towards a healthcare system ready for the future · real world real world real world time time....
TRANSCRIPT
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Cornerstones of the current ánd the futurehealth care system
SUSTAINABILITY
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The future is bright!
3http://medicalfuturist.com
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Human interaction?
Exponential cost?
Labour market impact?
Privileged use?
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The future is bright?
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How to build a healthcare system ready for the future?
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SUSTAINABILITY
Don’t ask “what willthe future bring?” But shape the future
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7OECD (2013), “What Future for Health Spending?”, OECD Economics Department. Policy Notes, No. 19 June 2013.
Total public health and long-term carespending ratio to GDP As a % of GDP
1. Keep investing in health
>2% annualgrowth needed!
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Set clear societal limits: what are we –society – willing to pay for health gains?
Government Agreement
Annemans L. Health Economics for non-economists. Pelckmans June 2018. https://nolledz.com/product/health-economics-for-non-economists/
2. Challenge the cost-effectiveness of new technologies
Value Informed & AffordablePrices
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Point of VerificationLaunch
Highly innovative? Disruptive?→Managed entry in selected centres with outcomes based agreement
1.Coverage upon evidence development
• Temporary approval, then final decision
2.Performance Linked Reimbursement (outcomes guarantee)
• Not as good as promised→ industry pays back
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Point of VerificationLaunch
Real World
Real World
Real World
Real World
time
time
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Priority forHigh MedicalNeed(Scitovsky)
Acceptablehealth
High need→ more solidarity→ invest more
Low need→ no funding
Worst possiblehealth
Best possiblehealth
ZIN Kosteneffectiviteit in de praktijk 2015
!
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3. Perfect health information system
If you don’t have all information for all the patients all the time you are wasting your money (G. Halvorson)
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4. Integrated healthcare
• GP, pharmacist, dentist, nurse, psychologist, physiotherapist, osteopath, dietician, occupational therapist
• Home adaptation, family help, …• Specialist, Hospital Network• New functions and professions!
CORTEXS project www.cortexs.org
Health and care zones
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We have to embrace digital, but we have to embrace each other even more
13Health care professionals of the future will become more psychologists and philosophers
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Networks between hospitals
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Reduce supply induced demand
Improve Quality of care
Less hospital beds
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Shift to home care & ‘homespitals’
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NOW 2030
hospital budget hospital beds
→ Set objectives!
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5. Change financial incentives
Introduce more episodic payments
Fixed amount per patient/insured per time period: pay to maintain health
+ decreased risk for overconsumption
+ improved access
+ more focus on prevention
+ improved quality of life health professional
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• Cardiologist: telemonitoring in cardio
• Oncologist: app for earlyreporting of adverse events
Possible examples
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Blended payment “cappuccino 2.0”
PRACTICE FEE
Fee for Service
P4Q
Episodic payments
(adapted from Guus Schrijvers)
COSTS
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I. Bundle hospital and physician services
II. Bundled payments that only pay for part of Potentially Avoidable Complications (PACs)→ reward those with lower PAC rates
III. Bundled paymentsinclude all costs in the 30 days post an inpatient stay, including any return to the hospital
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HOSPITALS: incentives to avoid complications
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6. Invest much more in health promotion
Health is in all policies
Healthcare
Localcommunity
WorkEducation
Family
Leisure
VAGZ dec 2016
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7. Equity!
Lowest vs Highest 20% income category
• 20% less screening
• One third less dental care
• More smoking
• More sedentary behaviour
• 2 x more disabled
• Psychiatric admission x 3
• …
Avalosse at al. 2015
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How to tackle inequity• No co-payment in case of
– essential care AND
– no risk for overconsumption
• Everyone a GP, a pharmacist and a dentist, part of a health and care network
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EQ health system
O
Equity and
Quality of careQuality of life citizensQuality of life health professionals
Optimizing
The future healthcare system is EQO
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Features of an EQO health system1. Annual growth rate for public health expenditure >2%/yr
2. Societal thresholds for willingness to pay for new technologies
3. A perfect health information system: all information all the time
4. Integrated digital-based health and care networks with citizen/patient as co-producer of health
5. Payment system for healthcare providers that rewards good practice and health maintenance
6. Extra-proportional investment in health promotion
7. Tackles health inequalities: everyone is subscribed to a health care practice, and essential care is free of charge
L. Annemans
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Lieven Annemans
@LievenAnnemans
Last point:
it is difficult to create a just health care system in an unjust society (Loewy, 1998)