1 Οι Νέες Τεχνολογίες ως Εργαλείο Εξορθολογισμού στον Τομέα της Υγείας Κλινική Διακυβέρνηση Κυριάκος Σουλιώτης Επίκουρος Καθηγητής Πολιτικής Υγείας, Πανεπιστήμιο Πελοποννήσου Επιστημονικός Συνεργάτης Επισκέπτης Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ Αθήνα, 1 Οκτωβρίου 2014
2 Presentation Outline 1. First facts: the financial environment 2. The awful truth in Greece 3. Save by spending: investing on e-health
3 Presentation Outline 1. First facts: the financial environment 2. The awful truth in Greece 3. Save by spending: investing on e-health
4 Introduction Less resources Financial crisis INTEGRATE HEALTH SYSTEMS? Budgetary constraints Access inequalities Higher, diversified need
5 The real patient: Greek economy Facts for Greece (in times of crisis): 25% reduction in GDP Unemployment rate is 27,5% Private demand is the weakest in Europe Household dept is the highest in Europe
6 The real patient: Greek economy GDP Investments Final consumption Unemployment
7 GDP α 2013 β 2013* -0,2% -3,1% -3,8% -4,9% -5,6% -7,1% -6,4% Source: IOBE, ELSTAT, October 2013.
10 Final consumption 2,9% -0,3% -6,8% ,3% -7,2% ,2% ,7% α 2013 β 2013* Source: IOBE, ELSTAT, October 2013.
11 Presentation Outline 1. First facts: the financial environment 2. The awful truth in Greece 3. Save by spending: investing on e-health
12 The impact: Social and health policy Facts for social and health policy in Greece (in times of crisis): reduction in public social spending reduction in public health spending (under 6% of GDP) (* maybe 5%!!!) out of pocket payments remain high this causes barriers to access to health services
13 Percentage changes in real public social spending and real GDP, 2007/08 to 2012/13 Source: OECD, Society at a Glance 2014 Highlights: GREECE The crisis and its aftermath, March 2014.
15 Germany France Greece UK Sweden
16 Demand vs. need
17 Public Pharmaceutical Ependiture (in billion ) Source: IOBE 2014
18 Public Pharmaceutical Ependiture (in billion ) Source: IOBE 2014
19 Per capita Public Pharmaceutical Ependiture (in billion ) EU ANERAGE Source: IOBE 2014.
20 Public Pharmaceutical Ependiture vs. public hospital admissions Νοσηλευόμενοι ασθενείς Hosp. admis Φαρμακευτική δαπάνη Public pharma ep.
24 Source: European Commission, Health Inequalities in the EU, 2013.
25 The awful truth: 25% of the population are uninsured vs. less than 5% in % of the citizens cannot afford their medication (average copayment increased from 12% to 28%) 45% of the citizens pay in order to have access to a physician consultation 49% of the patients with Rheumatoid Arthritis face barriers in access to treatment 58% increase in depression ( ) among adults 2% of the population are gambling to meet their financial needs
26 Satisfaction with welfare state Source: OECD Social Ependitures Database (SOCX); OECD Employment Outlook 2013; Instituto de Pesquisa Econômica Aplicada (IPEA), Brazil; Asian Development Bank (ADB-SPI); World Health Organisation (WHO); European Commission (2012),http://ec.europa.eu/public_opinion/inde_en.htm.
27 Note Σημειώνεται ότι στο πλαίσιο της παρούσας μελέτης διερευνάται μόνο η άμεση δημοσιονομική επίδραση της μείωσης της φαρμακευτικής δαπάνης, χωρίς να εξετάζεται η επίπτωση σε άλλους κλάδους ή οι οικονομικές συνέπειες από ενδεχόμενα προβλήματα πρόσβασης των ασθενών στη θεραπεία, λόγω της διαρκούς συρρίκνωσης της εν λόγω αγοράς. Υπό το πρίσμα αυτό, οι δημοσιονομικές απώλειες αφορούν κατά βάση στην απώλεια θέσεων εργασίας (και στις συνέπειες που αυτές έχουν στα φορολογικά και ασφαλιστικά έσοδα) και στη μειωμένη φορολογία των επιχειρήσεων και επαγγελματιών του κλάδου.
28 Presentation Outline 1. First facts: the financial environment 2. The awful truth in Greece 3. Save by spending: investing on e-health
36 E-health has been defined as the use of Information and Communication Technologies (ICT) across the whole range of healthcare functions (European Commission, 2004) European Commission (2004), ehealth making healthcare better for European citizens: An action plan for a European e-health Area, Bruessels, European Commission
38 E-prescription key concepts eprescribing is easy e-prescription means a medicinal prescription, as defined by Article 1(19) of Directive 2001/83/EC of the European Parliament and of the Council, issued and transmitted electronically. (Commission Recommendation of 2 July 2008 on cross-border interoperability of electronic health record systems C(2008) 3282)
39 E-prescription use Deloitte/Ipsos, ehealth Benchmarking (Phase III): Final Report. 2011, Deloitte/Ipsos (for the European Commission): Brussels.
40 E-prescription use Deloitte/Ipsos, ehealth Benchmarking (Phase III): Final Report. 2011, Deloitte/Ipsos (for the European Commission): Brussels.
42 Source: Mantzana et al., 2014
43 No e-prescription 29% Pilots on e-prescription intended for regional / national implementation 32% No Bulgaria eprescription Hungary Pilots on e-prescription intended for regional / national implementation Italy Portugal Latvia Austria Lithuania Belgium Luembourg Czech Republic Malta Finland Romania Poland Slovakia Norway Slovenia Germany Cyprus Source: Mantzana et al., 2014
44 Regional e-prescription 10% Regional e-prescription Bar coded, paper based prescriptions UK Wales Netherlands Spain
45 National e-prescription 29% National eprescription Bar coded, paper based prescriptions National e-prescription / patients access medication profile UK Ireland Denmark Estonia Sweden UK England Iceland UK Scotland Greece Croatia France
46 E-diagnosis case study Greece
48 E-diagnosis case study Greece
49 E-diagnosis case study Greece
50 E-diagnosis case study Greece
51 E-diagnosis case study Greece - 40%
53 E-prescription cross border roadmap
54 E-prescription recommendations ehealth Task Force Report Redesigning health in Europe for 2020, Publications Office of the European Union, 2012
56 Registries provide unique information about a disease and patient s population in real conditions, which cannot be studied in clinical studies. In this way, they offer measurable advantages: Actual, realistic picture of patients and disease Processing of personal data for the production of information for the health system
57 A patient registry: is an organized, integrated system that uses observational study methods to collect information in a uniform manner (clinical and other) evaluates results for a specific target population - as defined by a particular disease or health condition serves predefined, scientific, clinical goals or health policy goals
58 Through the registry, the individual data become information about the system Diabetes center details System infrastructure Patient personal details Etent and characteristics of diabetes Individual consumption of healthcare services Use of healthcare services for the system
59 Incorporating all procedures, even administrative, which are involved in care provision
60 To measurably improve the results of interventions through structured partnerships Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1:2-4.
61 Implemented jointly by the University of Peloponnese and the National University of Athens
62 We are here
63 Sub-systems Users and centers management Patient record management Diagnosis management Disease course management Reporting management
64 For the production of monitoring indicators... Diabetes center details System infrastructure Patient personal details Etent and characteristics of diabetes Individual consumption of healthcare services Use of healthcare services for the system
65 For the production of monitoring indicators for each period... System infrastructure Diabetes center details Distribution of centers and users by type and capacity Etent and characteristics of diabetes Etent and characteristics of diabetes by type / age / gender / disease duration / age at diagnosis Patient characteristics by generic risk factor / general health Diagnosis characteristics by complication / comorbidity Patient personal details Use of healthcare services for the system Individual consumption of healthcare services Average number of visits / prescriptions / tests diabetes clinic and type of diabetes and Number of unique patients served in a diabetes clinic Number of hospitalizations by cause and type of diabetes Number of hospitalizations per type of diabetes
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