HOW CAN THE DUTCH TOP PERFORMANCE WORK IN FAVOUR OF HEALTH CONSUMERS?

Johan Hjertqvist, HCP, at CEE Prague September 24, 2012

Comparing healthcare systems performance in 35 countries from a consumer/patient view.Since 2004, more than 40 index editions, available for free.

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AboutHealth Consumer Powerhouse

Europe

Euro Health Consumer Index 2005, 2006, 2007, 2008, 2009, 2012Euro Consumer Heart Index 2008Euro Diabetes Care Index 2008Euro HIV Index 2009Euro Patient Empowerment Index 2009Nordic COPD Index 2010Tobacco Harm Prevention Index2011Euro Headache Index 2011Euro Hepatitis Index 2012

Sweden, others

Health Consumer Index Sweden 2004, 2005, 2006Diabetes Care Index Sweden 2006, 2007, 2008Breast Cancer Index Sweden 2006Vaccination Index Sweden 2007, 2008Renal Care Index Sweden 2007, 2008Smoke Cessation Index Sweden 2008COPD Index Sweden 2009, Nordic 2010Advanced Home Care Index Sweden 2010Euro-Canada Health Consumer Index Canada 2008, 2009Provincial Health Consumer Index Canada 2008, 2009, 2010

FinlandSweden

Norway

Romania

Estonia

Latvia

LithuaniaDenmark

Poland

CzechRepublic

Slovakia

HungaryAustria

Germany

Netherlands

Belgium

France

Italy

Spain

Portugal

UnitedKingdom

Ireland

Iceland

Greece

Bulgaria

Luxembourg

Switzerland

Albania

Macedonia

Serbia

CroatiaSlovenia

Cyprus

Malta

2005

2006

2007

2008

2009

2012

2013?

Turkey

Ukraine

EHCI growth since 2005

Oooops….The DG Sanco internal design!

Upward and downward mobility

Some countries seem to survive almost everything we throw at them!

Netherlands, the Nordics, Belgium, …

UK less stuck in waiting time swamp!

Germany, Austria, Italy not doing too well on new indicators?

Czech Republic, Slovakia, Croatia crawling upward!

The Dutch example should provide inspiration!

There is (and should be!) a significantpositive relationship between moneyand outcomes, but some countries areover-performers, and some are under-achievers!

EHCI 2012

SE NO

ICEFI

CZ

LU

HRCH

MT

AT

PT

Healthcare somewhat affected by financial crisis?

Longer waiting times for (expensive) elective surgery most noticeable in countries hit by financial difficulties!

A very slight tendency towards increased private payment shares

Blue: 2009Maroon: 2012

Healthcare quality remarkably unaffected by financial crisis?

Infant deaths (per 1000 live births), WHO HfA January 201220 countries out of 34 score Green – up from 9 out of 29 in 2007!

Actual medical outcomes keep improving – the good part of ”physician civil disobedience”?

Why do we not (yet) see clearer traces of the financial

crisis?Healthcare traditionally weak at measuring output/outcomes.

“The good old days that never were”

Possible decline in services and access reported as “soft” rather than “hard” data – “patient witnesses”

Underlying improvement forces are very strong!

”The health consumer ladder”

”You are somebody”

”I can make a choice”

”All healthcare is

not the same”

”I need to navigate and

be in control”

EU patient mobility directive – one year

to go…

(Web)information to the public about which hospitals have the best results (2012)

FinlandSweden

Norway

Romania

Estonia

Latvia

LithuaniaDenmark

Poland

CzechRepublic Slovak

Republic

HungaryAustria

Germany

Netherlands

Belgium

France

Italy

Spain

Portugal

UnitedKingdom

Ireland

Iceland

Greece

Bulgaria

Luxembourg

Switzerland

Albania

Macedonia

Serbia

CroatiaSlovenia

Cyprus

Malta

Accessibility of European healthcare (EHCI 2012)

Europe is divided into”waiting list territory” (Red) and ”non-waiting list territory” (Green).

This is remarkably constant over time, and independent of GDP/capita.

FinlandSweden

Norway

Romania

Estonia

Latvia

LithuaniaDenmark

Poland

CzechRepublic Slovak

Republic

HungaryAustria

Germany

Netherlands

Belgium

France

Italy

Spain

Portugal

UnitedKingdom

Ireland

Iceland

Greece

Bulgaria

Luxembourg

Switzerland

Albania

Macedonia

Serbia

CroatiaSlovenia

Cyprus

Malta

Accessibility poorly correlated with numbers of doctors

Source: WHO Health for All database, January 2012

Access to e-Prescriptions

FinlandSweden

Norway

Romania

Estonia

Latvia

LithuaniaDenmark

Poland

CzechRepublic Slovak

Republic

HungaryAustria

Germany

Netherlands

Belgium

France

Italy

Spain

Portugal

UnitedKingdom

Ireland

Iceland

Greece

Bulgaria

Luxembourg

Switzerland

Albania

Macedonia

Serbia

CroatiaSlovenia

Cyprus

MaltaSource: Empirica, Bonn (2012)

e-Prescriptions are dependent on Electronic Patient Records to be meaningful

Websites with comprehensive information about all registered pharmaceuticals (OTC and

Rx)Austria: www.austriacodex.at/avmain/ http://pharmaweb.ages.at/index.jsfBelgium: http://www.bcfi.be/, www.pharma.beCroatia: http://www.almp.hr/?ln=hr&w=lijekoviCzech Republic: www.zdravotnickenoviny.cz/scripts/modules/catalogue/search.php?catalogueID=2Denmark: http://medicin.dk/ Estonia: www.raviminfo.ee Finland: www.fimea.fi/lakemedel/produktresumeer/humplFrance: www.doctissimo.frGermany: www.onmeda.deHungary: www.ogyi.hu/drug_database/ Ireland: www.medicines.ie Italy: www.prontuariofarmaci.comLatvia: http://www.zva.gov.lv/index.php?id=375&sa=375&top=334 Malta: http://medicinesauthority.gov.mt/products/search.htmNetherlands: www.cbg-meb.nl/CBG/en/human-medicines/geneesmiddeleninformatiebank/default.htm Norway: www.legemiddelverket.no/custom/Preparatsok/prepSearch____80333.aspx?filterBy=CopyToConsumer Portugal: www.infarmed.pt/infomed/inicio.php Romania: www.anm.ro/en/html/pharmacopoeia.htmlSlovakia: www.liekinfo.skSlovenia: www.zdravila.net Sweden: www.fass.seSwitzerland: www.kompendium.ch U.K.: http://emc.medicines.org.uk/

If anything, drug information available to patients seems to contain drug spending

(2009)!

Finland349Sweden

334

Norway285

Romania74

Estonia102

Latvia113

Lithuania120

Denmark341

Poland111

CZ154 SK

157

Hungary194

Austria329

Germany305

Netherlands282

Belgium376

France418

Italy282

Spain303

Portugal329

UnitedKingdom

238

Ireland438

Iceland405

Greece>400

Bulgaria71

Luxembourg

Switzerland361

Albania

Macedonia

Croatia144

Slovenia241

Cyprus222

Malta188

Numbers denotetotal drug sales percapita (€/year)(Source: EFPIA)

Dutch inspiration

Getting rid of politicians!

Separation of funding and provision

Competition

Consumer choice a driver

Transparency on offers and performance

An electronic version of this presentation is available at www.ceehpn.eu

Thank you!

All HCP Index information at: www.healthpowerhouse.com