The Impact of Co-morbidity

ACC Service Utilisation & Costs

2012 - 2025
Dr Barry Gribben
CBG Health Research

Dr John Wren
Principal Research Advisor
ACC
Lauren Prosser
Senior Policy Advisor
ACC
2nd ACHRF
Auckland, New Zealand
8 November 2012

The Questions
WHAT is the effect of a health co-morbidity on ACC clients ?
injury treatment claim rates (utilisation)
duration of claim
costs over time

WHAT are the cost effects on an aging population ?

WHAT are the policy implications ?

The Process
BUILT on the pilot studies reported in 2010 (Wren & Mason)

LINKED Primary Health Care data (GP Practice) with

Ministry of Health & ACC data using New Zealand NHI
Random sample of 337,665 people
Sample representative of the New Zealand population
Descriptive & Multivariate Statistical Analysis

Co-morbidities
Asthma
Chronic obstructive pulmonary disease
Ischaemic heart disease
Heart failure
Diabetes mellitus
Mental health condition
Cancer diagnosis
Osteoarthritis
Hypertension

Variables & Interactions

Age

Sex
Ethnicity
Socio-economic status (New Zealand social deprivation index)
Treatment utilisation
Claims duration
ACC Costs

Headline Statistical Results

Multivariate Model Analysis
Presence of a health co-morbidity was found to have a strong
statistically significant (95%) association with:
increased service utilisation

higher costs

The effects were independent of, and additional to, normal

health cost effects typically associated with age, gender,
ethnicity & socio-economic status

Headline Statistical Results

Presence of one or more health co-morbidities showed
28% more claims
346% higher lump sum payments
59% higher medical treatment costs

39% more weekly compensation costs

OVERALL 59% more total ACC cash costs

across all cost categories

Cost relativity
stronger relativity for some than others
Average total cost per person per year (95% CI)
Average total cost per annum

NZD
1400

1200

1000

800

600

400

200

0
Yes

No

Osteo-arthritis

Yes

No

Stroke

Yes

No

Hyper-tension

Yes

No

Mental Health

Yes

No

IHD

Yes

No

Heart Failure

Yes

Cancer

No

Yes

Asthma

No

Yes

No

Diabetes

Claim Utilisation
Claims Utilisation vs. Number of Co-morbidities
2.50

2.00

Claims
per
annum

1.50

1.00

0.50

0.00
0

Number of co-morbidities present

Medical Treatment Cost

Medical Treatment Costs vs. Number of Co-morbidities
$500
$450
$400
$350
Medical $300
Treatment
$250
Cost
$200
$150
$100
$50
$0

Number of co-morbidities present

Total Annual Cost

Total Annual Cost vs. Number of Co-morbidities
$3,000

$2,500

Total
Annual
Cost $2,000

$1,500

$1,000

$500

$-

Number of co-morbidities present

Based on the analysis

10.7%

Total Annual ACC Cost is

attributable to
presence of co-morbidities in the
New Zealand population

276 million

(NZD, 2011)

Ageing Effects
Mean $ NO co-morbidity

Average total cost per person

Age group co-morbidity vs. no co-morbidity

Mean $ co-morbidity

2000

Mean cost per annum per person

1800
1600

1400
1200
1000
800
600
400
200

Excess cost is the area

of the gap between the
two lines largest gap is
in the working age
population

Age group

Modelling Ageing Effects to 2025

Population by age group
with co-morbidity vs no co-morbidity
160,000
Without co-morbidity

140,000

With co-morbidity

100,000
80,000

Expect this area to

get bigger

60,000
40,000
20,000

Age group

+
90

5-

9
10
-1
4
15
-1
9
20
-2
4
25
-2
9
30
-3
4
35
-3
9
40
-4
4
45
-4
9
50
-5
4
55
-5
9
60
-6
4
65
-6
9
70
-7
4
75
-7
9
80
-8
4
85
-9
0

0
04

Number of people

120,000

Costs Attributable to Co-morbidities

14.0%

Percentage of total ACC costs

12.0%

10.0%

8.0%

6.0%

4.0%

2.0%

0.0%

no change
1% growth
2% growth

2012
10.66%
10.71%
10.77%

2015
10.67%
10.83%
11.00%

2020
10.96%
11.43%
11.91%

2025
11.25%
12.06%
12.72%

Conclusions
Presence of a wide range of health co-morbidities in the
population has a real effect on injury compensation
treatment utilisation volumes and costs
To 2025, 10.7% to 12.7% of total annual ACC costs is
estimated to be attributable to presence of co-morbidities in
the population
It appears that although aging of the population means more
people have co-morbidities, this is counterbalanced by
relatively fewer people being in the age groups where the
cost differences are greater
Results are consistent with recent research from NCCI in
America about working age effects

For further information

Gribben, B. & Wren, J. ( 2012) The Impact of Health
Comorbidities on ACC Injury Treatment and Rehabilitation
Utilisation and Costs, and cost estimate to 2025 of effects in
an aging population.
CBG Health Research and ACC Research, Sep 2012.

Wren, J. & Mason, J. 2010. Results of Three Pilot Studies

Exploring & Quantifying Health Co-morbidity Effects on ACC
Injury Treatment Utilisation and Costs.
ACC.

Additional Slides

Health Literature
Pre-existing health co-morbidity effects on increased health
service utilisation well-documented in recent World Health
Organisation (WHO) reports
Injured people are different from the non-injured population in terms
of pre-existing morbidity
Patients with higher numbers of co-morbidities utilise injury services
more than patients with lower co-morbidities.
Cameron, Prudie, Kliewer et al., 2005)

Health co-morbidity (ICD9-CM Chapter)

Source: Adapted from Cameron et al,
2005. Tables 4 and 5 respectively.

Rate Ratios* Injured/ Non-Injured

*Adjusted for age, sex and place of
residence *
Hospital Admissions

Physician

Claims per 1000 person years

Mental Health disorders

9.31

3.50

Injury and poisonings

3.68

2.72

Blood diseases

3.36

1.53

Endocrine and metabolic

2.79

1.38

Musculoskeletal disorders

2.61

1.76

Nervous system diseases

2.35

1.42

Respiratory diseases

1.98

1.38

Circulatory diseases

1.70

1.21

Health Literature
Role of Mental Health, Alcohol and Psychological Traits
There appears to an aetiological link between mental health
conditions and injury, particularly in relation to risk-taking

behaviours, alcohol misuse, and psychological traits such as

impulsivity, sensation-seeking, and risk-perception.
(Cripps & Harrison, 2008. Briefing report for the Australian Institute of Health and Welfare)

Workers Compensation Literature

Increased injury risks, higher medical treatment costs
(including pharmaceutical services), workers compensation
costs, and poor work performance (presenteeism) have
consistently been associated with specific lifestyle risk
factors such as tobacco use (current and previous), obesity,
stress, and lack of regular physical activity among working
people in a variety of settings

(Studies published by Health Management Research Centre, and Others)

Workers Compensation Literature

Considerable confidence the excess risk from health comorbidities accounts for at least 25% to 30% of medical
costs per year across a wide variety of companies,
regardless of industry or demographics
The biggest cost factors are the cost of extra treatment
utilisation, and medical costs associated with the
complications of a co-morbidity
(Studies published by Health Management Research Centre)

ACC Claims Costs

Highly skewed

All Results Significant at 95%

Multivariate Analysis

Future Cost Calculation

The proportion of ACC costs attributable to chronic
illness in any given out year is a function of:
the population structure (the matrix Nij)
the number of years from our baseline, n.
Pij, r, $ccij and $nccij are all constants calculated
earlier, or assumed.

P f ( N , n)

n
N
P
(
1

i
)
($ccij $nccij )
ij ij
ij

n
n
N
($
cc
P
(
1

i
)

$
ncc
(
1

P
(
1

i
)
)
ij ij ij
ij
ij
ij