eprd16 - paul vincke - european healthcare fraud and corruption network
Post on 11-Apr-2017
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www.ehfcn.org
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30%
healthcare expenditure
waste
Healthcare “Waste” defined
“healthcare spending that can be eliminated without reducing the quality of care” The New England Health Institute (NEHI)
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waste
waste with intention
40%40%
Integrity violations
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fraud
waste with intention
15%
40%corruptio
n45%abuse
Patients are exposed to:
– Physical harm due to low value care as the result of
• Underuse (capitation) – substandard medical devices or incomplete DRG’s
• Over(use)consumption (unnecessary and or to expensive care) (fee for service)- lots of invasive tests with no added value (lack of legal basis for the development and enforcement of clinical guidelines)
– Financial harm due to• Informal payments• Refusal of reimbursement by payer (non compliant
billing) 6
Healthcare spending without waste• Patients must be
– Informed– Educated– Made responsible
• Healthcare professionals must be – Informed– Educated– Made responsible
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www.ehfcn.org
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