Properly Financed and Properly Financed and Managed Healthcare Managed Healthcare ––

the biggest European Engine the biggest European Engine

1

Rotterdam, December 2010

Dr. Arne Björnberg

Health Consumer Powerhouse

Brussels/Stockholm

the biggest European Engine the biggest European Engine for Economic Growth?for Economic Growth?

ProloguePrologue::ThingsThings wewe must must believebelieve in in beforebefore wewe carrycarry on!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

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» 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!

Should healthcare become a service Should healthcare become a service industry?industry?

� Why not – healthcare is an excellent consumption item;

» not fattening

3

»

» not immoral

» only mildly addictive

» very labour-intensive (lots of jobs per M€!)

» has a low environmental footprint

» cannot be outsourced to India!

Europe except FSU:

Turnover: TUSD 1.4

14 000 hospitals

"Healthcare"Healthcare–– the the largestlargest industryindustry on Earth”on Earth”

14 000 hospitals

3.4 million hospital beds

1.7 million doctors

3.9 million nurses

~ 9% of GDP

Healthcare Healthcare capabilitycapability and output has and output has beenbeen and is and is growinggrowing rapidlyrapidly (# 1)(# 1)

� This is a problem:

» medical development is the major reason for the perceived financing problems of healthcare systems – and the need for rationing

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systems – and the need for rationing

Medicine Medicine –– a a victimvictim of of itsits ownownsuccesssuccess

+

Change in probabilityof patient survival ifdoctor arrives

6-

C:a1830

Today

Healthcare Healthcare capabilitycapability and output has and output has beenbeen and is and is growinggrowing rapidlyrapidly (# 2)(# 2)

� This is also a fantastic opportunity:

» introducing attractive ways of consuming "extra" healthcare can be done without taking

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"extra" healthcare can be done without taking away such 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

Not a question of “peddling more Not a question of “peddling more appendix operations”!appendix operations”!

Healthcare has long been in transition from curing sickness to providing wellnessHealthcare has long been in transition from curing sickness to providing wellness

� Acute stroke and

infarct

� Curative cancer

therapy

� ”Heavy” psychiatry

� Severe infectional

disease

� Fractures

� Rehabilitation� Cataracts

� Imigran

� Gonorrhea and clamydia

� Palliative radiation

therapy

� Cancer surgery

� Blood diseases

Severe hip and knee joint

� Varicose veins

� Oestrogen treatment

� Breast reductions

� Hip and knee joint

replacement

� Incontinence

� Prostate trouble

� Moderate arthritic pain

� The bulk of dermatology

Not paid for by public

benefit systems

� Moderate problems

from columns 2 & 3!� Small varicose veins

� Gyms

� Cough drops

Wrinkles

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� Fractures

� Severe traumas

� Acute allergic reactions

� Complicated

childbirths

� Child leukemias

� Major bleeding ulcer

� AIDS

� Old patients with

severe multidiagnoses

� 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

� 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

� Wrinkles

� Esthetic plastic surgery

� Herbal medicine

� Vitamins

� Alternative medicine

� Liposuction

� Benign skin spots

� Regaine

� Bulk of dental care

� Antabus

"Need" "Demand"

The healthcare

"market"!

� Stop the rationing/containment paradigm!

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� Stimulate Healthcare to grow into a service industry!

StimulateStimulate healthcarehealthcare to to becomebecome a service a service industryindustry!!

� 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!)

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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!

… and Yes, this is meddling with … and Yes, this is meddling with the issue of Equitythe issue of Equity

� In our present systems, equity problems frequently hit the weakest groups of patients, not the wealthy and/or well-

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patients, not the wealthy and/or well-educated

� Improving the opportunities to consume healthcare services can provide better healthcare for everybody!

The Key IssuesThe Key Issues

� Financing solutions

» make consumption of healthcare services as easy and convenient as the consumption of capital goods or package

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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"

Is there a willingness to pay, which Is there a willingness to pay, which is not catered for?is not catered for?

Definitely - with the appropriate marketing:

”Fly more on Lufthansa - we need the money;» our planes are old

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» 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

How large can the healthcare How large can the healthcare industry be allowed to grow?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.

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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)

EU countries have blocked the underlying growth EU countries have blocked the underlying growth

potential of the healthcare industry by shutting it into potential of the healthcare industry by shutting it into

the “cost problem strait jacket”!the “cost problem strait jacket”!

60

80

100

Sh

are

of

GN

P

Manufacturing

& agriculture

Private

Manufacturing

& agriculture

Private

services

15

-20

0

20

40

EU USA

Sh

are

of

GN

P

Private

services

Other public

services

HealthcareHealthcare

Unemployed Unemployed

Source: Eurostat

services

Other public

services

So What?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

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� 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!

The The LisbonLisbon Agenda andAgenda andsustainablesustainable financingfinancing of of healthcarehealthcare in the EUin 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!"

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largest service industry on Earth: Healthcare!"

» and at the same time: improved healthcare services for all!

» and Sustainable Financing for Healthcare Systems!

So So wherewhere couldcould all that all that moneymoneycome from?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. 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”?

THANK YOU!THANK YOU!

www.healthpowerhouse.com