis
Intestinal Infections
Cervical-Uterine Cancer
Pneumonia
Birth-Related Causes
Non-Transmissible
Diseases
Transmissible Diseases Related to Nutrition and Reproduction
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30 23.415.7 11 7.1 5 3.5
62 72.8 81.8 85.3 86.4 86.6 87.8
8 3.7 2.5 3.7 6.5 8.4 8.7
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1985 1990 1995 2000 2005 2010 2015
InjuriesNon-transmissibleTransmissible, birth –related and nutrition-related diseases
Mexico – Increase of Non-Transmissible Disease in Mortality
Source: IMSS
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Mexico - Mortality by Age Group of IMSS Registrants, 1976-2005
0-4 years old 5-14 years old 15-44 years old 45-64 years old 65 + years old Source: IMSS
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Mexico - Index of Doctor Visits by Age GroupB
ase
ye
ar
19
86
< 1 year 1 – 4 years old 5-14 years old 15-24 years old 25-44 years old 45-64 years old 65+ years old
Source: IMSS
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Condition YearTotal Consultations
Treated Patients
Cases of Hospitalization
Out-Patient Spending
Pharmaceutical Spending
Hospitalization Spending
Total Spending
2005 8,066,616 638,953 35,663 3,829.5 534.8 739.6 5,103.82025 20,119,679 1,544,159 81,432 14,329.2 1,990.7 2,651.4 18,935.32005 9,745,105 582,659 13,747 4,493.7 265.5 283.3 5,042.5
2025 26,123,560 1,469,151 34,704 18,056.6 1,031.1 1,106.8 20,194.52005 581,062 10,400 71,171 392.5 1,018.0 2,027.3 3,437.82025 1,346,728 24,529 167,017 1,370.4 3,410.0 7,300.4 12,080.82005 137,436 30,206 6,666 93.5 14.1 227.2 334.72025 189,533 41,482 5,965 194.0 29.8 313.8 537.52005 838,623 166,023 4,810 498.6 409.4 140.7 1,048.72025 1,500,498 293,431 11,368 1,361.4 1,114.5 510.9 2,986.72005 155,647 29,273 3,287 105.0 1,152.2 129.6 1,386.92025 315,159 58,938 6,012 319.9 14,148.5 723.4 15,191.72005 19,524,489 1,457,514 135,344 9,412.8 3,394.0 3,547.7 16,354.42025 49,595,157 3,431,690 306,498 35,631.5 21,724.6 12,570.7 69,926.5
Source: IMSS
Breast Cancer
HIV/AIDS
Total
Mexico - Estimates of Total Consultations, Treated Patients, Hospitalizations, and Spending for Each Category, 2005 and 2025 Base Scenario
(Spending in Millions of 2005 Pesos)
Diabetes Mellitus
Arterial Hypertension
Kidney FailureCervical- Uterine Cancer
Michael Abbott [email protected]
North America: Growing Proportion of Deaths Are Elderly Deaths
2003 total deaths 65 years old and over % of total Mexico 472,140 247,215 52.4U.S. 2,448,288 1,804,373 73.7Canada 226,169 175,586 77.6Sources: INEGI, NCHS & Statistics Canada
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Years of Life Lost (000's) (%) (%)
All causes 222 100 100Ischaemic heart disease 43 19 15Trachea, bronchus, lung cancers 17 8 9Cerebrovascular disease 15 7 4Alzheimer and other dementias 10 5 2Chronic obstructive pulmonary disease 10 5 3Colon and rectum cancers 7 4 4Diabetes mellitus 7 3 3Lower respiratory infections 5 3 1Breast cancer 5 3 3Lymphomas, multiple myeloma 4 2 2Source: Death and DALY estimates by cause, 2002 WHO
DeathsCanada - Top 10 Causes of Death, All Ages, 2002
Years of Life Lost (000's) (%) (%)
All causes 2420 100 100Ischaemic heart disease 514 21 15Cerebrovascular disease 163 7 4Trachea, bronchus, lung cancers 157 7 7Chronic obstructive pulmonary disease 128 5 4Alzheimer and other dementias 93 4 1Diabetes mellitus 76 3 3Colon and rectum cancers 64 3 3Lower respiratory infections 59 3 2Breast cancer 45 2 2Road traffic accidents 45 2 6Source: Death and DALY estimates by cause, 2002 WHO
DeathsU.S. - Top 10 Causes of Death, All Ages, 2002
Years of Life Lost (000's) (%) (%)
All causes 469 100 100Diabetes mellitus 55 12 8Ischaemic heart disease 52 11 5Cerebrovascular disease 26 6 3Perinatal conditions 26 6 13Cirrhosis of the liver 24 5 5Chronic obstructive pulmonary disease 16 4 1Lower respiratory infections 15 3 4Congenital anomalies 12 3 6Road traffic accidents 12 3 5Hypertensive heart disease 10 2 1Source: Death and DALY estimates by cause, 2002 WHO
DeathsMexico - Top 10 Causes of Death, All Ages, 2002
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Non-Hispanic vs. Hispanic Causes of Death in Texas
Non-hispanic All Age Hispanic All AgeRank Disease Number of Deaths Rank Disease Number of Deaths
1 Heart disease 184,717 1 Heart disease 29,8412 Malignant Neoplasms 143,393 2 Malignant Neoplasms 24,0393 Cerebrovascular 45,083 3 Unintentional injury 9,8034 Chronic low respiratory disease 35,125 4 Diabetes Mellitus 8,3915 Unintentional injury 29,269 5 Cerebrovascular 7,4206 Diabetes Mellitus 18,469 6 Liver disease 3,9967 Alzheimer's disease 15,951 7 Homicide 2,7178 Influenza & Pneumonia 15,449 8 Influenza & pneumonia 2,6599 Suicide 9,155 9 Chronic low respiratory disease 2,648
10 Nephritis 8,318 10 Nephritis 2,319
Source: National Center for Injury Prevention and Control
Texas - 10 Leading Causes of Death, Non-Hispanic vs. Hispanic, 1999-2003
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Doctors/1000 Nurses/1000 Dentists/1000 Pharmacists/1000Mexico 1.98 0.9 0.79 0.03U.S. 2.56 9.37 1.63 0.88Canada 2.14 9.95 0.59 0.67Source: WHO, The World Health Report 2006,Statistical Annexes
North America: Density of Health Care Professionals
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Nurse Distribution by Age Group, Percent of Total, U.S. 2004
2.1
14.3 14
59.6
20-24 25-34 35-44 45+Source: HRSA
Nurse Distribution by Age Group, Percent of Total, Canada 2004
2.3
17.3
27.7
52.6
20-24 25-34 35-44 45+Source: CIHI
Profesional Nurse Distribution by Age Group, Percent of Total, Mexico 2006
6.2
35.833
24.9
20-24 25-34 35-44 45+Source: Observatorio Laboral
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Nurses - Monthly Earnings in North America
615
6,234
2,513
Mexico U.S. Canada
US
$
2006
2002
2003
Sources: USA: "ADVANCE" , Mexico: Observatorio Laboral, Canada: Saskatchewan J ob Futures Note: Coverted in U.S. dollars, exchange rates from: Bank of Canada, Average Yearly Exchange Rate for 2000 and 2003, Banco de Mexico: Average exchange rate of the average for J anuary, February and March 2006.
Michael Abbott [email protected]
Physician Distribution by Age Group, Percent of Total, Canada 2004
10.91
27.8631.68
20.30
9.25
Under 35 35-44 45-54 55-64 65+Source: CIHI
Physician Distribution by Age Group, Percent of Total, Mexico 2000
28.4
40.4
20.8
6 4.4
Under 35 35-44 45-54 55-64 65+Source: INEGI
Physician Distribution by Age Group, Percent of Total, U.S. 2005
16.43
26.48 27.30
18.09
11.70
Under 35 35-44 45-54 55-64 65+Source: Physician Workforce Shortages: Implications and Issues for Academic Health Centers and Policymakers, Academic Medicine, Vol 81, No.9 Sept 06
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Physicians - Monthly Earnings in North America
1,116
32,500
12,940
Mexico U.S. Canada
US
$
2006
2002
2003
Sources: USA: "Medical Economics" , Mexico: Observatorio Laboral, Canada: Saskatchewan J ob Futures Note: Coverted in U.S. dollars, exchange rates from: Bank of Canada, Average Yearly Exchange Rate for 2000 and 2003, Banco de Mexico: Average exchange rate of the average for J anuary, February and March 2006.
Michael Abbott [email protected]
Mexico - Nurses per 1,000 Population by State, 2004
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Mexico - Physicians per 1,000 Population by State, 2004
0.000.501.001.502.002.503.003.504.00
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U.S. - Registered Nurses per 1,000 Population by State, 2005
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR P A P I SC SD TN TX UT VT VA WA WV WI WY P R
Source: U.S. Census Bureau
U.S. - Physicians per 1,000 Population by State, 2005
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PI SC SD TN TX UT VT VA WA WV WI WY PR
Source: U.S. Census Bureau
Michael Abbott [email protected]
Canada - Nurses per 1,000 Population by Province, 2004
0.00
2.00
4.00
6.00
8.00
10.00
12.00
New
foun
dlan
dan
d La
brad
or
Prin
ce E
dwar
dIs
land
Nov
a S
cotia
New
Bru
nsw
ick
Que
bec
Ont
ario
Man
itoba
Sas
katc
hew
an
Alb
erta
Brit
ish
Col
umbi
a
Source: CIHI and CANSIM
Canada - Physicians per 1,000 Population by Province, 2004
0.00
2.00
4.00
6.00
8.00
10.00
12.00
CA
NA
DA
New
foun
dlan
dan
d La
brad
or
Prin
ce E
dwar
dIs
land
Nov
a S
cotia
New
Bru
nsw
ick
Que
bec
Ont
ario
Man
itoba
Sas
katc
hew
an
Alb
erta
Brit
ish
Col
umbi
a
Source: CIHI and CANSIM
Michael Abbott [email protected]
Medical & Nursing Schools in North America
Medical Schools Nursing SchoolsCanada 16 134Mexico 55 59USA 144 1513
Nursing Schools: Canada- The Canadian Nurses Association and Canadian Association of Schools of Nursing, USA - HRSA, Mexico- Asociación Nacional de Universidades e Instituciones de Educación Superior
Source: Medical Schools- IIME
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Supply of New Doctors & Nurses in North America
Graduates Physicians Year Nurses YearCanada 1543 2002 9064 2003Mexico 11610 2005 4584 2003USA 15736 2005 67189 1999Physician Sources: CIHI, Observatorio Laboral, AAMCNurses Sources: CNACASN, Observatorio Laboral, ANA
North America: Number of Health Professionals Trained Each Year
Michael Abbott [email protected]
Best Practices & Model Projects
• Public Health Education & Primary Health Care• Community Health Workers• Geriatric and Gerontology Specialties &
Continuing Education• Cultural Sensitivity Training• Public-Private Partnerships• Cross-Border Training Programs