Η ΚΑΡΔΙΟΛΟΓΙΑ ΣΤΗΝ ΕΛΛΑΔΑ ΜΕΤΑ ΤΗΝ ΚΡΙΣΗ

Η ΚΑΡΔΙΟΛΟΓΙΑ ΣΤΗΝ ΕΛΛΑΔΑ ΜΕΤΑ ΤΗΝ ΚΡΙΣΗ Νίκος Μανιαδάκης, BSc, ΜSc, PhD, FESC Καθηγητής & Διευθυντής Τομέας Οργάνωσης και Διοίκησης Υπηρεσιών Υγείας Αναπληρωτής Κοσμήτορας Εθνική Σχολή Δημόσιας Υγείας Συντονιστής, Μονάδα Πολιτικών Υγείας Ευρωπαϊκή Καρδιολογική Εταιρεία

ΠΑΡΟΥΣΙΑΣΗ Υγεία Οικονομία Κρίση Διεθνή εμπειρία και τάσεις Η Υγεία στην Ελλάδα πριν την κρίση Επιπτώσεις της κρίσης στο σύστημα υγείας Πριν και μετά: που είμαστε σήμερα Οι αρρυθμίες: benchmarking from ESC Atlas

Οικονομία, Οικονομία Υγείας και Υγεία

Υγεία και Οικονομία

There is a Significant Technological Effect Drugs Devices Equipment E health Source: Boston Consulting Group

*2 in Survival reguires *466 in Therapy Cost!!

The rapid pace of medical device evolution 1950 36 cc 2001 209 cc 1989 2013

ICD implantations and expenditure Worldwide Implantations and Expenditute on ICD Devices Expenditure (millions) $16.000 $14.000 $12.000 $10.000 $8.000 $6.000 $4.000 $2.000 CAGR: 13% 700.000 600.000 500.000 400.000 300.000 200.000 100.000 Implantations $0 2005 2006 2007 2008 2009 2010 2011 2012 2013 0 Source: Marketstrat February 2007 ICD Expenditure Implantations

Επίπτωσης οικονομικής κρίση στην υγεία

Healthcare is a solution and investment Health spending is a crucial investment to promote economic growth SOURCE: The contribution of health to the economy in the European Union, Suhrcke, McKee for the European Commission, DG Sanco (2005)

An era where outcomes are important

Empirical analysis shows that proper policies may aid HC systems to deliver same outcome at less cost Potential savings represent the difference between a no-reform scenario and a scenario where countries would become as efficient as the best performing countries Source: Joumard, Isabelle. 2010. Health Care Systems: Getting More Value for Money. No. 2. OECD Economics Department Policy Notes. OECD. http://www.oecd.org/eco/growth/46508904.pdf. 2-Oct-2013 European Health Policy Forum Gastein 18

Inefficiency and the Foregone Health Benefit Source: Joumard, Isabelle. 2010. Health Care Systems: Getting More Value for Money. No. 2. OECD Economics Department Policy Notes. OECD. http://www.oecd.org/eco/growth/46508904.pdf.

Mortality from CVD (%of all deaths) Cardiovascular mortality and GDP per capita in PPP (US$) 80 y = -11,01ln(x) + 156,21 R² = 0,403 70 GEO UKR BGR 60 50 MDA ARM KGZ MKD ALB BIH SRB TUN BLR MNE ROU AZE KAZ HRV POL LVA RUS EST SVK LTU HUN GRC CZE 40 EGY LBN LBY DZA TUR ESC Average MLT CYP FIN AUT SWE DEU 30 MAR SVN PRT ESP ISR ITA FRA ISL GBR IRL BEL NLD DNK CHE NOR LUX 20 0 10.000 20.000 30.000 40.000 GDP per capita, 50.000PPP (US $) 60.000 70.000 80.000 90.000 100.000

DALYs due to atrial fibrillation,total (per million people) DALYs due to atrial fibrillation (per million people) & GDP per capita, PPP (US$) 4.000 y = 625,16ln(x) - 5512,2 R² = 0.2995 3.500 SWE 3.000 2.500 2.000 MNE ESP DEU DNK BEL NOR 1.500 GRC AUT CYP ITA NLD IRL FRA 1.000 BGR PRT HUN SVK SVN GBR ISR FIN ISL ESC Average POL BIH TUR CZE 500 EST SRB MLT CHE RUS HRV UKR TUN LBN MAR LBY LTU LUX ARM KGZ MDA EGY MKD BLR LVA ROU 0 ALB KAZ DZA AZE 0 GEO 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

YLDs due to atrial fibrillation,total (per million people) YLDs due to atrial fibrillation (per million people) & GDP per capita, PPP (US$) 1.600 SWE y = 184,02ln(x) - 1588,8 R² = 0.1844 1.400 ESP 1.200 1.000 800 600 DNK DEU GRC BEL NOR 400 AUT TUR ITA PRT MNE BGR NLD CYP IRL HUN SVK FRA SVN BIH TUN POL ESC Average SRB CZE FIN 200 HRV EST RUS ISR GBR LBN ISL UKR LBY MLT MAR LTU CHE MKD BLR MDA LVA EGY KGZ ROU LUX ALB 0 DZA AZE KAZ GEO ARM 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

YLLs due to atrial fibrillation,total (per million people) YLLs due to atrial fibrillation (per million people) & GDP per capita, PPP (US$) 2.500 y = 441,19ln(x) - 3923,7 R² = 0,3102 2.000 MNE SWE DEU 1.500 DNK BEL NOR 1.000 GRC CYP ITA ESP FRA AUT NLD IRL 500 0 PRT BGR FIN ISL ISR HUN GBR SVK SVN ESC Average BIH POL CZE CHE EST MLT SRB TUR RUS HRV TUN LUX KGZ MDA UKR LBY LBN LTU MKD LVA ARM BLR EGY DZA AZE KAZ ROU 0 MAR 10.000 ALB 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GEO GDP per capita, PPP (US $)

Cardiologists (per million people) Cardiologists per million people & GDP per capita, PPP ($) 300 GRC y = -5,414ln(x) + 139,76 R² = 0,0059 250 GEO 200 BGR 150 EST CYP HUN ITA 100 50 MDA KGZ ALB UKR BIH SRB MKD AZE ROU TUR LVA POL KAZ PRT ESC Average CZE SVK ISL SVN ISR DEU DNK AUT NLD MLT ESP FRA FIN BEL SWE IRL CHE NOR LUX 0 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Electrophysiologists (per million people) Electrophysiologists per million people & GDP per capita, PPP ($) 18 16 POL GRC y = 2,587ln(x) - 21,162 R² = 0,122 14 CZE 12 10 ISL SWE 8 6 4 2 0 ESC Average LUX LTU SVK DNK MLT ALB HUN SVN EST NOR LVA ESP MKD CYP PRT MDA BGR SRB AZE ROU BIH 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Centres undertaking EPs (per million people) Centres undertaking EPs per million people & GDP per capita, PPP ($) 5,0 4,5 ITA y = 0,7843ln(x) - 6,4345 R² = 0,2608 4,0 BEL 3,5 FRA 3,0 ISL GRC 2,5 CYP 2,0 POL MLT ISR CZE PRT ESP AUT LUX 1,5 1,0 GEO MKD TUR EST ESC Average HUN LVA LTU SVN FIN SWE DNK NLD NOR 0,5 0,0 ALB SVK ROU KAZ KGZ MDA BIH SRB UKR AZE 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Centres implanting pacemakers (per million people) Centres implanting pacemakers per million people & GDP per capita, PPP ($) 14 y = 2,7602ln(x) - 24,314 R² = 0,4923 12 DEU 10 AUT BEL CHE LUX 8 ITA FRA 6 ISL GRC NLD ESP HRV POL CYP SWE NOR 4 EST PRT SVN FIN LBN CZE ESC Average GBR IRL TUR BGR SVK ISR SRB DNK GEO MLT 2 ALB BIH MNE HUN KAZ KGZ XK TUN LTU ROU ARM MKD BLR LVA RUS UKR MDA EGY DZA AZE MAR 0 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Centres implanting ICDs (per million people) Centres implanting ICDs per million people & GDP per capita, PPP ($) 10 y = 1,7993ln(x) - 15,866 R² = 0,4063 9 LUX 8 DEU 7 6 ITA CHE 5 4 3 2 1 KGZ 0 AUT FIN BEL IRL CYP LBN ESP POL SWE PRT HRV TUR ISL ISR FRA MLT GEO ESC Average NOR GRC GBR BIH ALB MNE CZE NLD EST SRB HUN ARM MKD BLR LVA LTU SVN DNK MDA TUN BGR ROU XK KAZ SVK UKR AZE RUS MAR EGY DZA 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Centres implanting CRT-Ps (per million people) Centres implanting CRT-Ps per million people & GDP per capita, PPP ($) 9 y = 1,4571ln(x) - 12,7 R² = 0,3478 8 DEU 7 6 ITA CHE NLD 5 4 3 2 1 0 GEO MNE LBN TUR HRV LVA ARM MKD SRB TUN BGR KGZ BLR BIH ROU ALB MDA MAR EGY UKR DZA CYP ESP CZE ISR MLT PRT ESC Average EST GRC HUN POL LTU SVN SVK KAZ RUS BEL FIN FRA GBR ISL AUT SWE DNK IRL 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $) NOR LUX

Pacemaker implantations (per million people) Pacemakers implantations per million people & GDP per capita, PPP(US$) 1.200 y = 374,18ln(x) - 3260,1 R² = 0,5829 ITA 1.000 FRA SWE CZE ISL DEU AUT 800 POL PRT LTU EST ESP FIN BEL DNK CHE GRC SVN GBR 600 HRV LVA HUN MLT SVK NLD NOR LUX SRB ISR BGR ESC Average IRL 400 BLR 200 TUN MNE ROU LBN RUS CYP MKD MDA TUR UKR GEO ALB KAZ KGZ ARM DZA EGY BIH 0 AZE 0 MAR 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

ICD implantations (per million people) ICD implantations per million people & GDP per capita, PPP(US$) 400 y = 100,67ln(x) - 919,05 R² = 0,5096 DEU 350 CZE 300 NLD 250 POL ITA DNK 200 FRA SWE 150 ISL BEL IRL CHE NOR LUX FIN SVK ISR HUN ESP AUT 100 GRC EST GBR TUR PRT ESC Average SVN LBN MLT 50 SRB MNE CYP LTU HRV LVA GEO ROU TUN ARM MAR BLR MDA BIH BGR RUS DZA MKD KAZ 0 0 UKR 10.000 ALB 20.000 EGY AZE 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 XK GDP per capita, PPP (US $)

CRT-P implantations (per million people) CRT-P implantations per million people & GDP per capita, PPP(US$) 80 y = 15,286ln(x) - 131,9 R² = 0,2943 DNK 70 GBR 60 50 HUN LTU FRA SWE CZE 40 BGR BEL 30 20 10 KGZ 0 MNE EGY TUN SRB HRV ROU SVN ITA FIN AUT NLD SVK ISL CHE ESC Average EST ISR DEU POL PRT ESP LUX LVA MLT IRL MAR MKD GRC BIH GEO LBN UKR KAZ CYP DZA 0 ALB 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $) NOR

CRT-D implantations (per million people) CRT-D implantations per million people & GDP per capita, PPP(US$) 180 y = 39,94ln(x) - 361,23 R² = 0,4173 ITA 160 140 CZE 120 DEU 100 ISR FRA DNK NLD 80 60 40 HUN GRC LVA POL SVK MLT PRT SVN ESP GBR FIN BEL SWE AUT IRL CHE NOR LUX LBN ESC Average 20 EST ISL MNE HRV MAR SRB LTU CYP UKR BIH TUN ROU KGZ GEO EGY RUS ALB MKD BGR KAZ 0 AZE 0 ARM 10.000 DZA 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Ablations (per million people) Ablations per million people & GDP per capita, PPP(US$) 900 y = 219,11ln(x) - 1980,1 R² = 0,5313 800 DEU 700 DNK 600 CHE CZE BEL 500 FRA NOR 400 FIN SWE NLD HUN AUT LVA EST 300 LTU ESP LUX GBR POL ISR ISL HRV ESC Average SVN IRL 200 SVK TUR PRT RUS SRB GRC MNE CYP 100 TUN BLR GEO KAZ BGR ROU ARM UKR MKD LBN KGZ ALB EGY AZE DZA MLT 0 MAR 0 10.000 20.000 30.000 40.000 50.000 60.000 70.000 80.000 90.000 100.000 GDP per capita, PPP (US $)

Ablations (per million people) Ablations per million people & HCE per capita, PPP(US$) 900 y = 183,61ln(x) - 1142,4 R² = 0,5984 800 DEU 700 DNK 600 CHE CZE BEL 500 FRA NOR SWE 400 FIN NLD LVA HUN AUT 300 200 TUR EST LTU POL HRV RUS ESP ISR ESC Average SVN SVK PRT GBR ISL IRL LUX GRC SRB MNE 100 KAZ TUN BLR CYP ARM ROU BGR UKR GEO MKD KGZ LBN EGY AZE DZA MLT 0 MAR ALB 0 1.000 2.000 3.000 4.000 5.000 6.000 7.000 Total health expenditure per capita, PPP (US$)

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