Independent living in Germany Tekes iWell

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Independent living in Germany(Tekes iWell)

• Christine Grumbach/Finpro Hamburg
• April, 2002

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Seniors over 60 years in Germany

• Baden-Württemberg (2.295.949)
• Bavaria (2.716.820)
• Berlin (702.754)
• Brandenburg (577.780)
• Bremen (166.550)
• Hamburg (398.061)
• Hesse (1.375.586)
• Mecklenburg-Western Pomerania (387.131)
• Lower Saxony (1.840.978)
• North Rhine-Westphalia (4.198.212)
• Rhineland Palatinate (953.573)
• Saarland (268.608)
• Saxony (953.573)
• Saxony-Anhalt (572.734)
• Schleswig-Holstein (387.131)
• Thuringia (572.734)

23 of the population
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The German social care system
Social Security Code
StatutoryHealth Insurance (SHI)
Occupational Accidence Insurance
Pension Insurance
Unemployment Insurance
Long-term care Insurance(Nursing care
insurance)
Different cost carriers support independent
living
4
Health care organisation
Government(Social Code Book )
Service provider

• Cost carrier
• Different insurers
• Private households
• Public household
• Employer
• Others

• Outpatient
• Doctors (129.000)
• Dentists ( 53.000)
• Paramedical practices
• Pharmacies ( 21.000)
• Nursing care ( 13.000)

• Inpatient
• Hospitals (2.263)
• Rehabilitation clinics (1.400)

Others Rescue services, health trade
establishments, consultant services,
...a significant part of the total social care
5
Spendings for health of different cost carriers
in 1998
67 influenced by the social care structures
6
Spendings 1998 for the different health
performances
In 2001 the spendings have increased up to more
than 250 billion
?
?
?
7
Target market for independent living

• Medical care
• Nursing care
• Personal care
• House care
• Social care
• Consulting

Persons with care need
1.35 million recipients of ambulant care financed
by the long-term care insurance
Products Services
over 3.2 million
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Where are the German grannies today ?(over 65)
Total 12.451.773
Source 2. Altenbericht der Bundesregierung
28.01.98
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Where the German grannies expect to live in
the future?
That stresses the need for Design-for-all
Source BAGSO, Ältere Menschen in Deutschland,
1999, Seite 57
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Players client groups
Seniorsas consumers
Care givers
Care payers
for solutions where the senior decides alone
without anyinfluence of a care giver orcare
payer (e.g. technical aids)

• hospitals, reha clinics
• GPs, health specialists
• all types of nursing homes
• nursing, security, catering consulting
  services
• family, relatives, friends

• social insurances
• municipality

mainly for solutions which makethe care more
efficient and helpto safe money (e.g.
networkingservices, managment tools)
for solutions where the care giver brings the
value add or which make the care services more
efficient(e.g. DMP tools)
Finnish products services
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Needs and wishes of non professional care givers
more support by professional care givers e.g.
day care / short time care (44 )
more practical support by other non professional
care givers e.g. friends, relatives (53 )
structural support for the care by e.g. housing
adaptation, training, technical products (38 )
more appreciation of the nursing care activity,
ideationally and financially (69 )
more medical information and consulting by the
treating physician (25 )
business opportunities
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Trends in elderly care

• more and more seniors want to stay at home as
  long as possible
• government supports the family care by financial
  and structural aids
• Disease Management Programmes (DMP) influence
  mainly the seniors
• professional care providers have to deliver
  better quality for lower prices (competition
  pressure)
• family (private care) will remain the most
  important care giver

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Technology road map - Germany
Lack of payablecare givers
Wish for a self-determined life
Lack of moneyin the social system
Reorganisation ofthe structures
Independentliving
Health Management
CareManagement

Building technologies, sensors, wireless
networks,e-cards, measurement devices, technical
aids, mobility devices
Monitoring, call centres, portals, networking,
e-learning (Most public funded RD projects aim
for a better networking of existing structures)
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ICT and home care
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Road map - Germany
interest
e-cards for patients
Efficient networking of the involved target
groups
high
DMP for chronicdiseases
Care management
medium
low
short term medium long term
time
16
Opportunities for Finnish companies

• large and growing business potential
• existing supply structure
• necessity to overcome old structures
• good reputation of Finnish products and solutions
• Finland offers advanced IT concepts (e.g.
  wireless applications)

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Threats for Finnish companies

• fragmented and complex service structures
• high competition pressure
• high market dynamics
• many financial and personal resources from the
  Finnish partner are needed
• own high tech industry

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The German health care system under construction
Christine Grumbach Finpro Hamburg
19
Spendings 1998 for the different health
performances
In 2001 the spendings have increased up to more
than 250 billion
?
?
?
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The facts today

• Spendings for health position 3
• Overall quality position 25 (using the WHO
  criteria)
• Doctors visits per patient and year 12 (France
  6 Scandinavia 3)
• Live expectance position 11(women) / 10 (men)
• ?
• The German health care system is too
• expensive and inefficient .

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The challenge for the future
Government

• Health Services
• Ambulant physicians
• Physiotherapist
• Care services
• Technical aids
• Pharmacists
• Hospitals
• Rescue services

Health Insurance Companies

• Tools
• Compulsary memberschip
• Budgets
• Service catalogues
• DMP / DRGs
• Quality assurance

Goals far-reaching therapeutical freedom and
individual services for patients
Goals far-reaching cost control to guarantee
qualified services for all insured patients
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The plans for the future

• No obligations for the health insurers to sign a
  contract with a physician
• Less influence of the doctors association (KBV)
• External quality controls for all health service
  providers
• Case related remuneration (Ar-DRGs) in hospitals
• To force Disease Management Programmes (DMP)
• Physician prescribes a pharmaceutical substance
  pharmacist chooses the respective brand
• To establish a prevention law
• No differentiation between basic and additional
  services
• Increase the income limits for compulsary
  insurance

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Disease Management Programmes

• Planned for different chronic diseases (e.g.
  diabetes, asthma, circulatory diseases)
• Family doctor as a disease manager clear
  decision of the leading legal health insurer
  (AOK)
• Diabetes management programmes should be started
  mid of 2002
• Electronic health cards (electronic patient file)
  a prerequisite for DMP

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DMP road map
Health insurersforce DMP
Physicians haveto invest
InformationTechnology
Measurementtechnique
Software
wireless data transmission e-files
management toolse-training
sensors, bio-technology
Most public funded RD projects aim for a better
networking of existing structures
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The new German health care system
2003
Prevention
Treatment
Rehabilitation
Care
...with more influence of the health insurances
(slogan from payer to player)