Healthcare Facts & Figures HEALTHCARE EXPENDITURE Public Expenditure on Health 1997-2006 Health Expenditure as a % of GDP 2003 Weekly Expenditure on Medicines versus Other Household Expenditure Growth in State Expenditure on Medicines 1997-2004 Pharmaceutical Expenditure as a % of Healthcare Expenditure in
3 4 5 6 7 8
Selected Countries
POPULATION AND LIFE EXPECTANCY STATISTICS Changing Population Trends 2004-2050 Comparison of Age-Related Public Expenditure Self-Perceived Health by Country (%) Principal Causes of Death in Ireland 2004 Medicine Information Sought on the Internet
COMMUNITY DRUG SCHEMES Community Medical Schemes Expenditure 2004 GMS Scheme Expenditure 1997-2004 The Ageing of the GMS 1994-2004 Drugs Payment Scheme Expenditure 1997-2004 Long Term Illness Scheme Expenditure 1997-2004 High Tech Scheme Expenditure 1997-2004 1
9 10 11 12 13 14 15 16 17 18 19 20 21
Healthcare Facts and Figures 2006
PHARMACEUTICAL MARKET STATISTICS Employment in the Pharmaceutical Industry in Ireland 1988-2005 World Trade in Pharmaceuticals 2004 Pharmaceutical Expenditure per Capita in Western Europe 2003 Self Medication Markets in Ireland 2005 OTC Medicines as a % of the Total Pharmaceutical Market 2004
RESEARCH AND DEVELOPMENT The Life Cycle of Medicines Cost of Developing a New Medicine Medicines in Development
VACCINE STATISTICS World Vaccine Market Uptake levels of Vaccines in Ireland 2004
22 23 24 25 26 27
28 29 30 31
32 33 34
2
Healthcare Expenditure
3
•
The last decade has seen an unprecedented increase in health expenditure following a period of cutbacks and stagnation in the 1980’s and the early 1990’s. Public expenditure on health has more than trebled in the period 1998 to 2006.
•
Healthcare expenditure in Ireland, relative to other European States, is coming from a low base. Irish expenditure in 2003, as a percentage of GDP, remained amongst the lowest in the EU.
•
The Irish healthcare system remains a mix between public expenditure (75%) and private expenditure (25%).
•
50% of the population now have some form of private health insurance.
•
The numbers employed in the health services increased by over 45% between 1997 and 2004.
•
State expenditure on medicines has increased in tandem with the increase in public expenditure on medicines. Medicines account for just 11.4 % of non-capital health expenditure – a small but vital component. This is a third less than the average across the OECD States of 17.8% of healthcare expenditure devoted to medicines.
•
Medicine prices have remained frozen since 1992 whilst in contrast health inflation currently runs at 6.2% per annum.
Healthcare Expenditure
Public Expenditure on Health 1997-2006
14 12.6 11.9
12 10.1 10
9.1 8.4
â‚Ź 8 Billion
7.2 5.7
6 4.9 4
3.7
4.1
2 0 1997
1998
1999
2000
2001
2002
2003
2004
2005*
2006
Source: Department of Health and Children Statistics * The 2005 figures include â‚Ź280 million in one-off items relating to the establishment of the Health Service Executive (HSE) and in particular the change to an accruals rather than a cash based accounting system.
4
Healthcare Expenditure as a % of GDP 2003
Germany
11.1
France
10.1
Greece
9.9
Netherlands
9.8
Portugal Belgium Sweden*
9.6 9.6 9.2
Denmark
9.0
OECD Average
8.6
Italy
8.4
UK* Spain
7.7
Austria*
7.6
7.7
Finland
7.4
Ireland*
7.3
Luxembourg
6.1 0
Source: 5
2
OECD Health Data 2005 * Data relates to 2002
4
6 % of GDP
8
10
12
Healthcare Expenditure
Weekly Expenditure on Medicines versus Other Household Expenditure CDs
1.43
Crisps
1.47
Prescription Medicines
1.96
Other Medicines
2.25
Cakes and Buns Bus fares Hairdressing Cosmetics Chip Shop Purchases
2.72 3.29 3.40 3.54 4.06
Newspapers
4.39
Betting/Lottery
4.66 5.05
Sweets/Chocolate
12.46
Tobacco
13.24
Telephone Petrol
17.13
Alcohol
31.64 5
10
15
20
25
30
35
â‚Ź
Source:
Central Statistics Office Household Budget Survey 1999/2000 6
Growth in State Expenditure on Medicines 1997-2004
1100
1050
1000 898
900 769
800 700
630
â‚Ź 600 Million
504
500
411
400
360 307
300 200 100 0 1997
Source: 7
1998
1999
2000
2001
2002
2003
2004
GMS Annual Reports from 1997-2004. The GMS figure includes the ingredient cost only and the Hi-Tech Scheme figure excludes patient care fees.
Healthcare Expenditure
Pharmaceutical Expenditure as a % of Healthcare Expenditure in Selected Countries 2003
Denmark Switzerland Ireland * Netherlands 1 Luxembourg USA 1 Sweden Germany Greece Finland Austria1 Canada OECD Average France Spain Italy 0
Source:
9.8 10.5 11.4 11.4 11.6 12.9 13.1 14.6 16.0 16.0 16.1 16.9 17.8 20.9 21.8 22.1 5
10
%
15
20
OECD Health Data 2005 (1) Data relates to 2002 * OECD Data for Ireland relates to 2002 and is 11%, IPHA estimate for 2003 is 11.4%
25
8
Population and Life Expectancy Statistics
9
•
The population of the Republic of Ireland now exceeds 4 million for the first time since 1871. The population has increased by nearly a third in the last thirty years and may increase to over 4.8 million by 2031.
•
The percentage of elderly people in the population is set to increase by nearly 50% by 2025. This will have significant implications for public spending and in particular healthcare expenditure. For example a recent European Commission report found that average public expenditure in Ireland on those in the 80-84 age cohort was more than double that on those in 60-64 cohort.
•
The life expectancy of those over the age of 65 has improved significantly in recent years but remains low by comparison to our Western European neighbours.
•
Circulatory diseases are the principal cause of death in Ireland and along with cancer account for nearly two thirds of all deaths.
•
Approximately one in five deaths in Ireland is of a person aged less than 65 years old.
•
Over 87% of Irish people perceive themselves to have very good/good health (as against an EU 15 average of 61%). This is in a country where 1 in every 8 persons is obese and every 2nd person is overweight. Between 1989 and 1999, Ireland had the highest increase in alcohol consumption amongst EU countries.
•
People are increasingly accessing information in relation to health from the Internet with information about medicine side effects, safety and efficacy being that most commonly sought.
Population and Life Expectancy Statistics
Changing Population Trends 2004-2050 TOTAL POPULATION MILLIONS 2004
2025
EU 25
456.8
470.1
449.9
EU 15
382.7
398.8
Ireland
4.03
4.9
Source:
2050
POPULATION STRUCTURE %65+
% CHANGE 2004/2050
2004
2025
2050
-1.5
16.4
22.6
29.9
384.4
+0.4
17.0
21.8
30.0
5.5
+36.0
11.1
16.5
26.2
Eurostat 2005 10
Comparison of Age-Related Public Expenditure MALES
FEMALES
8000
8000
7000
7000
6567
6110
6034
6000
6000 5392 4964
5000 4514
€
4472
5000
4604
€
4052 3854
4000
4000 3365
3000
2800
2914
3000 2518 2117
2000
2000
1000
1000
0
60-64 yrs
70-74 yrs
80-84 yrs
90-94 yrs
0
1939
60-64 yrs
70-74 yrs
80-84 yrs
90-94 yrs
Ireland EU 15 Source: 11
The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long term care, education and unemployment transfers (20042050), European Commission 2006
Population and Life Expectancy Statistics
Self-Perceived Health by Country (%) - 2003 VERY GOOD/GOOD
FAIR
BAD/VERY BAD
Ireland
87.1
11
1.9
Netherlands
77.7
17.9
4.4
Belgium
77.3
18.9
3.8
Denmark
75.4
18.4
6.2
Austria
74.8
18.2
7
Sweden
74.2
19
6.8
73
17.8
9.2
UK
68.5
22.2
9.3
Spain
68.1
23.1
8.8
Italy
61.1
31.6
7.3
Finland
58.8
30
11.2
France
58.2
33.9
7.9
Portugal
47.7
33
19.3
Germany
47
34.3
18.7
Greece
Source:
Source: Eurostat Data 2005 *Data was collected in relation to men and women and averaged for presentational purposes 12
Principal Causes of Death in Ireland 2004
Circulatory Diseases 37.7% Cancer 27.4% Respiratory Diseases 14.4% Injury and Poisoning 4.4% Other Causes 16.1%
13
Source:
Central Statistics Office 2004
Population and Life Expectancy Statistics
Medicine information sought on the internet
Online Purchases
16.1
Prices
29.1
Generics
48.3
Interactions
48.3
Herbal or Natural
51.7
Efficacy
60.5
Safety
66.4
Side effects
71.9
0
Source:
5
20
30
%
40
50
60
9th HON Survey, Health On the Net Foundation, Winter 2004-2005. NB: respondents had a multiple-choice questionnaire. (http://www.hon.ch/Survey/Survey2005/res.html#Ancre13)
70
80
14
Community Drug Schemes Expenditure on the community drug schemes has risen steadily in recent years. The factors behind that growth include: •
Ireland’s rapidly increasing and ageing population - Ireland’s population has increased by over 500,000 since 1996. The number over 65 is increasing steadily and is projected to double to over 840,000 by 2031.The granting of medical cards to everyone over 70 is accentuating the effect of the ageing population on the medicines bill.
•
The development of new treatments and more patients availing of them – for example in the areas of preventative medicine and the long-term treatment of chronic illness. The number of patients registered under the High Tech Scheme now exceeds 29,000, up from 8,250 in 1997 (an increase of 250%).
•
The introduction of Government initiatives to improve public health - for example the cardiovascular strategy. The prescribing frequency of cardiovascular system medication in the GMS Scheme has increased from 3.6 million in 1996 to 8.6 million in 2004 (an increase of 139%).
•
Epidemiological evolution - the increased incidence of chronic and non-communicable diseases is generally quite costly to treat. Ireland has one of the highest incidences of asthma in the world, currently 12%, and has increasing levels of diseases like diabetes and obesity.
•
State decisions on eligibility and administration of the drug schemes - the granting of medical cards to everyone over 70 and the introduction of the Drug Payment Scheme saw substantial growth in the State bill. The Deloitte review* of the GMS noted that the provision of medical cards to the over 70s cost an additional €126m in the first full year of the arrangement in 2002. It also noted that the number of claimants under the DPS increased by 40% between 2000 and 2002.
The growth in medicine expenditure also has to be seen in the context of the fact that Irish spending on pharmaceuticals is starting from a low base. According to comparative OECD data for 2003 Ireland had the lowest expenditure per capita on medicines in Western Europe. It also has to be seen in the context of the large scale and ongoing increases in Irish health spending. * Deloitte & Touche Review of Governance and Accountability Mechanisms in the General Medical Service 15
Community Drug Schemes
Community Medical Schemes Expenditure 2004 597
600
525
450
375 â‚Ź 300 million 224
225
150
141 86
75
0 Long Term Illness Scheme
Source:
High Tech Scheme
Drug Payment General Medical Services Scheme (GMS) Scheme
GMS (Payments) Board Annual Report 2004 The GMS figure includes the ingredient cost only and the High Tech figure excludes patient care fees 16
GMS Scheme Expenditure 1997-2004 The Scheme provides free medical services to persons who would not otherwise be able, without undue hardship, to afford such services.
597
600 515 500 433 400 338 300 â‚Ź Million 200
271 231 179
202
100
0 1997
Source: 17
1998
1999
2000
2001
GMS (Payments) Board Annual Reports 1997-2004 Figures include ingredient costs only
2002
2003
2004
Community Drug Schemes
The Ageing of the GMS 1994-2004 While the overall numbers eligible for medical cards have been falling, the number of cardholders aged 65 and over has increased (a trend accentuated by the granting of medical cards to everyone over 70 years old in 2001).
YEAR
TOTAL No. OF ELIGIBLE PERSONS
AS A % OF THE POPULATION
TOTAL No. AGED 65+
65+ AS A % OF ELIGIBLE PERSONS
2004
1,149,000
29.3%
383,000
33.3%
2000
1,148,000
30.3%
323,000
28.1%
1994
1,287,000
36%
297,000
23.1%
Source:
GMS (Payments) Board Annual Reports 1994-2004 18
Drugs Payment Scheme Expenditure 1997-2004
224
225 204
200
192 178
175 150
141
â‚Ź 125 Million 100 75
105 96 76
50 25 0 1997
Source: 19
1998
1999
2000
2001
2002
2003
2004
GMS (Payments) Board Annual Reports 1997-2004. The data incorporates the Drug Refund Scheme and Drug Cost Subsidisation Scheme which were replaced by this Scheme in 1999.
Community Drug Schemes
Long Term Illness Scheme Expenditure 1997-2004 The Long Term Illness Scheme is for persons who suffer from one or more defined illnesses. It gives such persons the right to obtain, irrespective of income, relevant medication free of charge. 90
86
80 73 70 62 60 52 â‚Ź Million
50 42 40 34 29
30 25 20 10 0 1997 Source:
1998
1999
2000
2001
2002
2003
2004
GMS (Payments) Board Annual Reports 1997-2004 20
High Tech Scheme Expenditure 1997-2004 Developments in biotechnology and therapeutics have given rise to the introduction of medicines for the treatment of medicinal conditions, many of which previously had either no effective treatment or required extended in-patient hospital care. Under the Scheme these medicinal products are dispensed by the community pharmacist. 160 141
140 120 104 100 â‚Ź Million 80
80 61
60 49 40
40 26
32
20 0 1997
Source: 21
1998
1999
2000
2001
2002
2003
2004
GMS (Payments) Board Annual Reports 1997-2004 Figures exclude patient care fees. The number of patients registered under the Scheme has increased from just over 8,000 to over 28,300 in 2004.
Pharmaceutical Market Statistics
Pharmaceutical Market Statistics •
The pharmaceutical industry has been one of the principal contributors to the growth of the Irish economy in recent years. The industry employs 24,000 people directly, with a further 24,000 people employed providing services to it. In 2005, pharmaceutical exports exceeded €14.75 billion making Ireland the largest net exporter of pharmaceuticals in the world. Using the broader pharmachem measure, exports exceeded €44 billion, or nearly 50% of all exports from the state.
•
One hundred and twenty companies have operations in Ireland, including fourteen of the top fifteen worldwide and the total replacement value of the investment by the sector in the Irish economy exceeded €40 billion. Over €4.6 billion has been invested in the last six years in a period when job growth in the sector has averaged 1,400 annually.
•
The market for pharmaceuticals continues to grow as outlined in the previous section on the community drug schemes.
•
Irish consumption of medicines remains amongst the lowest in Western Europe. Growth in the Irish market has to be viewed against this background and against the ever-increasing sums being invested to improve public health.
•
Four therapy areas – the cardiovascular system (21%), the alimentary tract/metabolism (17%), the nervous system (18%) and the respiratory system (11%) - make up over twothirds of the total Irish market for prescribed medication.
•
Self-medication is an important element of the total Irish market for pharmaceutical products. The leading areas of the market include analgesics (23%), cough and cold treatments (17%) and vitamins and minerals (13%).
•
The Association of the European Self-Medication Industry (AESGP) has estimated that savings of over €75 million annually could be achieved in Ireland if self-medication was practised more widely. The savings could then be put to better use elsewhere in the healthcare system.
22
Employment in the Pharmaceutical Industry in Ireland 1988-2005
24000
25000 21000 20000 20000 16000 15000 No. of persons employed
13100 11200 9400
10000 7700 6200 5200 5000
0
Source: 23
1988
1990
1992
1994
1996
1998
IPHA Estimates based on CSO and IDA Ireland Data
2000
2002
2003
2004
Pharmaceutical Market Statistics
World Trade in Pharmaceuticals 2004
EXPORTS $M
IMPORTS $M
BALANCE $M
Ireland
18,803
2,456
16,347
Switzerland
23,027
11,608
11,418
Germany
34,056
26,274
7,782
UK
22,648
15,850
6,798
France
21,212
15,989
5,223
Sweden
7,220
2,484
4,736
10,664
9,987
677
3,576
3,727
-151
Italy
11,112
12,806
-1,694
Belgium
30,598
32,734
-2,136
Spain
4,857
8,323
-3,466
Japan
3,540
7,114
-3,574
23,980
35,371
11,391
Netherlands Austria
USA
Source:
World Trade Organisation 24
Pharmaceutical Expenditure per capita in Western Europe 2003 Ireland
261
Denmark
272
Greece
322
Finland
339
Sweden*
339
Netherlands
340
OECD Average
366
Austria
367
Luxembourg
370
Switzerland
398
Spain
401
Germany
436
Italy
498
France
606 0
Source: 25
100
OECD Health Data 2005 * Data relates to 2002
200
300 US $ PPP
400
500
600
Pharmaceutical Market Statistics
Self Medication Market in Ireland 2005
Total Market â‚Ź248 million* Analgesics 23% Cough and Cold 17% Vitamins and Minerals 13% Digestives & Intestinal Remedies 10% Skin Treatment 11% Others 26%
Source:
IMS Health * At consumer price level 26
OTC Medicines as a % of the total Pharmaceutical Market 2004 Portugal
8.1
Austria
9.1
Denmark
9.7
Sweden*
10.3
Italy
10.4
Finland
10.6
Spain
11.7
Netherlands
12.9
Belgium
13.5
Ireland
16.2
Germany
19.0
France
20.5
UK
25.5 0
5
10
15
20
%
27
Source: AESGP Economic and Legal Framework for Non-Prescription Medicines 2005 * Self Medication Market as a % of the Total Pharmaceutical Market
25
Research and Development
Research and Development •
Research and development of new medicines offers hope to an increasingly ageing population of a longer healthy life, well beyond that of previous generations. For example, there are currently over 900 medicines in development to combat the diseases of ageing such as Alzheimer’s disease/dementia (27), lung/respiratory disorders (52), rheumatoid arthritis (38).
•
Research based pharmaceutical companies are the engines of medicines innovation. They have discovered and developed over 90% of all new medicines made available to patients worldwide over the last twenty years.
•
The process of developing a new medicine is long, complex and risky. On average only one or two of every 10,000 promising substances will successfully pass extensive testing in the R&D phase to be approved as a marketable product.
•
Recent studies put the cost of developing a new medicine at almost €900 million.
•
It takes an average 10 to 12 years to turn a promising new compound into a marketable medicine that passes the regulatory standards of safety, quality and efficacy. Once on market the average medicine has only 8 to 10 years of effective patent protection left before facing generic competition. Only three out of ten marketed medicines produce revenues that match or exceed the costs of R&D before they lose patent protection.
•
The European pharmaceutical industry employed over 100,000 people in R&D in 2004 and spent a total of over €21.5 billion on such work.
•
In this uncertain world the pharmaceutical industry is working with governments to develop responses to bioterrorist threats such as anthrax, smallpox, plague and other diseases. Researchers are also focusing on infectious diseases that affect millions of people all over the world – hepatitis, fungal infections, herpes, influenza, rotavirus, sepsis, sexually transmitted diseases, tuberculosis, urinary tract infections and many more.
•
Pharmaceutical R&D has helped to produce medicines, which have improved life expectancy. According to the World Health Organisation (WHO), there is still no adequate therapy for three quarters of the 2,500 medical conditions currently recognised. Pharmaceutical R&D 28 offers hope that in the future such therapies may be developed.
The Life Cycle of Medicines From concept to product: steps in the genesis of a drug
10,000 molecules screened
100 molecules tested
10 candidate molecules 1 medicine
Research phase
Test phase
0
Development phase
5 years 10 years R&D
Patent filing
Source: 29
LEEM– Key Facts 2003
Administrative Procedures 10 years
Commercialisation phase 15 years
20 years
2 to 3 years
Patent expiry
Research and Development
Cost of Developing a New Medicine
1000 868 800
€ 600 Million 400
200
344
149
0 1975
1987
2000
Source: J.A Dimasi, R.W. Hansen and H.G. Grabowski, ‘The Price on Innovation: New Estimates of Drug Development Costs’, Journal of Health Economics 22 (2003): 151-185
30
Medicines in Development
HIV/AIDS
82
Heart Disease and Stroke
146
Cancer
399
Women
400
Ageing
900 0
Source: 31
200
400
600
800
PhRMA 2005, Innovation.org For further information about Medicines in Development visit www.ipha.ie
1000
Vaccine Statistics
Vaccine Statistics •
The development of childhood vaccines has been one of the great health success stories of the past hundred years. Diseases such as measles, polio and hib meningitis, which previously killed millions, can now be prevented.
•
Vaccines such as travel vaccines enable people to travel to different parts of the world protected from potentially fatal diseases. These vaccines also offer hope to the populations in those countries that diseases can be completely wiped out over time.
•
Research continues for new vaccines which offer the prospect of innovative ways to combat the serious threat to human kind posed, for example, by the possible development of bird flu.
•
Given the great benefits which childhood immunisation can bring it is deeply worrying that uptake rates for some vaccines in Ireland have fallen to levels significantly below the 95% required to ensure community protection.
•
Two million children worldwide die each from diseases that can be controlled and prevented through vaccination. Half of these deaths are due to measles.1
•
People get their information on vaccination from a wide range of sources. For example a European survey found that parents accessed information in relation to paediatric vaccines from a wide variety of sources – healthcare professional (81%), newspapers/magazines (36%), television/radio (27%), public health bodies/campaigns (19%), the Internet (10%) and relatives/friends (9%).2
•
The challenge in the years ahead is to develop ways of ensuring that parents have access to reliable, authoritative information upon which they can make an informed decision for the benefit of their children.
1 2
World Health Organisation Statistics European Vaccine Manufacturers Perceptions Survey 2005
32
The World Vaccine Market, 2004
Travel and other (A) $505
Combinations $479
Pneumoccal (A) $315
Diphteria $435 Hepatitis $90 Haemophilus $229 MMR $424
Influenza (A) $1,428
Pneumoccal $1,104
Hepatitis (A) $560 Poliovirus $343 Others $370 Varicella $315
Source: 33
Kalorama Information, All figures are in millions All the above figures relate to paediatrics unless followed by an (A)
Vaccine Statistics
Uptake Levels of Vaccines in Ireland 2004 These figures are based on uptake levels at the first opportunity for vaccination to take place.
100
80
60
40
20
0
BCG
Source:
D3
P3
T3
HIB3
POLIO3 MenC3
WHO*
HSE Health Protection Surveillance Centre * 95% is the World Health Organisations recommended uptake level for vaccines in order to prevent the spread of disease - Diphteria (D3), Pertussis (P3), Tetanus (T3), Haemophilus influenzae type b (HIB3), Meningococcal Group C (MenC3)
34
Franklin House, 140 Pembroke Road, Dublin 4. Tel: (01) 660 3350 Fax: (01) 668 6672 Email: info@ipha.ie www.ipha.ie www.medicines.ie
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