Paradigm Shift in Healthcare – From Curative Care to Preventive Care

1. Paradigm Shift in Healthcare –From Curative Care to Preventive Care Dr. Karl-Jürgen Schmitt Chairman of Task Force Structural Funds, COCIR

2. 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 Expenditures for Cars € 179 bln € 135 bln* *incl. employers’ share: € 67.5 bln **incl. remidies, additives and dental prothesis Source: Destatis and DIW 2008 Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 2

3. 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 andEarly Detection Diagnosis Therapy Care Source: Institute of Medicine, To Err is Human, 1999. Hospital Statistics. Chicago. 1999; RAND study, Sep. 2005 • 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 Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 3

4. Prevention means far more than healthy living • Prevent medical and medication errors (quality management and transparency) • Prevent illness through early diagnoses (screening and risk factors, e.g. breast and colon screening, procam score) • Prevent acute cases of chronic patients (screening and monitoring, e.g. diabetic retinopathy screening, chronic heart failure monitoring) • Prevent illness through healthy life style (education and life style change) Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 4

5. Telematic Services –Great Acceptance and Impact Tele-Monitoring at patients with chronic heart failure • Better health status • Faster help • Risk reduction • Better care • Higher safety • Less physician contact • Manage anxiety Patients‘ acceptance of telematic monitoring in % • Hospital stays / year / Pt. • Length of stay • Emergency cases • Hospital stays >3 / year / Pt. • Discharge to admission Hospital costs • Intensive care costs • Medication costs Efficiency regarding clinical and economical aspects % Source: Oberender and Partner, VDE Position paper “TeleMonitoring in der Prävention von Herz-Kreislauf-Erkrankungen” Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 5

6. Healthcare is the smallest, but most successful initiative in this compilation, adopted in 17 out of 27 Member States 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) Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 6

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 forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 7

8. How can we define incentivs for preventive measures, keeping people healthy ? Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 8

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 forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 9

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 forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 10

11. Potentially it is as simple as the fundamental equation in physics • 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. Dr. Karl-Jürgen Schmitt, Screening forDiabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 11