Rotterdam, December 2010 Dr. Arne Björnberg Health Consumer Powerhouse Brussels/Stockholm

1. Rotterdam, December 2010Dr. Arne BjörnbergHealth Consumer PowerhouseBrussels/Stockholm Properly Financed and Managed Healthcare – the biggest European Engine for Economic Growth?

2. Prologue:Thingswe must believe in beforewecarry on! • If a human activity is a cost item, or an industry contributing to economic growth, has nothing to to do with the nature of the activity! • This is dependent only on the number of Independent Consumption Decision Makers (”ICDM’s”) • Healthcare could and should become an industry, massively contributing to European economic growth! • This can be done without sacrificing European values of equity in healthcare!

3. Should healthcare become a service industry? • Why not – healthcare is an excellent consumption item; • not fattening • not immoral • only mildly addictive • very labour-intensive (lots of jobs per M€!) • has a low environmental footprint • cannot be outsourced to India!

4. "Healthcare – the largestindustry on Earth” • Europe except FSU: • Turnover: TUSD 1.4 • 14 000 hospitals • 3.4 million hospital beds • 1.7 million doctors • 3.9 million nurses • ~ 9% of GDP

5. Healthcare capability and output has been and is growingrapidly (# 1) • This is a problem: • medical development is the major reason for the perceived financing problems of healthcare systems – and the need for rationing

6. Medicine – a victim of itsownsuccess Change in probability of patient survival if doctor arrives + Today C:a 1830 -

7. Healthcare capability and output has been and is growingrapidly (# 2) • This is also a fantastic opportunity: • introducing attractive ways of consuming "extra" healthcare can be done without taking awaysuch healthcare, which people are accustomed to getting through public systems • it also emphasizes the need for doctors and healthcare systems to undertake sorting apart "need" from mere "demand" – this sorting has been practised for decades

8. The healthcare "market"! Not a question of “peddling more appendix operations”!Healthcare has long been in transition from curing sickness to providing wellness • Rehabilitation • Cataracts • Imigran • Gonorrhea and clamydia • Palliative radiation therapy • Cancer surgery • Blood diseases • Severe hip and knee joint problems • Severe RA • Ottitic children • 50% of coronary bypass operations • Gall bladder surgery • Semi-serious ulcers • Old patients with moderate multidiagnoses • Severe dental injuries • Acute stroke and infarct • Curative cancer therapy • ”Heavy” psychiatry • Severe infectional disease • Fractures • Severe traumas • Acute allergic reactions • Complicated childbirths • Child leukemias • Major bleeding ulcer • AIDS • Old patients with severe multidiagnoses • Not paid for by public benefit systems • Moderate problems from columns 2 & 3! • Small varicose veins • Gyms • Cough drops • Wrinkles • Esthetic plastic surgery • Herbal medicine • Vitamins • Alternative medicine • Liposuction • Benign skin spots • Regaine • Bulk of dental care • Antabus • Varicose veins • Oestrogen treatment • Breast reductions • Hip and knee joint replacement • Incontinence • Prostate trouble • Moderate arthritic pain • The bulk of dermatology • Hypospadi • Common cold • Carpal tunnel syndrome • Gall bladder surgery • Gastritis • Old patients with less severe diagnoses • Hearing aids • PC-based reading aids • Viagra • Mammography "Need" "Demand"

9. Stop the rationing/containment paradigm! • Stimulate Healthcare to grow into a service industry!

10. Stimulatehealthcare to become a service industry! • Healthcare is transcending from curing sickness to providing wellness! • Keep the present basic coverage provided by public systems (i.e. do not copy American social insurance systems!) • Make it as streamlined and pleasant to consume healthcare services as it is to consume package holidays or Korean-made electronics; • Yes! Stimulate over-consumption of healthcare services!

11. … and Yes, this is meddling with the issue of Equity • In our present systems, equity problems frequently hit the weakest groups of patients, not the wealthy and/or well-educated • Improving the opportunities to consume healthcare services can provide better healthcare for everybody!

12. The Key Issues • Financing solutions • make consumption of healthcare services as easy and convenient as the consumption of capital goods or package holidays • Prioritization within healthcare • open and transparent systems for sorting patients to the separate sides of the "brick wall"

13. Is there a willingness to pay, which is not catered for? Definitely - with the appropriate marketing: ”Fly more on Lufthansa - we need the money; • our planes are old • pilots and cabin staff are burned out • management is abysmal • regularity is appalling • check-in queues are mile-long • weather forecast is terrible!”*) *) typical healthcare “marketing” translated to the airline industry

14. How large can the healthcare industry be allowed to grow? • Answer: Literally no limit at all, as long as growth is fueled by a demand situation, where consumption decisions are made by 500 M Europeans. • There is a limit ONLY when healthcare consumption is “force financed” in such a way that it automatically makes all other goods and services more expensive! (e.g. through taxes)

15. EU countries have blocked the underlying growth potential of the healthcare industry by shutting it into the “cost problem strait jacket”! 100 Manufacturing & agriculture 80 Manufacturing & agriculture 60 Private services Private services Share of GNP 40 Healthcare Healthcare 20 Other public services Other public services 0 Unemployed Unemployed -20 EU USA Source: Eurostat

16. So What? • Instead of walking around showing perverse pride over the fact that we have been able to keep healthcare below 10 % of GNP - • what if in 2025, with justifiable pride, we could look back att how we brought healthcare to 15 % of GNP, creating >10 M European jobs in the process? • And at the same time strengthening European values of good access to healthcare for all!

17. The Lisbon Agenda andsustainablefinancing of healthcare in the EU • Ladies and gentlemen; • "I give you EUR 600 billion of additional economic growth for the EU provided by the largest service industry on Earth: Healthcare!" • and at the same time: improved healthcare services for all! • and Sustainable Financing for Healthcare Systems!

18. So wherecould all that money come from? • The NL 2006 reform provided one essential key: Multiple insurers, who cannot say No to a patient, secure access to good healthcare for all. • This provides a clue to the introduction of politically acceptable ways to allow additional consumption of healthcare services (i.e. multiple purchasers). • Attractive financing solutions for healthcare services can become as common as for other expensive consumption items! • Reflect: mobile telephones and communication technology has ”taken” ~5 % of household budgets in 15 years – where did all that money ”come from”?

19. www.healthpowerhouse.com Thank you!