PowerPointPrsentation

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HOW WE ADAPT TO AVAILABLE TECHNOLOGY A EUROPEAN
PROVIDERS VIEW
Buxtehude 06.05.2003
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WHY BOTHER ADAPTING?

• to improve medical diagnosis and therapy
• to become more efficient
• to exploit new reimbursement opportunities
• to enhance market position
• to provide opportunity for clinical research
• to satisfy physicians wishes

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Toys for Boys
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High Tech is fun
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and intriguing
HOW DO WE PAY FOR IT?
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REGULATORY PROCESS
Application for new method/ medical device
Federal Joint Committee
tough pt protection laws - radiation
exposure less malpratice pressure
courtesy Anne-Kathrin Haas, AOK
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TECHNOLOGY AGE
10.400
1.700
10.000
2.500
installed systems 2004
CT systems
MRI systems
lt 5 yrs
5-10 yrs
gt 10 yrs
Source Siemens Medical Solution
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HIGH TECH DISTRIBUTION
South-America
Other countries
Japan
Rest-Europe
USA
Germany
MR-systems/million pop
MR-systems installed
Source Siemens Medical Solutions, 2003
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PUBLIC RD EXPENDITURE
per capita public spending for biomedical research
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MEDICAL DEVICE MANUFACTURERS

• Europe global innovation leader
• Germany leader in Europe
• German manufacturers 2003 Sales 12.5 Billion
• 50 sales with products with market presence lt 2
  yrs
• 8 of sales for RD expenditure

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GERMAN HOSPITALS
Percentage hosp beds 8.8
source Statistisches Bundesamt, 2003
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HOSPITAL REVENUE
IN-PATIENTS
SHI SICKNESS FUNDS 88
OUT-PATIENTS
PHI 12
SELF-PAYERS
Federal Joint Committee
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HOSPITAL FINANCING
State subsidies for building and technology
infrastructure
PHI self-paying out-patients
Self-paying in-patients
PHI in-patients
SHI in-patients negotiated annual budget (SHI
PHI patients) until 12/04 based on nights
spent starting 1/05 based on treated diagnosis
(DRG)
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FINANCING HEALTH SYSTEM
AMBULATORY PHYSICIAN
HOSPITALS
ownership
public corporate
physician
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TECHNOLOGY SUBSIDIES
University Hospital
General Hospital
amb. care physician
Investment for device approved by Fed. Joint
Committee
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GERMAN HEALTH CARE TRENDS

• reimbursement conversion from nights to DRGs
• shortening of in-hospital stay
• definitive one-step diagnosis using high tech at
  outset
• introduction of integrated medical care programs
• better coordination of in- and out-patient
  sectors
• increasing emphasis on electronic patient record
  (tele-medicine)
• enhanced patient awareness
• increasing number of self-payers
• more attention to quality of medical services
• more patient co-payments
• less medical services sought

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THE BUDGET EFFECT
Introduction/Increase of co-payments January 2004
10 fewer in-patient services 15 fewer
out-patient services
until 12/2003 the covered top problem
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WAHT DO WE NEED?
more patient benefit better quality of medical
services more efficient processes better
networking across sectors
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HOW DO WE ADAPT?
Investment in Infrastructure

• new buildings
• new products
• new markets
• new technology

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NEW TECHNOLOGY PET-CT 1 1 3
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PET/CT STAGING
CT- chest
Dx in 3d
CT- abd/pel
Bone Scint.
Brain MRI
CXR



Biopsy

• more patient comfort
• more efficient (faster with less cost)
• more quality (increased accuracy)

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PET/CT IMPLEMENTATION

• DFG quits TA, Fed. Joint Com approves
  device PET/CT still not reimbursable for amb.
  sector
• add. 8 systems in University Hospitals add. 5
  systems in general hospitals
• first installation in physicians office
• first installation in General Hospital
• DFG decides to fund 5 systems
• first system sited by manufacturer in Germany
• first system sited by manufacturer in Europe
• Technology available from manufacturer

1/2005 1/2004 1/2003 6/2002 1/2002 7/2001 1/2001
7/2000
ADAPTATION TOO SLOW
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MR/CT COLONOGRAPHY
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MR/CT COLONOGRAPHY
1/2005 7/2004 1/2004 7/2003 1/2003 6/2002 1/2002 7
/2001 1/2001 7/2000
FAILURE TO ADAPT LACK OF STRUCTURED TA
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NEW PRODUCT MR BODY SCREEN
colon 10 min
RELEVANT FINDINGS IN 17 OF PATIENTS
heart 20 min
brain 15 min
lung 5 min
arteries 10 min
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NEW PRODUCT MR BODY SCREEN

• New Product Whole Body MRI
• part of comprehensive screening program
• cost-effectiveness never evaluated
• in keeping with all laws and regulations
• targets self-paying patients
• private insurances may pay as special benefit
• larger companies offer program as medical
  benefit
• Follow-UP cost born by SHI and PHI
• commercially available at 5 sites in Germany,
  today

GERMANY GOES CALIFONIA
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How do we adapt to available technology?

• spread of technology is governed by
• rationing of investment budgets
• reimbursement rules for SIH pts
• individual providers decision to target new
  markets (self-payers) with new products
• HTA lacks implementation and acceptance
• exception DFG peer review process
• adaptation of investment and reimbursement rules
  is often uncoordinated and too slow
• gt Slow adoption of innovations

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WHAT DO WE NEED TO DO?

• overcome separation of in- and out-patient
  sectors
• same financing system
• structured TA program (like peer review DFG)
• federal institute for Quality Assurance to
  enhance EBM awareness
• more transparency and information for the
  general population

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