Paradigm Shift in Healthcare –From Curative Care to Preventive Care
Dr. Karl-Jürgen SchmittChairman of Task Force Structural Funds, COCIR
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 2
In healthcare we have a problem in service delivery not in revenuePeople are willing to pay for transparent quality (Example: Germany)
Expenditures for CarsExpenditures of
Compulsory Health Insurance
Source: Destatis and DIW 2008
*incl. employers’ share: € 67.5 bln**incl. remidies, additives and dental prothesis
€ 135 bln* € 179 bln
vehicles38%
vehicle tax3%
repairs / maintenance
20%
petrol & engine oil24%
car rental, inspection, parking
15%
in-patient treatment
36%
drugs27%
medical treatment
21%
administration costs6%
sick-pay4%
others6%
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 3
Prevention is far better than healing • The goal of healthcare should be to keep people healthy rather than to fight against acute diseases• The results has to be measured, compared and published
‘Adverse Events’
Actual(without ‘Adverse Events‘)
Prevention andEarly Detection Diagnosis Therapy Care
Source: Institute of Medicine, To Err is Human, 1999. Hospital Statistics. Chicago. 1999; RAND study, Sep. 2005
US$
Ideal
… every year in the US:
90,000 Deaths
2,000,000 Adverse Events
Situation today(without “Accidence’‘)
‘Adverse events’
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 4
Prevention means far more than healthy living
1. Prevent medical and medication errors (quality management and transparency)
2. Prevent illness through early diagnoses (screening and risk factors, e.g. breast and colon screening, procam score)
3. Prevent acute cases of chronic patients (screening and monitoring, e.g. diabetic retinopathy screening, chronic heart failure monitoring)
4. Prevent illness through healthy life style (education and life style change)
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 5
Patients‘ acceptance of telematic monitoring in %
Efficiency regarding clinical and economical aspects %
Source: Oberender and Partner, VDE Position paper “TeleMonitoring in der Prävention von Herz-Kreislauf-Erkrankungen”
7788
7113
70
8030
-70-81
33
-55-51
49
-69-56
Better health status Faster help Risk reduction Better care Higher safety Less physician contact Manage anxiety
Hospital stays / year / Pt. Length of stay Emergency cases Hospital stays >3 / year / Pt. Discharge to admission Hospital costs Intensive care costs Medication costs
Telematic Services –Great Acceptance and Impact
Tele-Monitoring at patients with chronic heart failure
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 6
Member States and the EU should cooperate to complete this paradigm shift
1. HealthcareEuropean guidelines for breast screening(Goal: to reduce the mortality of this disease)
2. EducationBologna Process (Goal: to increase competitivnes of European universities)
3. Economic, Social, EnviromentLisbon Strategy (Goal: to make Europe the most competitive, dynamic and
knowledge based region of the world)
Light House examples are:
Healthcare is the smallest, but most successful initiative in this compilation, adopted in 17 out of 27 Member States
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 7
Healthcare as an Economical FactorHealthcare could support the goals of the Lisbon Strategy
Europe:
• Expenses for health: 8.6 % of GDP in EU-15
• Employment: around 10 % of European workforce
• 10% increase in average life expectancy means 0.35% increase of
GDP per year*
Germany:
• New Jobs in 2003: 25 000• Start-ups in 1995 – 2002 9 500
(Medical Technology)
*Source: Macro-Economics and Health, J. D. Sachs, WHO, 2001
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 8
How can we define incentivs for
preventive measures,
keeping people healthy ?
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 9
An integrated approach is necessary to achieve healthy systems
• EU Health Ministers have to conclude about the framework
• Care institutions, providers and payers have to make a joint effort defining services, procedures and reimbursement models to keep their clients healthy
• Clinical pathways have to be defined, committed and followed
• Transparency of care and quality measurements have to be established
• Only a competitive healthcare market serves the needs of people
• Potentially a population based approach is necessary
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 10
Let’s throw a glance over the ocean to Kaiser Permanente
Breast cancer screening: 79%
Chlamydia screening in women age 16-25: 64%
Childhood immunizations: 86%
Controlling high blood pressure: 76%
Persistence of beta-blocker treatment after heart attack: 85%
Comprehensive diabetes care, LDL-C screening: 95%
Quote: Every unexpected hospital admission is a failure of the system
Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 11
Potentially it is as simple as the fundamental equation in physics
1. Get the Health Ministers to conclude about the framework2. Define organizations where healthcare providers are becomming drivers of quality and efficiency within their professional and economic interest for the benefit of citizens.