Michael Abbott [email protected] Population Aging and the North American Health Care Workforce Scott Otteman Senior Editor/Researcher Commission for Labor

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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.


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


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.


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


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


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


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


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


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

Documents

Michael Abbott [email protected] Population Aging and the North American Health Care Workforce Scott Otteman Senior Editor/Researcher Commission for Labor