College bouw zorginstellingen. 9th Meeting EuHPN April 2006 Budapest Hungary. Marinus Verweij MD Chairman EuHPN

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1 9th Meeting EuHPN April 2006 Budapest Hungary Marinus Verweij MD Chairman EuHPN

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3 1. Brussels - October Florence - June Dublin - March The Hague - October Oslo - June Lisbon - March Edinburgh November Oulu June Budapest April 2006

4 EuHPN themes & European Observatory study Epidemiological and demographic trends Clinical practice and the use of health facilities The appropriate, forward-looking, built response Procurement & financing of that response

5 ? Very complicated, multi-determinant, issues

6 400 Increase in numbers of people with diabetes in the world millions King et al 1998, Wild et al 2004

7 Most adults have more than one chronic disease Hypertension Arthritis Heart Disease Eye Disorders Diabetes Mellitus Single Condition Condition+1 Condition+2 Condition+3 Condition+4+ 0% 20% 40% 60% 80% 100%

8 Scenarios for the development of required beds beds/ 1000 pop. 3,3 3,1 2,9 2,7 2,5 2,3 2,1 1,9 1,7 1,

9 From linear evolution to the uncertain Rapidity of technological change Dispersal - ICT; teleconferencing Spatial - miniaturisation; anaesthetic equipment Modalities - replacement therapies

10 Importance process redesign College bouw 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 On average 40% to 50% of patients need not be in hospital? Health asset consequences may prove to be substantial nobody really knows yet

11 The care pathway challenge Clinical & 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

12 Symbols of culture & values

13 Integrated Quality System

14 Strategic asset approach Adaptability will be the central theme for the future: portfolio approach of property and elastic buildings Level 1- hot floor: theatres, diagnostics, intensive care etc. Level 2 - hotel accommodation: low care nursing Level 3 office accommodation: out-patients, administrative

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

16 Hot Floor Specificity Investment cost Capacity fluctuation Asset marketability

17 Office Specificity Investment cost Capacity fluctuation Asset marketability

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20 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

21 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

22 Health Property in Europe NHS countries: UK en Scandinavia government has much stronger control over asset decisions, PFI/PPP because of budget constraints, political spotlight. Bismarck countries: insurance model, government at arms-length, mixed financing models Private providers within and outside the public system: Rhön Klinikum, UK, France

23 Ownership health infrastructure - EU Nederland Belgie Duitsland Frankrijk Oostenrijk Spanje** Zweden** Verenigd Koninkrijk Denemarken 0% 20% 40% 60% 80% 100% overheid particulier-non-profit particulier-profit particulier

24 Costs over the life cycle College bouw 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

25 ??????? Output of the study: understanding of Very complicated, multi-determinant, issues Also: practical tools for concrete decisionmaking

26 Position of the EuHPN Related to European Governments Public Arena Health property is the central issue - health property is the outcome of strategy and models of care - new health property is often catalyst for change - once built health property has a tremendous impact on delivery of health care

27 Participants - 27 countries England, Scotland, Wales, Northern Ireland, Ireland, Netherlands, Italy, Portugal, Austria, Germany, Finland, Sweden, Denmark, Norway, Belgium, France, Luxembourg, European Investment Bank, Greece, Malta, Czech Republic, Slovakia, Switzerland, Slovenia, Hungary, Latvia and Australia.

28 EuHPN vision in progress Tremendous potential for exchange of ideas and experience within Europe Joint learning through research projects Open method of coordination (EU) success of the peer review methodology Setting the health property agenda in our countries and wider within Europe through strategic knowledge base Exploring frontier issues

29 EuHPN vision in progress II The European Observatory/EuHPN study is of enormous strategic importance Exploring the frontier developments trough the case studies Combining innovation initiatives with sound research analysis and evaluation EuHPN observatory role: pooling and interlinking knowledge into a new phase Ongoing mission for EuHPN after the study

30 12 Paying Members Paying members: England, Scotland, Wales, Northern Ireland, Ireland, Netherlands, Italy, Finland, Sweden, Norway, EIB, Hungary. Membership needs to increase: challenge - new EU member countries - countries with federalised structure regional membership - associate membership for agencies with a strong common interest

31 Hartelijk dank voor uw aandacht! College bouw

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