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Reducing waste and efficiencies in healthcare improving quality Lieven Annemans

EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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Page 1: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

Reducing waste and efficiencies in healthcare

improving quality

Lieven Annemans

Page 2: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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)

Page 3: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

“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.”

Page 4: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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

Page 5: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

5

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

Page 6: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

6

Cost

Health effect(QALYs)

Currentcare

NOT C-Eff

C-Eff

Dominant

Threshold (1 to 3x GDP/capita)

New

New

Cost-effectiveness

New

Page 7: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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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

Page 8: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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

Page 9: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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

Page 10: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

=

Page 11: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

Overuse

MorePrevention

&Innovation

Re-investing in health !

Page 12: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

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George Halvorson, CEO,Kaiser Permanenteinterview http://vimeo.com/4039344

A crucial condition a perfect eHealth system

Page 13: EPRD16 - LIvien Annemans reducing waste and inefficiencies in helathcare

Reducing waste and efficiencies in healthcare

improving quality

Lieven Annemans