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OA
He
alt
h a
nd
Str
uc
tura
l F
un
d
Wo
rksh
op
Ro
me
Ma
y 2
01
1
Ba
rrie
Do
wd
esw
ell
Dir
ec
tor
of
Re
sea
rch
, EC
HA
A
Co
nte
xt
He
alt
h, a
de
fin
ing
so
cie
tal
va
lue
•A
rig
ht
to s
afe
, re
lia
ble
an
d a
ffo
rda
ble
he
alt
hca
re
•E
U m
em
be
rsh
ip –
rein
forc
es
pri
nci
ple
s o
f e
qu
ity
Po
pu
lati
on
he
alt
h
sta
tus
Th
e m
acr
o v
iew
Pe
rso
na
l
care
Sch
rijv
ers
C (
RIV
M),
Ku
nst
AE
(E
UR
-MG
Z),
Bo
ven
de
ur
I (R
IVM
).
Re
lati
ve in
de
x o
f in
eq
ua
lity
(R
II)
for
all
avo
ida
ble
mo
rta
lity
in
se
lect
ed
co
un
trie
s.
EU
ph
ocu
s\H
ea
lth
In
eq
ua
liti
es,
29
Ma
y 2
00
8.
Av
oid
ab
le
mo
rta
lity
Ho
w t
o i
mp
rov
e q
ua
lity
an
d e
qu
ity
du
rin
g a
pe
rio
d o
f se
ve
re p
ub
lic
serv
ice
au
ste
rity
?
-a
nd
co
ntr
ibu
te t
o e
con
om
ic g
row
th
Eu
roh
ea
lth
‘qu
ali
ty’
ind
ex
To
tal
He
alt
h S
pe
nd
ing
Pe
r-ca
pit
a
Sp
en
din
g -
an
d c
ap
ita
l a
sse
ts a
nd
te
chn
olo
gy
-u
nd
er
pre
ssu
re
•D
ire
ct g
ov
ern
me
nt
cap
ita
l su
pp
ly –
dry
ing
up
•B
an
k l
en
din
g –
mo
re d
iffi
cult
an
d e
xp
en
siv
e
•P
PP
mo
de
ls -
un
de
r sc
ruti
ny
•E
U s
tru
ctu
ral
aid
fu
nd
s –
‘he
alt
h’
un
de
r p
ress
ure
•R
ev
en
ue
sp
en
din
g –
squ
ee
zed
•C
ap
ita
l a
nd
te
chn
olo
gy
in
ve
stm
en
t -
curt
ail
ed
by
cu
rre
nt
eco
no
mic
fa
cto
rs =
50
% f
all
20
09
-2
01
0
“£5
00
m s
lash
ed
fo
r n
ew
ho
spit
als
an
d N
HS
re
furb
ish
me
nt
as
spe
nd
ing
cuts
bit
e”
Wh
at
cau
sed
th
e g
lob
al
cre
dit
cris
is?
Wil
l it
en
d s
oo
n?
•F
ina
nci
al
inb
ala
nce
be
twe
en
th
e E
ast
an
d W
est
•E
ast
-sa
vin
g c
ult
ure
•W
est
-sp
en
din
g c
ult
ure
-a
ffo
rde
d b
y d
eb
t
•D
eb
t fi
na
nce
d g
row
th –
pe
rso
na
l a
nd
pu
bli
c
•E
asy
cre
dit
•P
ub
lic
serv
ice
ex
pe
nd
itu
re f
ina
nce
d o
ut
of
hig
h l
ev
els
of
de
bt
(su
pp
ort
ed
by
GD
P g
row
th)
re
ve
nu
e a
nd
ca
pit
al
–la
rge
de
bts
an
d
de
fici
ts
•R
ed
uct
ion
in
pu
bli
c sp
en
din
g –
sta
bil
ise
s th
e p
rob
lem
, b
ut
•E
con
om
ic r
eg
en
era
tio
n i
s n
ee
de
d t
o r
ed
uce
de
bt
lev
els
•W
e t
he
n f
ace
th
e a
ge
ga
p p
en
sio
ns
cris
is
•T
he
se f
act
ors
ha
ve
tri
gg
ere
d a
po
licy
sh
ift
by
Go
ve
rnm
en
ts a
nd
th
e E
U
Three immediate and ongoing
impact factors for healthcare
•Ability to borrow and service
debt
•Cost of borrowing
•Sustainability of financing for
service cost
Po
rtu
ga
l
De
fici
t re
cov
ery
–th
e E
U L
isb
on
‘re
fle
ctio
n p
roce
ss’
“T
he
cri
sis
ha
s w
ipe
d o
ut
rece
nt
pro
gre
ss”
•Ga
ins
in e
con
om
ic g
row
th a
nd
jo
b c
rea
tio
n o
ve
r th
e l
ast
de
cad
e -
wip
ed
ou
t
•G
DP
fe
ll b
y 4
% i
n 2
00
9,
•in
du
stri
al
pro
du
ctio
n d
rop
pe
d b
ack
to
19
90
le
ve
ls
•2
3 m
illi
on
pe
op
le -
or
10
% o
f th
e a
ctiv
e p
op
ula
tio
n -
are
no
w u
ne
mp
loy
ed
.
•Pu
bli
c fi
na
nce
s -
sev
ere
ly a
ffe
cte
d
•d
efi
cits
at
7%
of
GD
P o
n a
ve
rag
e
•d
eb
t le
ve
ls a
t o
ve
r 8
0%
of
GD
P
•tw
o y
ea
rs o
f cr
isis
era
sin
g t
we
nty
ye
ars
of
fisc
al
con
soli
da
tio
n.
•G
row
th p
ote
nti
al
-h
alv
ed
•Th
e L
isb
on
Str
ate
gy
wa
s n
ot
stro
ng
en
ou
gh
to
ad
dre
ss s
om
e o
f th
e
cau
ses
of
the
cri
sis
fro
m t
he
ou
tse
t
•th
e o
ve
rall
pa
ce o
f im
ple
me
nti
ng
re
form
s w
as
bo
th s
low
an
d u
ne
ve
n
He
alt
hca
re i
n t
he
EU
Eco
no
my
He
alt
hca
re a
cco
un
ts f
or
8.5
% o
f E
U G
DP
, a
nd
ab
ou
t 1
0%
of
em
plo
ym
en
t
•W
he
n o
the
r a
spe
cts
of
soci
al
care
, a
nd
th
e "
seco
nd
ary
ma
rke
t" f
or
he
alt
hca
re r
ela
ted
pro
du
cts
an
d s
erv
ice
s a
re c
on
sid
ere
d t
he
to
tal
imp
act
on
ou
r e
con
om
y m
ay
be
tw
ice
th
is l
ev
el
–a
bo
ut
20
%
•T
he
eco
no
mic
im
pa
ct o
f h
ea
lth
is
incr
ea
sin
g r
ap
idly
•a
s p
op
ula
tio
ns
ag
e,
•a
s te
chn
olo
gy
im
pro
ve
s ca
pa
bil
ity
to
ta
ckle
dis
ea
ses
an
d
•a
s p
eo
ple
de
ma
nd
hig
he
r st
an
da
rds
of
he
alt
h c
are
.
•T
he
eco
no
mic
do
wn
turn
ad
ds
to t
he
se c
ha
lle
ng
es
•th
e h
igh
est
bu
rde
n o
f d
ise
ase
in
th
e E
U a
rise
s fr
om
me
nta
l il
lne
ss -
wh
ich
incr
ea
ses
wit
h u
ne
mp
loy
me
nt
an
d i
s g
oin
g l
arg
ely
un
no
tice
d i
n m
an
y h
ea
lth
syst
em
s.
Th
e E
U r
esp
on
se -
“Eu
rop
e 2
02
0”
Sh
ap
ing
fu
ture
EU
(S
F)
po
licy
•S
MA
RT
, S
US
TA
INA
BLE
AN
D I
NC
LUS
IVE
GR
OW
TH
Wh
ere
do
we
wa
nt
Eu
rop
e t
o b
e i
n 2
02
0?
•“
Th
ree
pri
ori
tie
s sh
ou
ld b
e t
he
he
art
of
Eu
rop
e 2
02
0:
•S
ma
rt g
row
th –
de
ve
lop
ing
an
eco
no
my
ba
sed
on
kn
ow
led
ge
an
d
inn
ov
ati
on
.
•S
ust
ain
ab
le g
row
th –
pro
mo
tin
g a
mo
re r
eso
urc
e e
ffic
ien
t, g
ree
ne
r
an
d m
ore
co
mp
eti
tiv
e e
con
om
y.
•In
clu
siv
e g
row
th –
fost
eri
ng
a h
igh
-em
plo
ym
en
t e
con
om
yd
eli
ve
rin
g
eco
no
mic
, so
cia
l a
nd
te
rrit
ori
al
coh
esi
on
.”
Health is not an explicit component of the strategy -it is implicit
ww
w.e
c.e
uro
pa
.eu
/gro
wth
an
djo
bs/
pd
f/co
mp
let_
en
.pd
f
Issu
es
of
go
ve
rna
nce
an
d
eco
no
mic
s
•S
tro
ng
er
eco
no
mic
go
ve
rna
nce
to
de
liv
er
resu
lts.
•E
uro
pe
20
20
wil
l re
ly o
n t
wo
pil
lars
:
•T
he
th
em
ati
c a
pp
roa
ch -
the
fla
gsh
ips
-co
mb
inin
g p
rio
riti
es
an
d
he
ad
lin
e t
arg
ets
; a
nd
•C
ou
ntr
y r
ep
ort
ing
-h
elp
ing
Me
mb
er
Sta
tes
to d
ev
elo
p t
he
ir
stra
teg
ies
to r
etu
rn t
o s
ust
ain
ab
le g
row
th a
nd
im
pro
ve
d p
ub
lic
fin
an
ces.
•N
ew
gu
ide
lin
es.
•C
ou
ntr
y-s
pe
cifi
c re
com
me
nd
ati
on
s fo
r a
ctio
n
7 F
lag
ship
in
itia
tiv
es
•In
no
va
tio
n U
nio
n
•Y
ou
th o
n t
he
mo
ve
•A
dig
ita
l a
ge
nd
afo
r E
uro
pe
•R
eso
urc
e e
ffic
ien
tE
uro
pe
•A
n i
nd
ust
ria
l p
oli
cy f
or
the
glo
ba
lisa
tio
n e
ra
•A
n a
ge
nd
a f
or
ne
w s
kil
ls a
nd
jo
bs
•E
uro
pe
an
pla
tfo
rm a
ga
inst
po
ve
rty
Oth
er
ke
y p
rio
riti
es
–d
ire
ct h
ea
lth
re
late
d
•H
ea
lth
y a
ge
ing
•H
ea
lth
eq
uit
y
•T
he
ca
rbo
n a
ge
nd
a
•C
ross
-bo
rde
r ca
re
A p
ara
do
x a
t th
e h
ea
rt o
f E
uro
pe
an
He
alt
hca
re
•In
mo
st M
S h
ea
lth
sp
en
din
g i
s re
ga
rde
d a
s co
st –
to b
e
con
tro
lle
d
•T
he
He
alt
h i
s W
ea
lth
pri
nci
ple
su
gg
est
s h
ea
lth
sp
en
din
g i
s a
n
inv
est
me
nt
–“E
uro
pe
20
20
”b
ut
----
-
He
alt
hca
re a
nd
Em
plo
ym
en
t (E
uro
pe
20
20
)
•P
ub
lic
serv
ice
au
ste
rity
–e
vid
en
ce o
f si
gn
ific
an
t jo
b c
uts
/ l
oss
es
•N
ew
(IC
T)
tech
no
log
ies
an
d ‘
cap
ita
l re
pla
cin
g l
ab
ou
r’–
can
re
du
ce c
ost
s -
bu
t a
t th
e e
xp
en
se o
f jo
bs
(un
less
re
inv
est
ed
)
•R
ed
uct
ion
s in
ca
pit
al
an
d t
ech
no
log
y s
pe
nd
ing
are
im
pa
ctin
g o
n
em
plo
ym
en
t in
th
e ‘
seco
nd
ary
’se
cto
r
He
alt
hc
are
im
pa
ct
on
‘20
20
’em
plo
ym
en
t p
oli
cy
•In
cre
asi
ng
th
e a
va
ila
ble
em
plo
ym
en
t p
oo
l
•B
ett
er
he
alt
h o
utc
om
es
an
d i
mp
rov
ed
he
alt
h s
tatu
s
•G
rea
ter
pro
du
ctiv
ity
–m
ore
fo
r le
ss
•H
ea
lth
y a
ge
ing
–e
xte
nd
ing
wo
rkin
g l
ife
•R
ese
arc
h a
nd
in
no
va
tio
n -
stim
ula
tin
g s
eco
nd
ary
ma
rke
t co
mp
eti
tiv
en
ess
•R
elo
cati
on
of
serv
ice
s -
urb
an
re
ge
ne
rati
on
Wo
rkfo
rce
=7
0%
tota
l co
st
Inn
ov
ati
on
is a
ke
y f
act
or
Pro
du
ctiv
ity
gro
wth
, Ou
tpu
t p
er
ho
ur,
Source: Boston Consulting Group, The Economist, A special Reporton Innovation, October 13th 2007, pg 4.
19
54
= 1
00
20
04
-3
00
Inn
ov
ati
on
Ca
pit
al
EU
wid
e -
Pre
ssu
res
an
d p
rob
lem
s
Co
nv
erg
en
ce o
n c
om
mo
n h
ea
lth
iss
ue
s
•Aff
ord
ab
ilit
y –
the
im
pa
ct o
f th
e c
red
it c
risi
s a
nd
be
yo
nd
•Ag
ein
g
•Ch
ron
ic i
lln
ess
•Te
chn
olo
gy
de
ve
lop
me
nt
an
d d
iffu
sio
n
•Pe
rso
na
l a
nd
pro
fess
ion
al
ex
pe
cta
tio
n
•Wo
rkfo
rce
mo
bil
ity
•Ca
rbo
n f
oo
tpri
nts
•He
alt
h e
qu
ity
as
a c
ore
ele
me
nt
of
soci
al
coh
esi
on
Th
e h
ea
lth
care
se
cto
r
•H
ea
lth
care
ma
ke
s a
dif
fere
nce
•5
0%
of
the
in
cre
ase
in
lif
e e
xp
ect
an
cy i
n r
ece
nt
de
cad
es
-a
re
sult
of
imp
rov
ed
in
terv
en
tio
na
l h
ea
lth
ca
re
•T
he
EU
-a
ho
spit
al-
cen
tric
mo
de
l o
f ca
re
•E
xp
en
siv
e –
be
twe
en
35
% a
nd
70
% o
f to
tal
he
alt
h s
pe
nd
ing
•‘L
ock
-in
’im
pa
ct o
n m
od
els
of
care
•D
em
an
d a
nd
co
st i
nfl
ati
on
ex
cee
din
g G
DP
gro
wth
ra
tes
•E
vid
en
ce s
ug
ge
sts
alt
ern
ati
ve
mo
de
ls o
f ca
re –
for
ma
ny
co
nd
itio
ns
–o
ffe
r b
ett
er
qu
ali
ty,
ou
tco
me
s a
nd
va
lue
•N
ew
te
chn
olo
gie
s a
re f
aci
lita
tin
g c
ha
ng
es
in t
he
lo
cati
on
an
d f
ocu
s
of
care
Th
e c
urr
en
t m
od
el
loo
ks
incr
ea
sin
gly
un
aff
ord
ab
le &
un
sust
ain
ab
le
Th
e p
op
uli
st v
iew
Th
e v
alu
e o
f ca
pit
al
an
d t
ech
no
log
y
inv
est
me
nt
Wh
at
are
we
try
ing
to
ach
iev
e?
•P
op
uli
sm a
nd
po
liti
cs –
the
pre
stig
e h
osp
ita
l
•C
an
we
re
late
ca
pit
al
spe
nd
ing
to
:
•C
lin
ica
l o
utc
om
es
•C
on
trib
uti
on
to
im
pro
ve
me
nt
in p
op
ula
tio
n h
ea
lth
•R
ed
uci
ng
he
alt
h i
ne
qu
ali
tie
s
•D
o w
e p
lace
a m
ea
sura
ble
va
lue
on
th
e i
nv
est
me
nt
•D
o w
e u
nd
ers
tan
d t
he
ris
ks
Mu
ch o
f th
e p
ast
de
cad
es
of
cap
ita
l in
ve
stm
en
t b
ase
d o
n u
nsu
sta
ina
ble
de
bt
Ha
s ‘n
ew
’ca
pit
al
inv
est
me
nt
ma
de
a
dif
fere
nce
?
Lon
ge
r-te
rm -
Str
ate
gic
•W
ide
nin
g h
ea
lth
ine
qu
ali
tie
s
•S
low
to
re
spo
nd
•C
hro
nic
ill
•E
lde
rly
•P
oo
r p
lan
nin
g
•Li
mit
ed
te
chn
olo
gy
dif
fusi
on
•E
con
om
ica
lly
un
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nce
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mp
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lect
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ait
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tim
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fety
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bli
c &
pro
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er
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t
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alt
h
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re
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20
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style
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d
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mu
nit
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inve
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en
t
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ort
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act
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alt
hy
ag
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am
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ng
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Str
ess
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ints
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ow
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spit
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oft
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ive
ap
pro
ach
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th
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vid
en
ce
Th
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mp
act
of
an
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g p
op
ula
tio
n
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Ratio of working
population to
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CE
E
Ky
me
nla
aso
Re
gio
n, F
inla
nd
Ne
uro
log
ica
l d
eg
en
era
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n –
cha
ng
ing
fo
cus
Inci
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nce
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n 1
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an
d 1
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of
all
EU
cit
ize
ns.
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y 2
05
0:
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igu
res
wil
l d
ou
ble
in
We
ste
rn E
uro
pe
, a
nd
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reb
le i
n E
ast
ern
Eu
rop
e
•W
ith
ou
t a
ctio
n c
itiz
en
s w
ith
de
me
nti
a c
ou
ld r
ep
rese
nt
be
twe
en
25
% a
nd
35
% o
f fu
ture
ho
spit
al
po
pu
lati
on
s
“Peo
ple
sh
ou
ld n
ot
suff
er f
rom
Dem
enti
a, t
hey
sh
ou
ld b
e su
pp
ort
ed
to l
ive
wit
h i
t, i
t is
a n
orm
al
pa
rt o
f a
gei
ng
”
Bri
tt O
stlu
nd
, Lu
nd
Un
iver
sity
We
ne
ed
to
re
con
sid
er
spe
nd
ing
pri
ori
tie
s -
Ma
kin
g
the
lin
ks
an
d c
ha
ng
ing
att
itu
de
s i
s th
e p
rob
lem
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oci
ety
ha
s b
eco
me
ex
pe
rt i
n
the
pro
du
ctio
n o
f ch
ron
ic i
lln
ess
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av
ing
in
terv
en
tio
n t
oo
la
te i
s th
e
ma
in c
on
trib
uto
ry f
act
or
in s
ust
ain
ing
an
ex
pe
nsi
ve
ho
spit
al-
cen
tric
mo
de
l
Ch
ron
ic i
lln
ess
Ch
an
gin
g t
he
lo
cus
an
d f
ocu
s o
f
inv
est
me
nt
Poverty Housing
Diet Smoking
Cardiovascular disease
Treatment
Death
Cu
rre
nt
bia
s to
wa
rds
cura
tiv
e i
nv
est
me
nt
Tra
nsf
orm
ati
on
al
inv
est
me
nt
Pa
tie
nt
cen
tre
d
inte
rve
nti
on
al
sup
po
rt
Co
mm
on
pa
tte
rns
of
cha
ng
e
•M
ov
ing
to
eco
no
mic
all
y m
ore
su
sta
ina
ble
mo
de
ls
•F
aci
lita
tin
g i
nn
ov
ati
on
an
d a
pp
lyin
g n
ew
te
chn
olo
gy
as
a
dri
ve
r o
f ch
an
ge
•M
ak
ing
he
alt
h s
yst
em
s m
ore
pa
tie
nt-
focu
sed
an
d l
ess
pro
vid
er-
cen
tre
d
•S
tre
ng
the
nin
g p
rim
ary
ca
re a
nd
re
du
cin
g t
he
un
ne
cess
ary
de
ma
nd
s (t
he
eld
erl
y a
nd
ch
ron
ic i
ll)
on
th
e h
osp
ita
l se
cto
r
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div
ers
ity
of
serv
ice
pro
vid
ers
to
im
pro
ve
sta
nd
ard
s a
nd
pro
mo
te e
ffic
ien
cy
•Im
pro
vin
g t
he
eff
ect
ive
ne
ss o
f co
mm
issi
on
ing
/ p
urc
ha
sin
g
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pro
vin
g t
he
eff
ect
ive
ne
ss o
f S
F
Re
sha
pin
g h
ea
lth
care
Lis
bo
n S
tra
teg
y e
va
lua
tio
n d
ocu
me
nt
We
ne
ed
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do
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tte
r -
Imp
rov
ing
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ve
stm
en
t
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tru
ctu
ral
Fu
nd
s h
av
e h
elp
ed
pro
vid
e i
nv
est
me
nts
fo
r g
row
th a
nd
jo
bs
bu
t
the
re i
s fu
rth
er
to g
o:
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ee
d t
o e
nh
an
ce p
oli
cy e
ffe
ctiv
en
ess
•D
iffi
cult
ies
wit
h t
he
pro
cess
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ea
k c
ap
aci
ty
•La
ck o
f st
rate
gic
ap
pro
ach
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oo
r in
teg
rati
on
of
pro
cess
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ea
k o
utc
om
e a
sse
ssm
en
t
•N
ee
d t
o s
tre
ng
the
n l
ev
era
ge
–“t
hro
ug
h f
ina
nci
al
en
gin
ee
rin
g”
•H
ea
lth
re
ma
ins
a h
igh
va
lue
in
ve
stm
en
t
•T
he
fin
din
gs
are
co
nsi
ste
nt
wit
h t
he
Eu
reg
io I
II c
ase
stu
dy
re
vie
w
We
ha
ve
go
od
ev
ide
nce
sy
ste
ms
Ne
ed
s b
ase
d p
lan
nin
g –
the
str
ate
gic
vie
w
Mortality
mapping
Finland
Op
po
rtu
nit
ies
for
eH
ea
lth
SF
in
ve
stm
en
t
De
mo
gra
ph
ic p
rofi
lin
g N
eth
erl
an
ds
0
20
40
60
80
100
120
140
160
180
200
220
05
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
Ikäryhmä
M E U R yht
eensä
PerusterveydenhuoltoErikoissairaanhoito
Vanhustenhuolto
Sairausvakuutuksen korvaama hoitoMuu terveydenhuolto
To
tal
cost
s o
f so
cia
l se
rvic
es
an
d h
ea
lth
care
Primary care
Secondary care
Nursing homes and
other services for
elderly
National insurance for sick leave,
medicines,”private sector”etc.
Finland Lahti Region
Looking at the bigger (integrated) picture
eH
ea
lth
, In
no
va
tio
n,
inte
gra
ted
esf
/ e
rdf
Th
ere
is
gro
win
g d
iscu
ssio
n a
bo
ut
wh
ere
to
in
ve
st f
or
be
st (
he
alt
h)
retu
rn o
n i
nv
est
me
nt
–
this
fo
rms
pa
rt o
f th
e E
U s
tra
teg
y d
eb
ate
Go
ve
rnm
en
ts o
fte
n c
ut
SS
to
pro
tect
he
alt
hca
re
So
cia
l sp
en
din
g p
er
cap
ita
Standardised all cause mortality
Per 100,000 population
Stuckler D et al. BMJ 2010;340:bmj.c3311
ES
F –
he
alt
h a
nd
so
cia
l in
teg
rati
on
La
ck o
f in
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rati
on
ca
n c
rea
te p
rob
lem
s
10
,00
0
2,0
00
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tie
nt
nu
mb
ers
20
07
2
01
0
Th
e d
ail
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um
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rs o
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lde
rly
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lock
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ed
s
in E
ng
lish
NH
S H
osp
ita
ls 2
00
7 /
10
? T
he
im
pa
ct o
f
un
coo
rdin
ate
d p
oli
cy
shif
ts a
nd
‘cu
ts’
–in
pri
ma
ry a
nd
so
cia
l
care
?
Th
e t
ran
sfo
rmin
g p
rin
cip
le
Po
pu
lati
on
-ba
sed
in
teg
rate
d c
are
de
liv
ery
eH
ea
lth
, in
no
vati
on
, h
ea
lth
y a
ge
ing
Pa
thw
ay
s -
are
a s
imp
le c
on
cep
t,
the
pro
ject
ma
na
ge
me
nt
of
(wh
ole
) d
ise
ase
-in
tern
ali
sed
(w
ith
in h
osp
ita
l) o
r
-e
xte
rna
lise
d (
inte
gra
ted
acr
oss
se
cto
rs)
Patient care / treatment trajectory
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eH
ea
lth
Th
e b
eg
inn
ing
of
tra
nsf
orm
ati
on
al
cha
ng
e
Ch
ron
ic I
lln
ess
Ag
ein
g
Ca
re s
ett
ing
•Fro
m:
Ho
spit
al-
ba
sed
ca
re (
acc
ide
nt
an
d e
me
rge
ncy
, in
-pa
tie
nt
wa
rds,
da
y-c
ase
surg
ery
, o
utp
ati
en
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inic
s) a
nd
ge
ne
ral
pra
ctic
e
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: A
co
mm
un
ity
-ba
sed
o
ut-
pa
tie
nt
clin
ic
wh
ich
o
pe
rate
s o
pe
nly
a
s a
m
ult
i-
ag
en
cy,
on
e-s
top
sh
op
.
Na
ture
of
inte
rve
nti
on
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m:
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eci
ali
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cli
nic
al
tre
atm
en
t
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t-a
-dis
tan
ce I
T m
on
ito
rin
g,
seco
nd
ary
pre
ve
nti
on
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d p
sych
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cia
l su
pp
ort
.
Du
rati
on
of
care
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m:
Ex
ten
de
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n-p
ati
en
t a
dm
issi
on
•To
: H
ea
lth
pro
vis
ion
fro
m m
ult
iple
se
rvic
e s
ett
ing
s, i
ncl
ud
ing
he
alt
h a
nd
so
cia
l
care
an
d t
he
vo
lun
tary
se
cto
r.
So
cia
l ro
le o
f th
e p
ati
en
t
•Fro
m:
Pa
ssiv
e a
nd
de
pe
nd
en
t
•To
: A
n e
ng
ag
ed
co
-pro
du
cer
wit
h r
igh
ts a
nd
re
spo
nsi
bil
itie
s.
ES
F /
ER
DF
/ In
no
va
tio
n/
He
alt
hy
ag
ein
g
Tra
nsf
orm
ati
on
al
imp
act
in
th
e h
osp
ita
l se
cto
r –
“ke
ep
ing
pa
tie
nts
ou
t o
f h
osp
ita
l”
•F
rom
: P
ati
en
ts u
se t
he
sy
ste
m i
n a
se
rie
s o
f u
nco
nn
ect
ed
ep
iso
de
s
•T
o:
He
alt
h s
yst
em
s d
ev
elo
p m
eth
od
s to
ma
na
ge
th
e w
ho
le p
ath
wa
yo
f
dis
ea
se
•F
rom
: P
ati
en
ts a
re d
ea
lt w
ith
in
ba
tch
es
an
d s
pe
nd
mo
st o
f th
eir
tim
e
in t
he
sy
ste
m w
ait
ing
•T
o:
Pa
tie
nts
flo
wth
rou
gh
th
e s
yst
em
wit
h m
inim
al
wa
its.
•F
rom
: S
erv
ice
s a
re d
esi
gn
ed
aro
un
d t
he
his
tori
c w
ay
pro
vid
ers
are
stru
ctu
red
–so
ma
tic
an
d t
err
ito
ria
l se
pa
rati
on
•T
o:
Mu
lti-
dis
cip
lin
ary
te
am
pro
ble
m s
olv
ing
–th
e h
osp
ita
l a
s a
kn
ow
led
ge
ce
ntr
e
•F
rom
: P
ati
en
ts a
re m
ov
ed
fre
qu
en
tly
fo
r tr
ea
tme
nts
–a
t h
igh
ris
k
•T
o:
Mo
vin
g i
nfo
rma
tio
n a
nd
sta
ff r
ath
er
tha
n p
ati
en
ts -
an
d h
om
e-
ba
sed
te
chn
olo
gy
an
d d
iag
no
stic
eq
uip
me
nt
ou
tsid
e t
he
ho
spit
al
to
red
uce
th
e u
se o
f h
osp
ita
lsE
SF
/ E
RD
F/
Inn
ov
ati
on
/ H
ea
lth
y a
ge
ing
Th
e d
igit
al
rev
olu
tio
n i
s o
ne
of
the
ke
y
tra
nsf
orm
ati
on
al
cha
ng
e f
act
ors
in
to
da
ys
he
alt
h
syst
em
s –
wh
y e
He
alt
h (
esf
)is
im
po
rta
nt
http://www.medicinenet.com/slideshows/article.htm
http://www.nlm.nih.gov/medlineplus/copdchronicobstructivepulmonarydisease.html
An
d
rese
arc
h &
seco
nd
ary
ma
rke
ts
Th
e q
ua
lity
im
pro
ve
me
nt
an
d c
ost
sa
vin
g d
ime
nsi
on
is c
lea
r
Current SF
Programme €5 bl
BUT ----
eH
ea
lth
eH
ea
lth
: -
Qu
ali
ty,
Cli
nic
al
cost
s, A
dm
inis
tra
tiv
e
cost
s,
Ne
w m
od
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of
care
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mp
ute
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ase
d p
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en
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cord
s,
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illi
on
Pro
fess
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Inte
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nt
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rk P
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ase
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em
ati
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pe
n,
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nic
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nce
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care
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re P
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ase
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est
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nt
pla
nn
ing
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ve
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ran
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est
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nt
solu
tio
ns
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ea
lth
te
chn
olo
gy
dif
fusi
on
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ross
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ttin
g f
aci
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tin
g
syst
em
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mm
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ial’
bu
sin
ess
pri
nci
ple
s
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asi
s fo
r fu
ture
SF
de
cisi
on
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teri
a ?
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em
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d
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n c
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ns
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pro
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safe
ty
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nt
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po
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Th
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en
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20
11
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Co
ng
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no
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20
20
)
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late
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ea
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be
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fit
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irm
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va
lua
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Pa
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ntr
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pa
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pa
thw
ay
s
flo
w
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lth
ne
two
rks
Hu
ng
ari
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sid
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cy
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thw
ay
s fo
r ch
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ge
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t
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nce
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en
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tie
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r
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ore
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llo
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ork
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gin
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ocu
s
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at
wo
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ha
t
Do
esn
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n t
he
‘n
ew
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e ?
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re p
ath
wa
ys
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cie
tal
an
d
eco
no
mic
be
ne
fit
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and networked to rural societies
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general acute hospitals
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accessible ‘niche’services
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Th
e c
om
ing
de
cad
e:
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ust
ain
ed
an
d s
ev
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pu
bli
c s
erv
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au
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rity
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teg
rate
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ho
le s
yst
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s p
lan
nin
g a
nd
in
ve
stm
en
t
-D
ev
olv
ed
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d o
uts
ou
rce
d s
erv
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de
liv
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–d
ive
rsit
y a
nd
co
mp
eti
tio
n
-In
ve
stin
g i
n h
um
an
ca
pit
al,
so
cia
l co
he
sio
n a
nd
ec
on
om
ic g
row
th
It w
ill
no
t b
e e
asy
Th
an
k y
ou
fo
r
yo
ur
att
en
tio
n
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