Implementation considerations related to a National Injury Insurance Scheme (NIIS)

Transcription

1 Implementation considerations related to a National Injury Insurance Scheme (NIIS) Anna Dayton, Daniel Cooper, David Bowen, John Walsh < copyright PwC Actuarial>

2 Agenda Characteristics of a National Injury Insurance Scheme Scheme establishment and governance Scheme governance tied to actuarial valuations

3 Introduction

4 Background to the NIIS The proposed NIIS is part of a much bigger series of changes in the disability system These changes have been happening gradually for a long time, the Accident Compensation world now needs to fit in with these larger scale changes Implementation therefore looks to existing Schemes (eg LTCS) to provide a template

5 Characteristics of a National Injury Insurance Scheme

6 Participant characteristics

7 Participant characteristics

8 Expansion to other Injuries Approximate Distribution of Serious Injuries by Injury Cause - Australia 7% 10% Motor Vehicle Injuries General Injuries 33% 50% Medical Misadventure Injuries Workers' Compensation Injuries

9 A typical participant journey Accident Injury Retrieval Intensive Care Hospital Acute Care Hospital Rehabilitation Care Community Reintegration and Support Rehabilitation, Equipment & Modifications Attendant Care Participation Options

10 Scheme establishment and governance

11 Being prepared Incidence Data and consultations Risks? Eligibility Assessment Spinal cord injury Brain injury Other injury Participant continuance

12 Incidence and continuance Number of Ultimate Participants Incurred 80 Number of Participants Sep-11 Jun-11 Mar-11 Dec-10 Sep-10 Jun-10 Mar-10 Dec-09 Sep-09 Jun-09 Mar-09 Dec-08 Sep-08 Jun-08 Mar-08 Dec-07 Sep-07 Jun-07 Mar-07 Dec-06 Accident Quarter Reported IBNR Expected Participants Incurred from previous Full Cost Modelling

13 Service levels and benefit entitlement Assessment of support needs (attendant care, equipment etc) as they relate to participants goals and aspirations Which assessment tools? Package of tools required to assess support needs All LTCS participants have a Community Living Plan Costs At least 80% of long term costs in attendant care Influence of award rates

14 Systems and processes Data on participants Small number High cost Utilisation Financials Health outcomes Informal supports Care coordination & case management Effectiveness is dependent on the quality of staff Service accreditation and quality control

15 Lessons for a large serious injury compensation scheme Important to begin with understanding the underlying pathology of serious injury Monitoring and benchmarking Type and severity of injury Focus on most severe injuries Long term continuance rates Standardised assessment measures Definitions of benefits covered Level of operating costs Scheme spending experience

16 Scheme governance tied to actuarial valuations

17 Governance Cycle Annual Budget Expected distributions of claimant across age and severity bands Available average budgets for each segment of claimant, in $$$ and mix of services for expected incidences Injury management plans, outcome measures and short-term budgets for each segment of claim streaming for each claimant Client Plan Accumulate and summarise number of claimants, plus IMPs, outcome measures and shortterm budgets Available annual budget for each injury-year cohort, derived from actuarial projection model of incidence / severity / cost Cycle of Governance Prudential Management and Stakeholder Satisfaction Scheme annual experience summary report for each injuryyear cohort incidence, severity and injury management plans Close the loop for another year of dynamic planning and prudential management Budget adjustments Annual actuarial valuation and projection, giving revised costs and available budgets, using results of monitoring experience & other outcomes Monitoring and benchmarking reports to cover reporting, service utilisation, costs, claimant satisfaction & health outcomes Develop database and evaluation tool-kit to measure reporting, utilisation, costs, claimant satisfaction and health outcomes Outcome measures

18 Significant drivers of scheme costs Factors that increase care needs Dual diagnosis Lack of family support Other health problems Drug and alcohol addiction Aging Transition points, including: o adolescence o family breakdown o transitions from school to work or community o living independently o managing relationships o death of parent or carer Factors that decrease care needs Employment Strong family support Personal resilience Meaningful community engagement

19 The Life Cost Estimator Sets an average case estimate for each participant based on their current characteristics Developed to assist in daily scheme management

20 Case Study Participant A 10 years of age at injury Significant behavioural and cognitive issues Impulsive and violent Lack of family support (DOCS is involved) Requires two carers for hours per week Lives in a remote community with his grandfather Costs to date have been 60% above expected

21 INDIVIDUAL PROFILE Life Cost Estimator in Action NET PRESENT VALUE OF FUTURE CASH FLOWS Estimate or Scheme # 7 03-Oct-01 Adjusted NPV Unadj NPV Adjustment % Flag Today's Date 21-Nov-11 Nov-10 Discount Rate 6.0% 4.00 Cost inflator 4.0% 4.00 RESERVES (in current values with no mortality): NPV Date 21-Nov-11 3/11/2012 Valuation Date 30-Jun-11 Adjusted Person Unadjusted Person Interim Period 2 yrs post Interim Interim Period 2 yrs post Interim Participant: 1.00 $356,536 $276,055 $213,087 $150,031 2 year Reserve 2 year Reserve $329,349 Scheme # Participant A (from 'today'): (from 'today'): Birthdate 01-Jan-08 Injury Date 01-Jul TOTAL: Cumulative Actual / Budgeted vs Estimated Age (years) on Injury 9 years $800 9 Years since Injury 4 years: 5 months 4 3 $700 Date of Scheme Acceptance 01-Aug $600 Injury Summary: $500 Injury Type Brain ASIA score 4 Injury Severity 5 adjustment: $400 ASIA $300 FIM $200 Costing Adjustments: Cost $000's $100 $ 6,543,302 $ 3,374, % Red Costing Method Injury Severity $0 Risk Profile Medium 01-Jan-00 Costing Injury Severity 5 Brain Survival Injury Severity 5 Brain Adj Factor to Attendant Care 2.00 Month Adj Factor to Other Benefits 1.50 Estimated (risk adjusted) Estimated (unadjusted) Actual Payments Dec-07 Mar-08 Jun-08 Sep-08 Dec-08 Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 $176,678 Jun-12 Sep-12

22 The Future of the LCE Closing the loop with the Actuarial valuation Future refinements and data capture Scheme governance