ehealth 2014_radu dop

International Lessons for the Development of a

Sustainable Health Care System

TIPS TO FINDING AND CHOSSING A DOCTOR

The process of finding and choosing a phisician to manage your

specific illness or condition is, in some respect, analogous to the

process of making a decision about whether or not to invest in a

particular stock or mutual fund.

It is important to keep in mind that you are not looking for just

any general physician but rather for a physician who has

expertise in the treatment and management of your specific

illness or condition.

4

Overview

*Global Trends in Health Care *Defining Succesful Systems *5 International Lessons *Practical Steps for Policy Makers

The Health Age

5

๏ Health Age has Begun

๏ 6 Billion People / Potential Patients

๏ Hospitals - 110’000 in the world

๏ Health Care Providers

‣ 9 Million Physicians

‣ 13 Million Nurses

‣ 1 Million Pharmacists

‣ 1 Million Dentists

The Big Picture

6

๏ US$ 2.9 Trillion Worldwide Health Care Expenditure

‣ 21% by consumers out of pocket

‣ 18% by Private payers or providers

‣ 61% Spent by Public Entities

Global Health Care Expenditure

Out of

Pocket

Consumer

s

21%

Private

Payer or

Providers

18%

Public

Entities

61%

7

๏ Medication & Devices 35%

๏ Hospital Care 33%

๏ Prevention & Outpatient Care 23%

๏ Nursing & Rehabilitation 9%

Health Care Expenditure Breakdown

Medicatio

n &

Devices

35%

Hospital

Care

33%

Preventio

n &

Outpatient

23%

Nursing &

Rehab

9%

McKinsey, March 2004 8

Global Trends

๏ Chronic Under-Investment in Health

๏ Public Sector Health Care limited, Private Sector Growing

๏ WHO is leading Global Health Care?

๏ Impact of Chronic Diseases

๏ Patient Empowerment

๏ Role of Communication & Information

9

TOTAL HEALTH SPENDING PER CAPITA

Based on data from the WHO 2004 World Health Report, Annex 6

COUNTRIES DIFFER ON HEALTH EXPENDITURE

Health spending per capita (USD Billion)

0 500 1000 1500 2000 2500 3000 3500 4000

Switzerland

Germany

France

Netherlands

Sweden

Ireland

Belgium

Greece

Cyprus

Czech rep

Slovakia

Poland

Lithuania

Bulgaria

Romania

Ukraine

3.4 %

4.2 %

4.7 %

5.8 %

6.1 %

5.7 %

7.4 %

6.1 %

9.5 %

9.1 %

7.3 %

9.2 %

9.1 %

9.7 %

10.9 %

11.2 %

% of GDP spend on

Health (2002)

Chronic Diseases: Biggest Burden

๏ * 35 Million People died from Chronic Disease in 2005

๏ * 17,5 million from Cardiovascular Disease

๏ * 7,5 Million from Cancer

๏ * 4 Million from Respiratory Disease

๏ * 1,1 Million from Diabetes

๏ Other:

๏ * HIV / AIDS – 2,8 Million deaths and 1,6 Million from TB

๏ * 880 000 deaths from Malaria

0 1000 2000 3000 4000 5000 6000 7000 8000

Unsafe health care injections

Vitamin A deficiency

Zinc deficiency

Urban air pollution

Iron deficiency

Indoor smoke from solid fuels

Unsafe water, sanitation, and hygiene

Alcohol

Physical inactivity

High Body Mass Index

Fruit and vegetable intake

Unsafe sex

Underweight

Cholesterol

Tobacco

Blood pressure

High Mortality Developing Countries

Low Mortality Developing Countries

Developed Countries

World Deaths in 2000 attributable to selected leading risk factors

Number of deaths (000s)

Source: WHR 2002

Urbanisation, lifestyles

and chronic diseases

Tobacco use Obesity Physical activity

Risk factors and trends

Patient Information &

Communication

NHS Hotline Growth

0

100

200

300

400

500

600

700

800

900

2002 1st Half 2002 2nd Half 2003 1st Half 2003 2nd Half 2004

0

200

400

600

800

1000

1200

1400

1600

Articles

Pledges

Global Fund for AIDS, TB & Malaria and Media Coverage

Number of

articles

Pledges, $ millions

Kraig Klaudt, Massive Effort Campaign

Media Coverage and the WHO Global TB Programme Budget

0

50

100

150

200

250

1985 1987 1989 1991 1993 1995 1997

0

2

4

6

8

10

12

14

16

Articles

Cases*

Funding

Number of articles & Cases notified per 100,000 population

Budget, $ millions

Kraig Klaudt, Massive Effort Campaign; WHO Global Tuberculosis Report, 2000

Global TB Emergency

declared

LESSON 1: Prioritize Health Agenda

Demonstrate benefits

(Health = Wealth)

1. Productivity

2. Education

3. Employment

4. Economic Growth

5. Competitiveness

(Singapore, Taiwan)

Lesson 2 : Increase Investment * Be Aware of False Standards (% of GDP)

* Budget for Double Burden of Disease

* Legislate Specific Entitlements

* Actively Promote More Money for Health, More Health for Money

(Mexico, UK)

Lesson 3: Patients Matter ๏ * Make Services

Patient-Centred

๏ * Optimize Patient Information & Communication

๏ * Ensure Quality Improvement

๏ (Japan)

๏ * Major Driver for Health Progress

๏ * New and better Technologies

๏ * Improves Personal Health Behaviour

๏ * Scientific Foundation for Policy & Practice

๏ (Finland, Ireland)

Lesson4: Evidence

Lesson 5: International Collaboration * EU, World Bank, WHO

* Framework Convention on Tobacco Control

* International Health Regulations (IHR 2005)

* Millenium Development Goals

(Foundations, Oxford Health Alliance)

Knowing is not enough; we must apply. Willing is not enough; we must do. – Goethe

Practical Steps 1. Understand Specific Issues in Romanian Health Care

2. Specify Objectives

3. Learn from Other Nations & Forge Alliances

4. Determine Feasibility

5. Consultation – Health Professionals & Stakeholders

6. Implement in Fair, Consistent Manner

7. Research, Review and Adjust

Time value of information

1/8 second: "instant"

1/4 second: "snappy"

1 second: cognitive drift

10 seconds: capture by other task

Health Application Platform

Walk Me

Clinical User Interface

Health Vertical

Knowledge Driven Health

Investments Customisati

on People & Partners

www.mscui.net

Why Communication is important

Caregivers preference their peers over text

Communication errors are the most common cause of preventable

medical errors

Blind calls and paging

Source: J. Westbrook et al, MJA, 5 May 2008

What are we trying to resolve

Issue 1: Not knowing who to go to for advice

Issue 2: No backup for the person with the info

Issue 3: One to One Communication does not

make a team.

Metcalfe's law states that :

The value of a network is proportional to the

square of the number of connected users of

the system (n2).

Most of Healthcare

Helping The Healthcare Workforce

Helping The Healthcare Workforce

Helping The Healthcare Workforce

Helping The Healthcare Workforce

BI and Reporting

Mobility

4/22/2009 43 THE LEAPFROGGROUP

WASHINGTON, DC, April 15, 2008

Patient Safety Rating PSR

http://www.leapfroggroup.org/cp?frmbmd=cp_listings&find_by=state&city=&state=AZ&cols=a.b.c.

d.e.f.g.h.i.j.oa

4/22/2009 44 THE LEAPFROGGROUP

4/22/2009 45 THE LEAPFROGGROUP

The Leapfrog Group was founded in November 2000 by the

Business Roundtable and is supported by its members:

•The Robert Wood Johnson Foundation,

•The Commonwealth Fund,

•The Agency for Healthcare Research and Quality and other

sources.

Other highlights of the 2008 hospital survey, include:

Relatively low percentages of reporting hospitals are fully

meeting volume and risk-adjusted mortality standards, or

adhering to nationally endorsed process measures for eight

high risk procedures, where following nationally endorsed

and evidence-based guidelines is known to save lives:

43% for heart bypass surgery

35% for heart angioplasty

32% for high-risk deliveries

23% for pancreatic resection

16% for bariatric surgery

15% for esophagectomy

7% for aortic valve replacement

5% for aortic abdominal aneurysm repair 46 THE

LEAPFROGGROUP

DOCTOR OF THE FUTURE

Patient centered

Team-based/outreach oriented

High tech AND high touch

Doctor of the Future 1

Genomic individualization/ functional medicine matrix

Prospective, preventive, behavioral science-based

change methods

Self-healing/homeostasis

Doctor of the Future 2

Natural treatments: nutrition, botanicals, lifestyle, mind-

body, CAM therapies

Integrative

Health system navigator

Doctor of the Future 3

Multidisciplinary/collaborative

Conscious design of healing environment

Systems biology/complexity theory methods

Doctor of the Future 4

Quality and outcomes focused, evidence-based

Empowering patient education through web based

resources, health coaching

Community based/Patient advocate/activist

Social/environmental /policy change and self-care

strategies

Doctor of the Future 5