Transcript Dr. Karl-Jurgen Schmitt - European Conference On Screening For

Paradigm Shift in Healthcare –
From Curative Care to Preventive Care
Dr. Karl-Jürgen Schmitt
Chairman of Task Force Structural Funds, COCIR
In healthcare we have a problem in
service delivery not in revenue
People are willing to pay for transparent quality
(Example: Germany)
Expenditures of
Compulsory Health Insurance
administration
costs
6%
Expenditures for Cars
others
6%
petrol & engine oil
24%
in-patient
treatment
36%
sick-pay
4%
repairs /
maintenance
20%
vehicle tax
3%
medical
treatment
21%
drugs
27%
car rental,
inspection, parking
15%
€ 135 bln*
*incl. employers’ share: € 67.5 bln
**incl. remidies, additives and dental prothesis
Source: Destatis and DIW 2008
Dr. Karl-Jürgen Schmitt,
Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 2
vehicles
38%
€ 179 bln
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
US$
‘Adverse events’
… every year in the US:
 90,000 Deaths
 2,000,000 Adverse
Events
‘Adverse Events’
Situation today
(without “Accidence’‘)
Actual
(without ‘Adverse Events‘)
Ideal
Prevention and
Early Detection
Diagnosis
Therapy
Care
Source: Institute of Medicine, To Err is Human, 1999. Hospital Statistics. Chicago. 1999; RAND study, Sep. 2005
Dr. Karl-Jürgen Schmitt,
Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 3
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, 4
Telematic Services –
Great Acceptance and Impact
Tele-Monitoring at patients with chronic heart failure
 Better health status
30
 Faster help
80
Patients‘
 Risk reduction
77
acceptance of
 Better care
88
telematic
 Higher safety
71
monitoring in %
 Less physician contact
13
 Manage anxiety
70
Efficiency
regarding clinical
and economical
aspects %
 Hospital stays / year / Pt.
-56
 Length of stay
-69
 Emergency cases
-70
 Hospital stays >3 / year / Pt. -81
 Discharge to admission
Hospital costs
 Intensive care costs
 Medication costs
33
-55
-51
49
Source: Oberender and Partner, VDE Position paper “TeleMonitoring in der Prävention von Herz-Kreislauf-Erkrankungen”
Dr. Karl-Jürgen Schmitt,
Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 5
Member States and the EU should
cooperate to complete this paradigm shift
Light House examples are:
1. Healthcare
European guidelines for breast screening
(Goal: to reduce the mortality of this disease)
2. Education
Bologna Process
(Goal: to increase competitivnes of European universities)
3. Economic, Social, Enviroment
Lisbon Strategy
(Goal: to make Europe the most competitive, dynamic and
knowledge based region of the world)
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, 6
Healthcare as an Economical Factor
Healthcare could support the goals of the Lisbon
Strategy
Europe:
• Expenses for health:
• Employment:
8.6 % of GDP in EU-15
around 10 % of European workforce
• 10% increase in average life expectancy means 0.35%
increase of GDP per year*
Germany:
• New Jobs in 2003:
• Start-ups in 1995 – 2002
(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, 7
25 000
9 500
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, 8
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, 9
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, 10
Potentially it is as simple as the
fundamental equation in physics
1.
2.
Dr. Karl-Jürgen Schmitt,
Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 11
Get the Health Ministers to
conclude about the framework
Define organizations where
healthcare providers are becomming
drivers of quality and efficiency
within their professional
and economic interest for the
benefit of citizens.