The healthcare challenge: more with less, more for more
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07/06/22 The Health-Care Challenge Prof. Dr. Marc De Vos
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When means and needs clash, how to change healthcare to do more with less, and how to enable it to do more with more?
Transcript of The healthcare challenge: more with less, more for more
09/04/23
The Health-Care Challenge
Prof. Dr. Marc De Vos
09/04/2309/04/23
Where are we?
Health Care Challenge p.2
09/04/23
The Belgian Health Care Challenge p.3
Financial
Government
Monetary
Economy
Welfare state
Demography
Demography
Democracy
Sociology
Banks
Debt
€ $ ¥
US NEU SEU China
EU US
Ageing
Immigration
EU US B
We!
09/04/23
The Belgian Health Care Challenge p.4
09/04/23
Quo vadis, België? p.5
60+
100+
x2
x10
80+
x3
1/4
1/2 1/1
1/3
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Quo vadis, België? p.8
100%
375%
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The Belgian Health Care System p.9A World in Transition p.9
The Reality
•Relative gradual decline
•Age of “austerity”
•Ageing: burden & competition
•Modest growth prospects
•Political “impotence”
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Health-Care Trends
Health Care Challenge
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HC-growth & GDP-growth 1980-2005: public expenditures
The Belgian Health Care Challenge p.11
09/04/23
Out-of-pocket expenditure on health (2009, OECD)
In 2009, additional health insurance covered €1,8 billion expenditure on health and €7,4 billion was paid for out-of-pocket in Belgium.
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The Belgian Health Care System p.13
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Cost to market of chemical/biological innovation
Health Care Challenge p.14
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Life Style
Health Care Challenge p.15
70%
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The Belgian Health Care Challenge p.16
€800 billion
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Average HC Cost (gender & age): Belgium
Health Care Challenge p.17
Men Women
0
1000
2000
3000
4000
5000
6000
7000
8000
0-1 1-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
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Persons in elder care homes (2007=100)
Health Care Challenge p.18
NumberNumber IndexIndex
20072007 20202020 20502050 20202020 20502050
Flanders 62 008 94 820 197 892 153 319
Wallonia 46 254 63 287 131 448 137 283
Brussels 14 595 16 981 29 445 116 202
BelgiumBelgium 122 857122 857 175 088175 088 358 785358 785 143143 293293
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The Belgian Health Care System p.19
Health Care hits the wall4%
7,5%
20%
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Policy Issues
Health Care Challenge
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The Belgian Health Care System p.21
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The Belgian Health Care System p.22
GOING FOR ECONOMIC GROWTH!
A new VISION for healthcare– More health but less healthcare:
prevention and lifestyle– More healthcare with less means:
efficiency, effectiveness, supply, ICT etc.– Different and more just healthcare with
the same means: accountability and value added across the board
– More but different means : an open and societal choice
– Grasping the opportunities of a HC economy
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1. Cost2. Quality3. Prevention4. Integration5. Information6. Patients7. Payment8. Funding9. Innovation10.Goals
EffectivenessResultsPrimary & secondaryNo barriersEverywhereEmpowered - ResponsibleThe right incentivesLess is (not) moreLevel playing fieldGoals!
Instruments for Change
09/04/23
Health Care Challenge p.24
Supply: HC MANAGEMENT
From a vertical approach where everybody works independently with separated budget – separated human and technical resources - independent strategy to maximize the turnover
Toward an integrated and horizontal approach, with a global strategy , a coordinator and a total exchange of information
09/04/23
Health Care Challenge p.25
Supply: promotion of QUALITY
Drastic measures to reduce - when necessary - the nosocomial infections : benchmarking of the hospitals and communication to the citizensAccreditation of hospitals Optimization of clinical pathwaysCertification of websites for the citizens-patientsMinimum level of activities regarding the international standardsWe only pay for quality and cost-effectiveness
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The Belgian Health Care Challenge p.26
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The Belgian Health Care Challenge p.27
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Expenditure on prevention: % of total HC (2008)
The Belgian Health Care Challenge p.28
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Preventive HC consumption per year (B 2011)
The Belgian Health Care Challenge p.29
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Health Care Challenge p.30
New roles for providers and hospitals
To promote prevention, management of chronic diseases ,long term vs. short term vision, choice of the best alternativesMore and more cooperation with each otherPartnership and sharing of knowledge with the patient who has access to more and more information via internetExtensive use of ICT and real time access to all types of informationUse of clinical guidelines and standardized proceduresAdapted remuneration system – both doctors for and for hospitals
09/04/23
Health Care Challenge p.31
New Roles for Sick Funds - Insurers
Informing and guiding the patient &
promoting prevention
Promoting continuum of care and disease
management
Quality and efficiency watchdog
More financial responsibility
ICT & data: the basis for rational steering
09/04/23
Health Care Challenge p.32
New Roles for the State
Cost-effectiveness across the board – ex ante
and ex post
More steering, coordination and rationalisation
Integrated policies on prevention + detection
+ care
Different incentives for the key actors: HC
professionals and patients
09/04/23
Health Care Challenge p.33
Private Insurance?
Belgium today = US
Private insurance will be necessary:
– Cf. pension funding debate: economy v taxation
– Objective efficiency v. subjective value
Towards a societal and rational choice: two
pillars?
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Health = Wealth: HC cost v Lost economic output
The Belgian Health Care Challenge p.34
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The Future?
Health Care Challenge
09/04/23
The Belgian Health Care System p.36
Short term: bickering over budget and
austerity: least resistance victims
Medium term: towards a coordinated
strategy - gradual
More institutional responsibility for the
key players in healthcare
Less freedom, more steering – evidence
based
More private HC realities and diversity
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09/04/23
The Care Challenge p.39
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The Belgian Health Care System p.40
