paradigm shift in healthcare – from curative care to preventive care dr. karl-jürgen schmitt...

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%


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’


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)


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


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


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


How can we define incentivs for

preventive measures,

keeping people healthy ?


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


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


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.

paradigm shift in healthcare – from curative care to preventive care dr. karl-jürgen schmitt...

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