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Reducing waste and efficiencies in healthcare
improving quality
Lieven Annemans
Consequences of the crisis…
2
Ann
ual g
row
th o
f hea
lthca
re e
xpen
ditu
res
in th
e O
EC
D
(OECD health statistics 2015)
“Health is a value in itself.It is also a precondition for
economic prosperity. People’s health influences economic
outcomes in terms of productivity, labour supply,
human capital and public spending.”
The real goal of health care systemsPrimary goal of health care policy = to produce health
= to maximize the health of the population within the limits of the available resources, and within an ethical framework built on equity and solidarity principles.
4
Report of the Belgian EU Presidency, adopted by the EU Council of Ministers of Health in Dec 2010
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Value for money
Cost
Health effect(e.g. QALYs)
Currentcare
Trea
tmen
t cos
tS
avin
gs
Sav
ings
N
et C
Ext
ra C
Hig
h ne
t Cos
tL. Annemans. Health economics for non-economists. Academiapress, 2008
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Cost
Health effect(QALYs)
Currentcare
NOT C-Eff
C-Eff
Dominant
Threshold (1 to 3x GDP/capita)
New
New
Cost-effectiveness
New
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PROBLEM: where is the threshold?
• BENCHMARKING • e.g. cost-effectiveness of caring for a dialysis patient historically 50,000 $ per QALY:
• WHO: Highly cost-effective (< GDP per capita); Cost-effective (between one and three times GDP per capita); (e.g. Belgium = +/- €35000) http://www.who.int/choice/costs/CER_thresholds/en/
• At the discretion of the decision maker… (England 25,000£/QALY
Examples: “league table”
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Intervention Net cost QALY gain ICERTraining for caregivers of stroke patients -6,000 0.00 Dominant
Diabetes education and self management for patients newly diagnosed with type 2 diabetes
200 0.04 5,000
Daily dialysis compared to dialysis every other day for 60 year-old men with kidney injury
13,000 2.14 6,000
ICD (implantable cardioverter defibrillator) for patients who are at risk for sudden death due to left ventricular systolic dysfunction
113,000 3.00 38,000
Annual CT for 60 year-old heavy smokers 6,000 0.04 140,000
Screen & treat osteoporosis for men age 65 and older with no prior fracture
4,000 0.03 150,000
https://research.tufts-nemc.org/cear4/Resources/LeagueTable.aspx
ICER = Incremental Cost Effectiveness Ratio
9Bekelman et al, JAMA, January 2016
27.7
24.8
21.7
19.0
18.3
17.8
10.7
10.6
6.0
5.0
5.0
7.4
7.0
5.0
0.0 5.0 10.0 15.0 20.0 25.0 30.0
Belgium
Norway
Germany
Canada
England
Netherlands
USA
Hospital days end of life
last 30d last 180d
=
Overuse
MorePrevention
&Innovation
Re-investing in health !
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George Halvorson, CEO,Kaiser Permanenteinterview http://vimeo.com/4039344
A crucial condition a perfect eHealth system
Reducing waste and efficiencies in healthcare
improving quality
Lieven Annemans
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