Shaping a strategic direction for health and health property in the Netherlands & Europe

Transcription

1 Shaping a strategic direction for health and health property in the Netherlands & Europe Dr. MARINUS VERWEIJ Board of Directors, Netherlands Board for Healthcare Institutions Chairman, the European Health Property Network

2 Introduction College bouw

3 Symbols of a value system

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5 The agenda for change in a European context

6 Increasing cost of healthcare Governments have strong influence on the provision of hospital/health care Increasing macro-economic constraints: rising % of GDP, yet costs of healthcare limited by national and EU budget constraints Health is not just a matter of costs, a healthy workforce is crucial for development and growth

7 Health Expenditure % GDP Source: OECD HEALTH DATA 2005 College bouw Australia Austria Belgium Canada Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Japan Korea Luxembourg Mexico Netherlands New Zealand Norway Poland Portugal Slovak Republic Spain Sweden Switzerland Turkey United Kingdom United States

8 Market-reform & competition Many EU counties: market-reform and competition in healthcare In most countries health square meters are free: cost of capital is not charged Times are changing: product pricing, cost of capital in the DTC s introducing new incentives NHS-model countries experimenting with forms of PFI and PPP

9 The third age of healthcare Re-emergence & revitalisation Diversity Community, Lifestyle Morbidity compression but also Comorbidities Hospital Hospital Public Health Acute Care Chronic Illness Aged Care

10 From linear evolution to the uncertain Rapidity of technological change e.g. Dispersal - ICT; teleconferencing Spatial - miniaturisation; anaesthetic equipment Modalities - replacement therapies Changing principles of healthcare delivery Devolution Patient empowerment

11 European pressures College bouw health and health facilities Expectation Affordability cost Policy aims Social development needs Economic needs Unsustainable - social Unsustainable - economic

12 Changes in the Dutch Healthcare system Tasks Netherlands Board for Healthcare Institutions

13 Dutch health care sector in a nutshell Since 1945 the Bismarck system (social) private health insurance funds hospitals/health facilities are private trusts hospitals/health facilities are not for profit organisations ownership of assets belongs to the hospital/health facility

14 Financing investments capital costs through the life cycle capital cost interest depreciation capital costs years

15 NHC s in de DBC "Oude kapitaalslasten" versus Integrale Huisvestingscomponent Rente Aflossing Huisvestingscomponent

16 Changing system: consequence Positief en negatief NHC-resultaat uitgedrukt in % AK aantal ziekenhuizen Effecten relatief beperkt: 12 ziekenhuizen met meer dan 2% van budget, zowel positief als negatief

17 Tasks of the NBHF licensing of construction plans: health facilities submit their own plans developing guidelines for planning capacity: e.g. ageing, IC capacity, geographical distribution of emergency care building guidelines, with basic quality requirements and best practice centre of expertise technological innovation: e.g. operating theatres building costs and procurement

18 Wat is mapping? Functionality Adaptability Cbz Technical quality Monitoring

19 Colours for functions College bouw

20 Measuring space College bouw

21 Results functional quality 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Algemene verpleging Special care Polikliniek Beeldvormende technieken Spoedeisende hulp Verlosafdeling boven referentiewaarde, boven gemiddelde boven referentiewaarde, onder gemiddelde onder referentiewaarde bestaande bouw

22 Score general wards 30% 25% 25% 23% 20% 15% 10% 5% 4% 6% 6% 11% 11%11% 2% 0% voldoet op alle punten niet aan de referentiewaarden voor bestaande bouw voldoet gemiddeld aan referentiewaarden voor bestaande bouw voldoet op alle punten aan de prestatie-eisen voor nieuwbouw

23 Beds per ward 60% 50% 40% 30% 20% 10% 0% 1 1 met sluis 2 3 en 4 5 en 6 %-verdeling kamers %-verdeling bedden

24 Score special care 18% 16% 14% 12% 10% 15% 14% 12% 11% 9% 8% 6% 4% 5% 3% 3% 6% 5% 6% 5% 6% 2% 0% voldoet op alle punten niet aan de referentiewaarden voor bestaande bouw voldoet gemiddeld aan referentiewaarden voor bestaande bouw voldoet op alle punten aan de prestatie-eisen voor nieuwbouw

25 Results technical quality 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% gemiddeld totaal bouwkundig bouwkundig extern intern installaties uitstekend goed redelijk matig (zeer) slecht

26 Construction type aantal gebouwdelen Goed Redelijk Matig Slecht flexibiliteitsklasse

27 Consequences for asset strategy

28 Paradigm shift No longer a split between investment and recurrent budgets net present value Asset moves from a risk free environment to a risky business Strong drive towards efficient workforce engagement process re-engineering Drivers towards a better fit between primary process and the built environment Need for capacity building the CEO s

29 Capital investment risk management Clinical risk technology and models of care Workforce risk availability, change management Demand risk markets, consumerism and transitions Political risk policy shifts, public opinion Financial risk debt servicing and capitalisation

30 Answers to change Adaptable and fit for purpose

31 Financial integration: investment and recurrent Process re-engineering Adaptable, design concepts

32 Importance process redesign Care pathways at different levels Micro: process redesign in the hospital Intermediate: cross setting care pathways between service providers Macro: new service delivery models - disease management, especially for chronic illnesses

33 The care pathway challenge Win-win-win: better, safer, cheaper and client friendly Volume! research by P. Degeling, Durham: only 30 DRG s are responsible for 50% of hospital output Health asset consequences may prove to be substantial nobody really knows yet

34 Capital fit for purpose Adaptability in face of uncertainty: both internal and external flexibility Sustaining intrinsic value: maximising residual value

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38 Delft Hospital - the Netherlands College bouw

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40 Strategic asset approach Level 1- hot floor: theatres, diagnostics, intensive care etc. Level 2 - hotel accommodation: low care nursing Level 3 office accommodation: outpatients, administrative

41 Model general hospital Hot floor 33,5% Hotel 30,5% Office 23,2%

42 Hot Floor Specificity Investment cost Capacity fluctuation Asset marketability

43 Office Specificity Investment cost Capacity fluctuation Asset marketability

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46 Patientlogistics Patientlogistics organised trough two principles Clinical/body grouping: mother/child, oncology etc. And/or Patientlogistics based on typology: acute, elective, chronic etc.

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48 Life cycle costs Level 1: classic LCC: including energy saving, sustainability, choice of material Level 2: LCC as above, but including adaptability and flexibility of the building Level 3: Life cycle economy integrated model for the fit between the primary process and the building/asset

49 The Model: Discount to net present value Investment (capital) cost Annual MOM costs Replacement and periodic maintenance costs Life Time Cost Annuity Cost Functional Lifetime Consider: Cost of action Intervals of action Real rate of return Lifetime of building

50 Investment versus annual costs

51 Totalannualcosts College bouw

52 EuHPN Peer Review of case studies Utrecht, 13/10/06 6 central themes: Importance of whole systems approach The success of the business model within a public framework - competition Flexibility & adaptability to reduce risks The value of patient focussed architecture The importance of capital financing models The necessity for visionary leadership

53 To sum up: Adaptability

54 Thank you very much! Netherlands Board for Healthcare Institutions College bouw - Bouwcollege Churchilllaan 11, 7e etage 3527 GV UTRECHT The Netherlands cbz@bouwcollege.nl