Vienna October 27 th, 2011

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1 Cross Border Healthcare in European Regions Vienna October 27 th, 2011 European Academy of Sciences and Arts

2 John Dalli Member of the European Commission Biography: John Dalli served as a Cabinet Minister in the Maltese Government since 1987 having been first elected to the House of Representatives of Malta on behalf of the Nationalist Party in He has served as Parliamentary Secretary for Industry ( ), Minister of Economic Affairs ( ), Minister of Finance ( , ) Minister of Finance and Economic Affairs and Minister of Foreign Affairs and Investment Promotion (2004). Between March 2008 and February 2010, John Dalli served as Minister for Social Policy which includes the Health, housing, employment and industrial relations portfolio. As a qualified accountant, Dalli has also worked in the private sector in Malta and abroad, both in industry and as an independent consultant. In February 2010 John Dalli was appointed as European Commissioner responsible for Health and Consumer Policy. John Dalli was born on 5th October He is married and has two daughters. 2

3 Innovative Financing Strategies in Healthcare Stefan Brunnhuber Biography: Stefan Brunnhuber is Vice-chairman of the European Institute of Health and Medical Director and CMO of Diakonie Kliniken in Zschadrass, Germany. Since 2009 he works as Consultant and Deputy-Head at the department of Psychiatry and Psychotherapy at the University of Salzburg (SALK), Austria. Stefan Brunnhuber is Scientific Advisor to the EU-Commission and has several Visiting-Professorships, for example at the WHO collaboration centre, Beijing and the PPKE-University of Budapest. Special interests: Mental public health, financial strategies in social security systems, Complementary medicine; 3

4 Borders of Cross Border Healthcare Hanjo Allinger The big challenge for European member states is the growing mobility of the European population. Medical care is not longer necessarily taken in close vicinity to each persons residence. The European patients sees themselves as consumers of medical services and want to choose the location of treatment according to individual preferences on their own. Inpatient treatment patients are often willing to take the longer way to get the best possible treatment abroad. In border regions foreign doctors or hospitals are often easier to reach as in the home country. Despite an European agreement, there is an established law against the comprehensible will of the patient. With this, states try to avoid additional costs for local insurances by service imports. Due to that, insurants are only allowed to travel in other countries to receive medical care under very strict conditions. This means for example in outpatient medical care to waive any of the usual insurance benefits. In impatient medical care, treatment abroad requires authorization by the proper health insurance in advance. Otherwise, patients loose their entitlement to benefits. Hanjo Allinger has a lectureship in classical and international economics at the University of Applied Sciences in Deggendorf/Germany. He is also managing partner of INWISO, a commercial research institution. He developed organizational and financing structures for the Bavarian-Austrian and the Bavarian-Czech border to improve a borderless European Health. 4

5 Beveridge versus Bismarck yet again! Arne Björnberg All public healthcare systems share one problem: Which technical solution should be used to funnel typically 7 10 % of national income into healthcare services? For more than half a century, particularly since the formation of the British NHS, the largest Beveridge-type system in Europe, there has been intense debating over the relative merits of the two types of system. Already in the Euro Health Consumer Index (EHCI) 2005, the first 12-state pilot attempt, it was observed that In general, countries which have a long tradition of plurality in healthcare financing and provision, i.e. with a consumer choice between different insurance providers, who in turn do not discriminate between providers who are private for-profit, non-profit or public, show common features not only in the waiting list situation Looking at the results of the EHCI , it is very hard to avoid noticing that the top consists of dedicated Bismarck countries, with the small-population and therefore more easily managed Beveridge systems of the Nordic countries squeezing in. Large Beveridge systems seem to have difficulties at attaining really excellent levels of customer value. The largest Beveridge countries, the U.K. and Italy, keep clinging together in the middle of the Index. There could be (at least) two different explanations for this: Managing a corporation or organisation with employees calls for considerable management skills, which are usually very handsomely rewarded. Managing an organisation such as the English NHS, with close to 1½ million staff, who also make management life difficult by having a professional agenda, which does not necessarily coincide with that of management/administration, would require absolutely world class management. It is doubtful whether public organisations offer the compensation and other incentives required to recruit those managers. Arne Björnberg is Chief Operating Officer at Health Consumer Powerhouse in Brussels and Stockholm. He is inventor of 6 patents in the areas of electronic materials, process metallurgy, environmental technology and credit card systems. Arne Björnberg earned his Ph.D. In inorganic In Beveridge organisations, responsible both for financing and provision of healthcare, there would seem to be structure chemistry at the University of Umeå a risk that the loyalty of politicians and other top decision makers could shift from being primarily to the and was Director of Life Science Consulting customer/patient. Primary loyalty could become shifted to the organisation these decision makers, with Services at KPMG in Stockholm. justifiable pride, have been building over decades (or possibly to aspects such as the job-creation potential of such organisations in politicians home towns). The 2009 Euro Health Consumer Index has a completely novel ranking situation, with The Netherlands outpacing the competition by 44 points on a scale. 5

6 Wearable Technologies for Innovative Healthcare Management and Communication Concepts Astrid Böger Wearable technologies, as part of interactive communication networks, appear to own high solution potential in consideration of the present challenges like demographic factors, lack of medical professionals especially in rural areas, increase of chronic illnesses and not sufficient resources for medical care in future times. Applications of wearable systems like e-textiles or smart clothes as special subcategories of mobile technology may offer user-friendly ICT solutions capable to communicate between patients and the health system including all participants and objects and become part of innovative health-support systems. Main topics of research subjects are intelligent fashion interfaces, wellness medical fashion and successories, smart medical clothes concepts like senswear, medical jewellery, tele-wellness as well as continuous biomedical monitoring through wearable electronics. With e-textile-platforms added functions like sensing, actuating, treating, computing or power management become realistic. The integration into clothes of several kinds of e.g. biosensors for health monitoring provide daily physiological parameters through a continuous, personalized, and self-made detection of vital signs or the tracking of posture and gestures of a subject. The health service needs new attempts to solve the rising problems of care and, besides, within the scope of e-health Wearable technologies will take a key position. Therefore, classification and standardisation of textile and on-body-health product interfaces, implementing e-textile platforms and establishing integrated healthcare services for a new type of management of hybrid technological products are central objectives of further research in Europe. Dr.-Ing. Astrid Böger is Jun.-Professor at BTU Cottbus, Institute of Electrical Engineering and Communication, faculty 3 and former deputy director of KSI Klaus Steilmann Institute, project manager and R&D scientist. She has graduated from Humboldt-University Berlin, Germany with degrees in Scientific Information (1990) and the Ph.D. degree from University of Witten/Herdecke, Germany in Engineering Science. 6

7 Mobility of Doctors in Cross Border Healthcare Vincenzo Costigliola Every health care system in every country in the EU faces the same problems. Rising costs, uninformed patients or mediocre quality. Due to that, the question is, how you can we avoid and face this problems. Within the European Union and especially in the health care sector following points concerning the mobility of doctors in the European Union can be outlined: Every country has to recognize the professional qualifications for physicians. It is very important that this is forced by European and national legislation. The motivations for doctors to go abroad are financial motivation, better working conditions or specialization. There are mobility patterns, especially in the fields of East-West, North-South and neighbor countries. Physicians migration may lead to major shortages and financial loss in source countries. For balancing migration a better use of existing healthcare facility is required It s important to implement health workforce strategies in order to manage physicians migration. Due to these bullet points following recommendations can be derived. First of all we need more Quality and more health at reasonable costs. More patient safety is necessary to create a sustainable Cross Border Healthcare. The European Union should develop more educational programs and above all more Cross Border Joint courses for MDs. To implement the listed measures it s crucial to have more collaboration between the member states, to pay more attention to reimbursement and for the last to recognize prescriptions. Vincenzo Costigliola graduated in Medicine from the University of Naples in 1972 and in Anaesthesiology and Intensive Care from the University of Pisa in He has a family practice in Brussels and is medical advisor for the W.E.U. (Western European Union). Vincenzo Costigliola is among other positions, President of I.R.M.A. (International Rescue Medicine Association) and President of E.M.A. (European Medical Association). 7

8 Legal situation and reform options Susanna Kochskämper In the European Union responsibility for financing health care lies within the member states. Nevertheless the common market rules are generally applicable on health care services and health insurance. The resulting sometimes conflicting rules characterize the legal situation regarding health care and health care financing. From an economical point of view these rules are not always agreeable as they do not always contribute to efficiency in financing health care. Reforms are necessary on a national and on an European level. Discussing reforms implies also discussing about who should be responsible in which area, about an efficient mix of harmonization and state competition. Susanna Kochskämper is scientific assistant at the institute of economic policy of the University of Köln/Germany and is responsible for the research project Challenges for the National Health Policy in European Integration Process. She won the contest Perspective 2020 Health as an Opportunity organised by Janssen-Cilag. 8

9 The Benefits of mhealth for Europe What works well? What should we consider to change? Axel Nemetz Vodafone implements a program to bring the different stakeholders in the health care System together. There was a first start in Greece to connect GP s and Specialists and the pilot project turned out to be successful on all levels. The outcome was that there was more efficient use of resources through remote diagnosis and treatment consultation between local GP s and centralized specialists. Due to that further pilot projects in other regions were planned. The benefits of mhealth for Europe can be summarised in following two points: mhealth improves healthcare outcomes and quality of live by giving patients and healthcare professionals increased flexibility and freedom mhealth allows out-of-hospital/out-of-practice monitoring, diagnosis and care delivery. The main focus of Vodafone lies on continue focusing on pragmatic solutions, start changing reimbursement systems and they consider about combining health and social budgets. Axel Nemetz joined Vodafone Global Enterprise in October 2010 and heads the global mhealth Solutions business unit. He holds a PhD in Physics from Max Planck Institute and was European Vice President of Novo Nordisk. He headed Rothschild s German pharma/healthcare business and worked with McKinsey in Europe and the US for pharmaceutical and healthcare clients. 9

10 Using IT for promoting the Personal Anatomy of the Elderly and of People with Special Needs-development of new solutions on accessibility e-care and e-health José Luis Ripoll text Prof. Dr. José Luis Ripoll is chairman of the Vodafone Foundation in Spain. He is also full professor of Universidad Politécnica de Valencia, at the School of Civil Engineering (Emeritus) and honorary Professor of the Telecommunication Engineering College of Madrid University. José Luis Ripoll is also trustee of COTEC Foundation, the leadings Association for Technological Innovation, under the chairmanship of his Majesty, the King of Spain. 10

11 Introduction and Basic Considerations Johann-Matthias Graf von der Schulenburg Although we are living in one European Union, the health care systems in the EU countries employ a large number of different pricing, reimbursement and financing schemes. In these different countries we have various payer organizations. Most of them are sickness funds as well as public and private health insurers. The distinction between sickness funds and health insurers is that sickness funds use a pay-as-you-go financing scheme and health insurers require actuarial calculated premiums taking into account the individual risk profile. In addition we have large differences across countries how health services are provided. In summary the boarders between health care systems of the member states are still high. Currently many European citizens living close to frontiers, being hundred thousands of kilometers long, suffer from a suboptimal provision of health care. Clinical centers are mostly not placed at the boarder of a country but in its political and economic centers. Moreover, citizens have monetary, legal and social problems to use the health care facilities of the neighboring country. To improve this situation, the European Academy of Science and Art proposes the project Health in the Regions. This project has many dimensions which we have discussed in an interdisciplinary working group of the Academy. All the recommendations are derived from focusing on the patient. Payers organizations, health care providers, institutional settings, payment and communication systems have to learn that patient needs should be in the focus of health care system organization, regardless if he or she lives across the border or not. To optimize the health care for people living in regions close to their countries boarder the Academy has developed a sophisticated action plan, called Health in the Regions. The implementation of the project could serve as a signal for more integration of health care system in Europe and stimulate Johann-Matthias Graf von der Schulenburg is Director of the Center for Health Economics, the Institute for Risk and Insurance Research and full professor at the Gottfried Wilhelm Leibniz University Hannover, Germany. He completed his masters degree in economics at the University of Göttingen and earned a PhD in economics at the University of Munich (LMU). For his scientific work he has received among others the American Risk and Insurance Award and the Alexander von Humboldt Award. 11

12 E-Health and it s example on Diabetes Kurt Völkl Management of patients with chronic diseases in general and Diabetes mellitus in particular requires a dedicated infrastructure to support patients and doctors to communicate and collaborate intensively, without the need of frequent face to face meetings. The term mhealth is more and more used to encompass these ideas of patient centered, prevention oriented, and decentralized health management and treatment of chronic conditions, using mobile and wireless communication technologies. In 2010, the Austrian Social Insurance Institution for Railways and Mining Industry (Versicherungsanstalt für Eisenbahnen und Bergbau, VAEB) started with a proof-ofconcept telediabetes project, called Health Dialogue ( Gesundheitsdialog ). The project aims at setting a new standard in the management of chronic diseases by integrating different healthcare elements across different healthcare sectors (patients, general practitioners, specialized clinics, hospitals). Initially, the project addresses primarily Diabetes mellitus but it will be extended to other chronic diseases (cardiovascular diseases) and towards prevention programs for patients with known risk factors (obesity, pre-diabetes). Overall aims of the Gesundheitsdialog are to increase the quality and efficiency of healthcare. Dipl. Ing. Kurt Völkl is general manager of the Insurance Institution for the Austrian Railways and Mining Industry. He also has lectureships at the Universities of Graz, Linz and the Medical University of Vienna. 12

13 Accessible ICT for Helping People Mari Satur Torre text Mari Satur Torre is Technical Director and coordinates all the technical activities of the Fundación Vodafone España. She is Telecommunication Engineer from the Polytechnic University of Madrid, MSc. in Mobile Communications by the Polytechnic University of Barcelona and Executive MBA by EOI (Industrial Organization School). Additionally, she has contributed to more than 10 publications related to mobile communications and ICT for vulnerable groups. 13

14 Behind the Scenes and the European Academy of Sciences and Arts Neue ppt-toolbox 14

15 Vienna Divison Healthcare Our Services Our healthcare team is ideally positioned to offer specially tailored support when it comes to meeting the ever changing demands of the healthcare system. Our considerable experience in auditing and consultancy matters together with our numerous contacts throughout the medical sector mean that we are able to provide you with the best possible service. What also enables us to offer the latest in healthcare related expertise to our clients is our international and interdisciplinary network. It is the unique knowledge and experience gained from this network through which we are able to guarantee effective solutions which are ideally suited to your needs. Healthcare management systems, models and procedures Development of models to ensure integrated patient care Implementation of evidence based solutions Establishment of disease management programmes Consultancy services in setting up partnerships Establishment of PPP models Transaction consultancy Search for investors (equity and debt capital) Formulation and plausibility analyses of business plans 15

16 Vienna Divison Healthcare Efficiency optimisation and streamlining Profitability and feasibility analyses for healthcare organisations Assessment of the range of services offered by healthcare organisations Change management, Process development Quality control and safety issues (risk management) Auditing Audit teams with experience in the healthcare sector and in matters related to hospitals and healthcare administration bodies Annual audits, special audits, financial conduct audits and compliance audits Tax Individually prescribed healthcare solutions Extensive experience in dealing with separate legal entities, commercial institutions and non-profit organisations Support in the establishment of corporate groups and reorganisation processes Optimisation of input tax deduction Grants and subsidies Transaction tax and fees Contracts and transactions 16

17 Dr. med. univ. Andrea Kdolsky Vienna Professional Experience Since June 2009 Managing Director Advisory Healthcare Services Austria, Vienna Federal Minister for Health, Family and Youth (Austria) 2006 CEO of the NÖ Landeskliniken Holding (Lower Austrian Provincial Clinics Holding), executive spokesperson 2005 Hospital Manager for Landeskliniken Holding/NÖGUS (Lower Austrian Health and Social Fund) Deputy CEO of the Federal Institute for International Training and Technology Transfers Senior physician at University Clinic for Anaesthesia and Intensive Care Education Legal Studies University of Vienna (1 st part of course) and Business Studies at Vienna University of Economics and Business Administration (1 st part of course) Medical Studies University of Vienna; Degree: MD Training for Hospital Management and Economy, Vienna University of Economics and Business Administration; Degree: MBA Course on process-orientated quality management/ WIFI Vienna (management college); Degree: Diploma Quality control manager for small and medium companies; Internal auditor 17

18 European Academy of Sciences and Arts Salzburg The European Academy of Sciences and Arts was founded in 1990 by Prof. Felix Unger, Cardinal Franz König and Prof. Nikolaus Lobkowicz, prominent figures in their fields. The Academy focuses on interdisciplinary discussion across specialist areas, ideologies and scientific cultures as well as promoting transnational dialog and visionary developments of new scientific knowledge and academic thinking. The European Academy of Sciences and Arts now brings together over 1500 scientists and researchers, philosophers and artists from Europe, Asia and the USA, including 29 Nobel Prize winners. This has resulted in a networked think tank on ethical and scientific values in a society that is increasingly fragmented. Developing knowledge Future-critical topics such as environmental damage through technology and industry, Genetic engineering, Economic globalization boundaries of medical technology, etc. are discussed at symposiums, congresses and on interdisciplinary, scientific working parties. Disseminating scientific information One of the Academy s key aims is to ensure that everyone has access to information. Alongside the regular publications, electronic media and new interactive communication systems are being used to disseminate information. 18

19 European Academy of Sciences and Arts Salzburg Implementing major projects major project Health is Wealth Optimal heath care should be delivered throughout Europe based on the facts and validated research findings. This project will also focus on interdisciplinary discussion between industry and medicine, to disseminate theoretical medical findings to industry, industrial technology and medicine, to combine theory and practice. major project Tolerance For the representatives of the European Academy of Sciences and Arts tolerance is a virtue, by which man as an individual can live in freedom within the spirit of the law. Tolerance means behaving in a way that does not harm your neighbors or restrict their freedom. The aim is to set up a Tolerance institute that runs scientific symposiums, promotes and commissions research and holds public debates on tolerance. 19

20 Prof. Dr. Dr. h.c. Felix Unger European Academy of Sciences and Arts Professional Experience Director of the University Clinic for Cardiac Surgery, PMU Salzburg Since 1990 Since 1990 Since 2001 Founder and President of the European Academy of Sciences and Arts Director of the European Heart Institute Director of the European Institute of Health Education Medical Studies, University of Vienna University Clinic for Cardiology and Cardiac Surgery, Vienna Cardiovascular Research Fellow; Houston, Cleveland, Salt Lake City, USA Selected Awards 1975 : Dr.Karl Renner Preis with Prof.Navratil and Prof.Polzer 1992: Billroth Preis of the Austrian Society for Surgery 1998: Order of Merit 1 st Class, Germany 2005: Order of Merit of the State of Salzburg 2006: Austrian Cross of Honour for Science and Arts 1 st Class 20

21 Impressions 21

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