Health is Wealth: Strategic Visions for European Healthcare at the Beginning of the 21st Century, Report of the European Parliament

131 Pages·2004·5.368 MB·English

by  Felix Unger (auth.)

Health is Wealth
Health is Wealth
Strategic Visions for European Healthcare
at the Beginning of the 21 Century
st
Report to the European Parliament
Prepared by:
Felix Unger (Chairman), Frank Anton, Katja Borchardt,
Reiner Brettenthaler, Stefan Brunnhuber, Vincenzo Costigliola,
Ibrahim Elmadfa, Gilbert Fayl, Veronika Fialka-Moser,
Alexander von Gabain, Probal Ghosh, Klaus-Dirk Henke,
Rolf Krebs, Johannes Meran, Konrad Meflmer, Andreas Penk,
Nina Schiffer, Maurice Wagner
With comments by:
Klaus Albegger, Monika Derecque-Pois, JoAnne Epping-Jordan,
Thomas C. Gartenmann, Gunther Grabner, Mario Grobovschek,
Gloria Gutman, Michael von Hauff, Jeremy Hurst, Werner Klein,
Hans Martin Sass, Gernot Schlosser, Alfons Staudach,
Michael Studnicka, Vilmos Vecsei, Marc Zeiter
fl
Springer
EUROPEAN INSTITUTE OF MEDICINE
European Academy of Sciences and Arts
European Institute of Medicine (EOM)
Chairman: Prof. Dr. Dr. h. c. Felix Unger
Monchsberg 2
5020 Salzburg
Austria
Citation: Unger F (2004) Health is Wealth, Strategic Visions for European
Healthcare at the Beginning of the 21 th Century. Springer, Berlin
Heidelberg New York
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ISBN 978-3-642-06098-4 ISBN 978-3-662-07738-2 (eBook)
DOI 10.1007/978-3-662-07738-2
This report is the result of a comprehensive effort by the EOM. It is headed by medi
cal doctors and supported by relevant professional organisations.
The EOM has additionally invited input and comments by experts in finance, ad
ministration, the pharmaceutical and biomedical industries, as well as from the
European Commission, WHO, OECD and the World Bank.
The EOM gratefully acknowledges the input given by the various supporters, inter
locutors and observers, who have made this Strategic Visions a reality. The EOM
wishes to thank its sponsors, without whom it would not have been possible to
launch this report as a basis for intensive European-level debate.
This edition was generously supported by
• The European Academy of Sciences and Arts
• The European Institute of Medicine
• The European Institute of Health
• The European Heart Institute
• AXA Konzern AG
• Baxter AG Osterreich
• Boston Scientific Ges.m.b.H.
• Eucomed
• Herzzentrum Salzburg GmbH
• Johnson & Johnson Medical Products GmbH
• Medtronic GmbH
• Pfizer Osterreich
• Siemens Medical Solutions
• st. Jude Medial
• Medizintechnik Ges.m.b.H.
• VAMEDAG
The European Academy of Sciences and Arts is sponsored by
the Federal Republic of Austria and the European Union.
v
Introduction by the Chairman
This report has been prepared at the request of the European Parliament. Its pur
pose is to form the basis for Parliamentary hearings and intensive debates on health
and healthcare-related issues throughout Europe. It was presented to the European
Parliament in Brussels on December 4t\ 2003.
Our report is unique in that it aims to put people, patients and their dignity at
the centre of focus. We feel that human dignity is one of the distinct characteristics
of European Society.
There are currently severe differences in the various national healthcare pro
visions in Europe. Moreover, no rational long-term strategy for public healthcare
currently exists in Europe, neither at member state nor at EU-Ievel. This is particu
larly regrettable in view of the political objectives laid out by the EU leaders at the
Lisbon Summit (March 2000): "to become the most competitive and dynamic know
ledge-based economy in the world, capable ofs ustainable economic growth with more
and better jobs and greater social cohesion" by 2010.
At EU member state level, it is the national political leaders' responsibility to pro
vide the conditions for adequate healthcare for its citizens. The EU should then
complement these initiatives in the area of public health and ensure they comply
with the principle of subsidiarity. We feel that the initiatives must be strategic and
have a long-term perspective in order to be useful.
Our strategic vision aims to address this need for an overall strategy that can be
adapted and implemented locally.
We have identified some key issues that need particular attention at European
level. The following certainties must be addressed at a European level:
• Healthcare is an indispensable factor for wealth creation.
• Healthcare is by necessity a European endeavour.
• There can be no national and local solutions without a European endeavour.
We expect that the average yearly health care costs per capita will increase from
approx. € 2000.-today to € 2500.-in the year 2020 allowing for a annual rate of in
crease of 2 %.
The following four pillars underpin our strategic vision for healthcare in Europe:
• Respecting the patient as a dignified individual.
• Optimising the medical arts to meet patients' needs.
• Promoting synergies of access and quality to ensure that patients receive their
healthcare requirements.
• Ensuring patient oriented, affordable healthcare regardless of where in Europe
it is delivered.
The strategic vision puts specific emphasis upon cost containment. New mecha
nisms have to be established to control the spiralling cost of healthcare. Clear rules
for healthcare delivery are needed to prevent the introduction of multi-class health
care in Europe. It requires a new underlying paradigm.
Salzburg, December 2003,
Prof. Dr. Dr. h. c. Felix Unger
VII
Table of Contents
Principles ........................................................ 1
Introduction ..................................................... 5
A The Patient ...................................................... 9
Reflections on the Strategic Vision
Reflections on the Strategic Vision .................................. l3
B Cluster I ......................................................... 15
Medical Arts
What Can Be Done in Medicine and What Does the Patient Need?
Introduction ..................................................... 17
Prediction ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25
Prevention ....................................................... 25
Medical Arts .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 28
Reflections on the Strategic Vision .................................. 38
C Cluster II ........................................................ 39
Organisation of Medicine
Where Does The Patient Find Help And Information?
Introduction ..................................................... 41
Medical Services .................................................. 41
Education ........................................................ 50
Reflections on the Strategic Vision .................................. 53
Annex ........................................................... 55
o
Cluster III ........................................................ 57
Healthcare Financing
What Can Be Done to Make Healthcare Affordable?
Introduction ..................................................... 59
"External" Financing .............................................. 61
Purchasing ("Internal" Financing) .................................. 72
Public - Private - Partnerships (PPPs) ............................... 76
Implications for Healthcare Reforms and Trends in Europe ............. 76
Reflections on the Strategic Vision .................................. 80
IX
Table of Contents
E Appendix ....................................................... 83
References ....................................................... 85
Information About the Strategic Vision Report. . . . . . . . . . . . . . . . . . . . . . .. 88
European Institute of Medicine EOM ............................. 88
Sponsors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 90
Timetable ..................................................... 90
List of Participants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 91
List of Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 92
Distribution List ............................................... 93
Editorial Support .............................................. 93
Index. . . . . . . . . . .... . . . ... . . ... . . .. . . . . . ... . . . . . ... . ... . ... . . . .... 95
x
1. Health............................................................ 4
2. Healthcare ........................................................ 7
3. European Healthcare ............................................... 7
4. The Patient ........................................................ 12
5. Patient Information ................................................ 12
6. Prevention ........................................................ 26
7. Nutrition ......................................................... 26
8. Social Prevention .................................................. 27
9. Vaccination ....................................................... 27
10. Classification of Medical Procedures ................................. 28
11. Genetic Testing .................................................... 30
12. Nursing ........................................................... 31
13. Drugs ............................................................. 32
14. Self Medication .................................................... 32
15. Homoeopathic Therapy ............................................. 33
16. Integrative Psychotherapy/Psychoeducation .......................... 33
17. Gene Therapy ..................................................... 34
18. Cell Therapy ...................................................... 34
19. Ethical Considerations .............................................. 34
20. Natural Medicine .................................................. 35
21. Invasive Therapy .................................................. 36
22. Disposables in Medicine ............................................ 36
23. Medical Outcome Studies ........................................... 37
24. Diffusion of Progress and Incentive of Science in Medicine .............. 37
25. Healthcare Delivery ................................................ 43
26. The General Practitioner ............................................ 45
27. Specialists ......................................................... 46
28. Hospitals ......................................................... 49
29. Institutions for Chronically III Patients ............................... 49
30. Rehabilitation ..................................................... 50
31. Long-term Institutions ............................................. 50
32. Medical Schools ................................................... 51
33. Professional Societies ............................................... 52
34. National Medical Associations ....................................... 52
35. Paramedical Professional Schools .................................... 53
36. Principles of External Financing ..................................... 61
37. Personal Contributions ............................................. 69
38. Private Insurance .................................................. 71
39. Cost of Purchasing ................................................. 72
40. Purchasing of In-Patient Care ....................................... 75
41. Purchasing of Out-Patient Services ................................... 75
42. Premiums ......................................................... 75
43. Obligatory Insurance Schemes ....................................... 76
44. European Institute of Health - EIH ................................... 79
45. National Institutes of Health - NIH .................................. 80
XI
List of Tables and Figures
Table 1 Life expectancy at birth in years (1998) ......................... 18
Table 2 Life expectancy at age 65 in years (1998) ........................ 18
Table 3 Diseases ranked by incidence and death ........................ 20
Table 4 Risk factors: Smoking in % of the population,
Alcohol consumption in litres, Body Mass Index (BMI) ........... 22
Table 5 Practising physicians/WOO population (late 1990s) ............... 44
Table 6 Doctor consultation per year (late 1990's) ....................... 44
Table 7 Number of total in-patient beds per 1000 population
(late 1990s) ................................................. 48
Table 8 Hospital admissions for in-patients per 1000 population
(late 1990s) ................................................. 48
Table 9 Characteristics for evaluating funded and non-funded
insurance systems ........................................... 68
Table 10 Effects of different purchasing models in out-patient care ........ 73
Table 11 Expenditure on health as a percentage of GNP, 1998.
Per capita (USD), growth rate (GR) in % 1980-1998 .............. 74
Table 12 Public Funding as a percentage of total health expenditure 1998 ... 81
Table 13 Expenditure on pharmaceuticals as percentage of total health
expenditures (199711998) ..................................... 81
Figure 1 European healthcare market .................................. 2
Figure 2 Overview of the European healthcare market ................... 4
Figure 3 Structural reform for European healthcare . . . . . . . . . . . . . . . . . . . . .. 6
Figure 4 Patient-doctor nucleus ....................................... 13
Figure 5 Demographic results and perspectives ......................... 19
Figure 6 Cluster I: medical arts ........................................ 23
Figure 7 A lifespan in healthcare ...................................... 24
Figure 8 Classification of medical procedures ........................... 29
Figure 9 Cluster II: medical organisation ............................... 42
Figure 10 Cluster III: financing and reimbursement ....................... 59
Figure 11 HC-cost: A direct investment in society ........................ 60
Figure 12 Payers and forms of financing in the German healthcare system ... 62
Figure 13 Provisions of basic needs ..................................... 64
Figure 14 Population above 65 as percentage of total population ............ 65
Figure 15 Standardised health expenditure of German Sickness Funds ...... 66
Figure 16 Constant premiums for lifetime ............................... 70
Figure 17 Cost and quality control in the EHCM .......................... 77
Figure 18 Expenditure in healthcare .................................... 82
XIII