A MICROSIMULATION MODEL GUPTA MODEL OF A HEALTH BENEFIT PROGRAM AND ITS SUSTAINABILITY _____________

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A MICROSIMULATION MODEL (GUPTA MODEL) OF A
HEALTH BENEFIT PROGRAM AND ITS SUSTAINABILITY___
_________________________Anil Gupta, Loan Nguyen
and Eric LlewellynMicrosimulation Modelling and
Data Analysis DivisionApplied Research and
Analysis DirectorateHealth Canada
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Background

• National non-essential health benefit programs
  include the Veterans Affairs Canada Health
  Benefit (VACHB) and the Non-Insured Health
  Benefit (NIHB) programs
• They provide health services and goods that are
  not covered by the essential health care services
  by provincial plans for Veterans and Registered
  First Nation and Inuit people
• Sustainability of these programs is a concern due
  to steady cost increases during the period from
  1994-2004, especially in expenditures for the
  pharmaceutical benefits
• In order to assess alternative ways of delivering
  these programs, we developed a microsimulation
  model the Gupta model

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Model Objectives

• Simulate the pharmaceutical benefits
  simultaneously from the current NIHB/VACHB
  programs and new hypothetical drug programs
• Compare those plans across the provinces to
  select the best alternative drug plan
• Assess distributional impacts on families
  /individuals and federal/provincial expenditures

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Model Components

• Made up of two components
• A micro database containing
• - A representative population of both claimants
  and non-claimants
• - Individual/family socio-economic demographic
  characteristics
• - Pharmaceutical utilization and expenses
• 2. A model with two parallel benefit simulation
• systems - the Base and Option systems, and the
• SA/GIS simulation system

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Data Sources
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Data Syntheses
2004/05 Pharmacy Data- Multiple Claims Per
Client
2004/05 Pharmacy Claim Data with One Claim
Record Per Claimant
2004/05 NIHB Annual Report
Add Non-Claimants Into the 2004/05
Pharmacy Claim Data
2001 and 1996 Individual Census Data
Build Family Structure Onto The Synthesized
Model Data
Model Database
2001 Family Census Data
Data Validation
Simulate Income for Individuals/Families in the
Synthesized Model Data
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Health Benefit Modelling
The Base System - NIHB/VACHB Programs
The Option System - New Hypothetical Plans
Model Data
For Each Family/Individuals in A Family
SA/GIS Simulation System
Selected Individual/Family Pharmacare Plans
Apply Individual Plans to All Members In a
Family. Calculate Total Benefits for A Family
Apply Appropriate Family Plans. Calculate
Benefits For A Family
Benefits Total Costs OOP
Select The Plans That Optimize Benefits For The
Family/Individual
Benefits Calculated From the Base System
Benefits Calculated From the Option System
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Model Applications - scenarios

• Two illustrative Scenarios
• Scenario 1 - Provinces/Territories (P/Ts) First
• Payers
• P/Ts cover the prescription drugs for the First
  nation and Inuit (FN/I) people as per other
  residents of the provinces/territories- the FN/I
  seniors and SA recipients picked up by provinces
• Federal pick up the difference (cover the
  clients out-of-pocket)
• Scenario 2 The Insurance option Shared
  Federal-
• Client contribution
• After 50 deductible, client pays 25 of their
  drug cost to a max of 30/claim. Max. cost share
  is 500/person.
• For seniors and SA recipients, client pays
  5/claim and up to a maximum of 100/person

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Model Applications scenario 1
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Model Applications scenario 2
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Conclusions

• The Gupta model is
• A highly parameterized and robust policy tool.
• - Contains a representative data source for the
  pharmaceutical modelling work
• Can assess the impacts on F/P/T expenditures,
  impact analysis families/individuals under
  different insurance type programs
• Flexible can simulate a variety of drug options
  modified from the current drug programs or
  created from scratch
• The model can be adapted for other populations in
  Canada or abroad