Creating a Sustainable, Strategic Health Care System

Elias Mossialos

The Greek paradox I

Low percentage of public expenditure but also high waste Highest percentage of private expenditure in the EU Highest number of doctors, dentists and pharmacies per 1,000 people in the OECD Lowest number of practicing nurses per 1,000 people in the EU

The Greek paradox II

Highest per capita pharmaceutical expenditure in Europe in 2009 High imports (more than 85%), low employment, negligible R&D. Highest growth rate in the world between 2000-2009 (more than 400%)

Highest number of CT scans per 100,000 in the world, (second highest in number of MRI scans)

The Greek paradox III

Highest prevalence of overweight (including obesity) among 15-year-olds in the EU Highest prevalence of smoking in the EU Highest consumption of antibiotics in Europe and highest prevalence of antibiotic resistance (i.e. klebsiella pneumoniae percentage of multidrug resistant K. pneumoniae, MRSA) Second highest number of road fatalities in the EU in 2012 Highest percentage of C-sections in Europe

The Greek paradox Spending more and getting less?

Life expectancy in Greece - OECD raking and (% of GDP spent on health) 1980 6th (6.6%) 1990 4th (7.4%) 2000 12th (9.3%) 2011 13th (10.2%)

as

as

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Number of chronic disorders by age group

Source: Barnett et al. 2012. Lancet 370: 37-43.

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For Savings, Go Where the Money Is

10% of patients account for 65% of costs Focus efforts on patients with highest costs Three part strategy: Primary care/delivery system reform Payment reform Health information technology

Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2009 Annual Mean 1% Expenditure 5% 10% $90,061 22% 45% 50% 65% 97% $40,682 $26,767 $7,978

Case-frequency distribution of chronic diseases by number of comorbidities

High comorbidity

Intermediate comorbidity (1)

Intermediate comorbidity (2) Low comorbidity

Source: Garca-Olmos L, Salvador CH, Alberquilla , Lora D, et al. (2012). PLoS ONE 7(2): e32141.

Practical uses DARTS diabetic study

100 90 80 70

Mortality Post Myocardial Infarction

No Diabetes Diabetes

% alive

60 50 40 0 1 2 3 4
Years Post MI
Diabet Med 2002; 19, 448448-55

Increased Cost of Chronic Disease w/Mental Illness Comorbidity

Chronic Disease Condition Arthritis Asthma Cancer CHF COPD Diabetes % Cost Increase w/Mental Illness 105% 169% 62% 76% 186% 124%

Source: Wyatt Matas-A Healthcare Investment Banking Firm.

Creating a National Plan for Sustainable, Strategic Health Care System

The way forward: structural reforms vs austerity

Depoliticization of the health system Hospital efficiency gains and restructuring Comprehensive pharmaceutical policy National strategy New approaches to primary care organisation Human resources Public-private mix