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Early inequality in access can heighten efficiency in health care supply mid-term

Early inequality in access can heighten efficiency in health care supply mid-term. Constant increase of life expectancy (at birth in Germany from 1960-2006). Source: OECD 2008. Life expectancy in Germany by gender and east/west. west. east. west. female. east. male. 1960. 1975. 1990.

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Early inequality in access can heighten efficiency in health care supply mid-term

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  1. Early inequality in access can heighten efficiency in health care supply mid-term

  2. Constant increase of life expectancy (at birth in Germany from 1960-2006) Source: OECD 2008

  3. Life expectancy in Germany by gender and east/west west east west female east male 1960 1975 1990

  4. 1840 1860 1880 1900 1920 1940 1960 Impact of health care on increase of health status / life expectancy? • Thomas McKeown1976: The roleofmedicine: Dream, mirage oder nemesis? • "Healthresultsfrom a combinationofsocial, economic, andpsychologicalas well aspurelybiologicalphenomena. Most doctors now understand this and so increasingly do politicians; this enhances their reluctance to invest heavily in health services when they have only a small effect on health." (Morrison und Smith 1994) • Contrarytowhathasbeen suggested by some authors, there appears to be a significantly positive relation between health expenditure and health, particularly for women. (Or, Z, 2000)

  5. Health care is not a static factor • Evidence-based Medicine: • „Burn your textbooks because knowledge renews every few years.“ • Straus SE, Richardson WS, Glasziou P, Haynes RB (2005)

  6. Progress in pharmaceutical care (Germany, 1975: West Germany) provenefficacy, lifesaving provenefficacy, not lifesaving benzodiazepines efficacy not proven, efficacy not proven,

  7. 2008 market shares of TOP25 drugs prescribed in 1975 marketshare in 1975 marketshare in 2008

  8. „War against heart disease“: Cardiovascular causes of death decline much faster since mid 80s (West Germany) - 31% 771 - 23% DMDR (deaths per 100,000 - 19% 593 596 All other COD Andere Todesursachen - 49% 300 Cardiovascular COD Herz-Kreislauf-Erkrankungen 2000 2006 1985 1970

  9. Health care costs strongly influenced by expen-ditures for innovative services (here: biologicals) 9.690 1,5 Noch unbekannte AM Autoimmun-krankheiten 2,4 6.022 expend. in 1,000,000 Euros 2,3 Krebs 4.014 0,4 Wachstum 0,3 Epo 0,4 Diabetes 1,9 Orphan

  10. Cost containment strategies frequently based on assessment and apraisal of new services (drugs) „highequity countries“ priceregulation after utility assessment no yes yes no yes yes yes

  11. Countries with strong regulations („high equity countries“) show late penetration of new drugs marketpenetrationofnewmolecules relative to USA DanzonandFurukawa, 2003

  12. Late penetration deprives patients of (proven) health benefits (e.g. statins) proofofefficacy

  13. equity health for all finan-cial limits limited choice late penetration (for all) early penetration (for few) little choice stimu-lus for innova-tion

  14. From a different world:How the airbag penetrated the car market 1981 Airbag verfügbar 1.800 DM (nur Fahrer-Airbag) 5 % von 39.000 DM Airbag NICHT verfügbar (1.800 DM entsprächen 15 % von 12.000 DM) 1991 Airbag seit 10 Jahren verfügbar Airbag ERSTMALIG verfügbar 1.120 DM (Fahrer + Beifahrer) 6% bzw. 3% von 18.000 DM 2001 Airbag = Serienausstattung Airbag = Serienausstattung

  15. How „high equity countries“ can stimulate the innovation process • Allow early use of services only for out-of-pocket-payers • Establish innovation insurance scheme as add on • Allow choice within public health care systems

  16. www.iges.de

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