Presentation Title Goes HereHealth Economics in the Ministry of Health

Nanna Skovgaard, Head of DivisionVisit from Belgium

April 20, 2015

“What, how and why” of health economics

Long term structural changes

More value for money

Economicincentives

Coordinated changesin organisational,

physical and technical

infrastructure and capabilities

Promote transparency

Activity

Resources

Results

What wework with

How we do it

Short term Long term

Why wedo it

1. Key figures

2. Expected gains

3. Main areas of change

4. Initial challenges

5. Reshaping the landscape of health

care in Denmark

The Super Hospital Programme

Key figures – budget and number of projectsGovernment

€ 3,6 billion

€ 6 billion budget - 16 building projects

Region of Southern Denmark

North Denmark

Region

Central Denmark

Region

Region Zealand

Capital Region of Denmark

Regions

€ 2,4 billion20 per cent of budget reserved

for investments in ICT and medico-technical devices

Key figures – expectations

Expected developments in hospital activity 2007-2020

- Reduction in average bed days from 3,5 to 2,9

- 50 per cent increase in outpatient treatment

- 20 per cent reduction in number of beds

Key figures – expectations vs. actual developments

4,000

4,500

5,000

5,500

6,000

6,500

7,000

7,500

Nu

mb

er

of

be

ds

Year

Number of beds, 2007-2020

Actual development, 2007-2013

Linear extrapolation of actual development

Initial expected development (-20% 2007-2020)

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

10,000,000

11,000,000

Ou

tpat

ien

ttr

eat

me

nt,

no

. of

case

sYear

Outpatient treatment, 2007-2020

Actual development, 2007-2013

Linear extrapolation of actual development

Intial expected development (+50%, 2007-2020)

Unique patients vs. bed days (2009 = index 100)

80

85

90

95

100

105

110

115

120

2009 2010 2011 2012 2013

Un

iqu

e p

atie

nts

Year

Cancer

Patients

Bed days

80

85

90

95

100

105

110

115

2009 2010 2011 2012 2013

Un

iqu

e p

atie

nts

Year

Cardiovascular diseases

Patients

Bed days

80

85

90

95

100

105

110

2009 2010 2011 2012 2013

Un

iqu

e p

atie

nts

Year

COPD

Patients

Bed days

80

90

100

110

120

130

140

2009 2010 2011 2012 2013

Un

iqu

e p

atie

nts

Year

Type II diabetes

Patients

Bed days

Main areas of change

Three areas of change

- New hospital structure: 50 per cent reduction in number of emergency departments

- New organisation: The specialist in front

- New division of labour in the health care system

Expected gains

We expect improvements in

- Patient flow

- Patient safety

- Efficiency

- Quality

By spending

- more resources on early diagnosis and treatment

- Less resources on hospitalisation

Initial challenges and drivers of change

Initial challenges Actions

Funding dependent on regional commitment to

structural reform

Strict supervisory regime

Efficiency gains as conditionfor approval of project

Closing local hospitals

”Over time, over budget, over and over again”

Secure return on investment

Regions as partners in structural reform

Promotion of innovation

Opportunity to rethinkwhat we do and how

Drivers of change

Expected efficiency gains

% of total efficiency gains

100

80

60

40

20

0

Total for 6 building projects

756

38

16

632

9

72

3

11

4

Optimised patient journeys/length of stay

Logistics/IT

Satisfaction among staff

Patient safety

Centralisation of funktions (not mergers)

Energy and water consumption

Building maintenance

Cleaning

Transport

Mergers

Fewer sites

2

1

3

Optimised patient journeys make up 38% of the total savings

The projects see different efficiency possibilities

65%

20%

15%

% of total efficiency gains

100

80

60

40

20

0

Hvidovre

58

26

16

21

17

17

Gødstrup

158

322

191

Herlev

62

65

214

15

47

20

46

15

8

43

46

Kolding

8

0

Aalborg

15

6

1312

OUH

26

7

157

10

295

10

71

13

Logistics and tracking technology

Electronic registration boards for emergency care in all hospitals

Reshaping the healthcare landscape

- From castles to lighthouses

Telemedicine – an example

Telemedical ulcer assessment: The method

- The nurse photographs the ulcer with her cell phone and mails the image to the doctor.

- The doctor prescribes new treatment or new medication.

- Communication between nurse and doctor is based on a shared web based patient record.

- Positive Business case:

- 30 per cent reduction of healing time

- fewer visits by the municipal nurse

- fewer outpatient visits to the hospital

- 50 per cent reduction in number of amputations

Telemedicine – an example

Telemedical ulcer assessment: The pay-offsPatients:

- High satisfaction

- Less travelling

- Can log on to shared web record, monitor own treatment

Nurses

- High satisfaction

- Improved ulcer care skills from the direct communication with the experts in hospital

Doctors and specialists in hospitals

- Only see the most complicated ulcers

- More exciting jobs, better use of public resources

New eHealth strategy 2013-2017

22 initiatives within 5 focus areas:

1. Better use of e-health systems - ”no more paper” with in hospitals

2. Connected care: Better cross sector cooperation

3. Better use of health data

4. Patient empowerment - treatment at home and patient-centred data

5. Transparency on progress/commitment

Shared Medication Record

• One national database: updated information about prescription medicine for all patients in Denmark

• Access for all doctors, nurses, pharmacists and hospitals.

• Viewing access for citizens (own data)

• Fully implemented in all hospitals and GPs in 2014, all municipalities in 2015

Background:

• Reducing number of medication errors • Better communication about medicine

between all involved parties• Improving quality of the treatment

Use of Shared Medication RecordWorking with transparency – an example

New North Zealand Hospital

Thank you for your attention