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7
Plenary Session
TAMAS SZENTES. BUDAPEST
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Development and Future of Health Care Institutional Patient Care Service Structure
Dr. Tamás Szentes Deputy Mayor Budapest Página3
Organiza/onal units of ins/tu/onal pa/ent care
• Doctor (pa/ents are treated by professionals with ini/ally homogenous, later diverse qualifica/ons) spontaneous organiza/on • Ins/tu/on (pa/ent care is provided by professionals with various competences together) • Ins/tu/onal system (ins/tu/ons with diverse competences) • Different ins/tu/ons • Increasing popula/on size • Human resources and technology with different competences Página4
First Phase of the Development of Health Care Ins/tu/ons • It has always been the structure of disease to have the strongest impact on the development of service structure. Un/l the first half of the 20th century, disease structure used to change in a hec/c way, and the majority of diseases that caused mortality were infec/ous diseases, which defined the forma/on of the ins/tu/onal system besides technological development. Apart from this, wars and the spread of urban lifestyle also had an intensive impact on technological development. (Infec/ous diseases, war/me crisis had paved the highway of development.) • Hospital (nurses and doctors) • Forma/on of hospital departments (reasons: infec/ous diseases and pa/ents treated with unified methods have been organized together) • Diverse types of ins/tu/ons (ins/tu/onal development encouraged by mass diseases, eg. the most significant ins/tu/onal development was produced by tuberculosis in Hungary at the beginning of the 20th century) Página5
Second Phase of the Development of Health Care Ins/tu/ons
• As a result of the improved efficiency of an/microbial treatments, as well as the widespread use of vaccines, the number of infec/ous diseases has decreased, consequently the increasing average age is the factor that mostly determines disease structure. • In case of rela/vely homogenous disease structure, structural development is defined by technological development. Página6
Second Phase of the Development of Health Care Ins/tu/ons
• Technological development: Cardiovascular diseases, oncological diseases, musculoskeletal diseases (great number of pa/ents, differen/ated technological needs) Reacts to rare diseases as well Rare diseases or specific rarely-‐used technologies have made the establishment of centrums necessary, thus the popula/on size has also increased on which the system can be organized. Página7
Second Phase of the Development of Health Care Ins/tu/ons
• The organiza/onal level of the system is gradually increasing, the popula/on size on which the system can be ra/onally organized is con/nuously increasing. • The organiza/onal level of the system is becoming gradually higher; in the second half of the 20th century, local community level seemed to be op/mal for the purpose, when the service could be organized for ten or a hundred thousand people; today, this number is above a million and is increasing quickly. • Today, most European countries are s/ll capable of organizing and maintaining their en/re health care system in terms of their own popula/on number; however, the /me will soon come when the establishment of cross-‐border coopera/on and interconnected service systems will be inevitable. • Developmental needs were mostly fulfilled by ins/tu/onal developments and their inner restructuring. Página8
Third Phase of the Development of Health Care Ins/tu/ons
• The development of European health care ins/tu/ons have an es/mated history of two centuries. However, these ins/tu/ons have limited adap/ve capaci/es as opposed to current needs. • Technological development and specializa/on, segmented pa/ent needs, health care system capable of providing service for not only mass but rare diseases, increasing popula/on size on which the system is organized, decreasing or stagna/ng sectoral resources are factors that call for the dras/c transforma/on of the health care system Technological development and specializa/on Segmented pa/ent needs Health care system capable of trea/ng both mass and rare diseases Increasing popula/on size on which the system is organized Decreasing or stagna/ng level of sectoral resources Página9
Third Phase of the Development of Health Care Ins/tu/ons
• Other types of ins/tu/ons are needed than before • We also have to determine the types of ins/tu/ons and their capaci/es to organize the service system • System structure have to be built on new grounds Página10
The Municipality maintains 12 (opera/ng) ins/tu/ons, their budget has reached 100 billion HUF altogether in 2009
Number of beds
772
1 196
9 245
9,6%
2.
Egyesített Szent István és Szent László Hospital
1 787
2 166
22 790
23,6%
3.
Heim Pál Children’s Hospital
537
1 121
5 239
5,4%
1 263
1 644
8 208
8,5%
645
835
4 090
4,2%
12.
III.126
IV.101 XIII.107
II.86
4.
XV.83
5.
7. V.27
VI.38
XII.59
6.
10. 9.
I.26
VII.58 11. 8. XIV.113 3. IX.57
XI.131
VIII.73 1. 2.
XVI.71
X.76
XXI.78
XVIII.99
Jahn Ferenc DélPesti Hospital Károlyi Sándor Hospital
6.
Central Stomatologic Institute
-
147
556
0,6%
7.
Nyírő Gyula Hospital
681
652
3 615
3,8%
1 358
2 016
11 535
12,0%
653
917
6 676
6,9%
1 769
1 965
14 130
14,7%
850
1 252
9 436
9,8%
230
166
855
0,9%
10 545
14 077
96 376
8.
XIX.61
4. XX.65 XXII.53
XVII.84
9.
Péterfy Sándor u. Hospital Szent Imre Hospital
10. XXIII.22
Szent János Kórház és Északbudai Egyesített 11. Hospitals Uzsoki Hospital
Popula/on of districts (thousands)
Principal Share in the Budget Municipality’s (million budget for HUF) healthcare
BajcsyZsilinszky Hospital
1.
5.
Number of patients
12. Visegrád Rehabilitation Specialist Hospital Összesen
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There are several (differently maintained) hospitals opera/ng in the capital city
Hospitals maintained by the Municipality
12.
1.
Bajcsy-Zsilinszky Kórház
15.
Állami Egészségügyi Központ
2.
Egyesített Szent István és Szent László Kórház
16.
Gottsegen György Országos Kardiológiai Intézet
Heim Pál Gyermekkórház
17.
Országos Idegtudományi Intézet
Jáhn Ferenc Dél-Pesti Kórház
18.
Országos Korányi TBC és Pulmonológiai Intézet
Károlyi Sándor Kórház
19.
Országos Onkológiai Intézet
7.
Központi Stomatológiai Intézet
20.
8.
Nyírő Gyula Kórház
Országos Reumatológiai és Fizioterápiás Intézet
9.
Péterfy Sándor u. Kórház
21.
Országos Sportegészségügyi Intézet
22.
Országos Orvosi Rehabilitációs Intézet
23.
Országos Baleseti és Sürgősségi Intézet
3.
5.
4. 5.
26. 14.c 20.
NaConal insCtuCons
• Municipal hospitals
7.
27. 15. 24. 25. 11. 18. 13. 8. 17. 14.a 19. 6. 23. 22. 10. 21. 3. 14.d 1. 16. 9. 14.b 2. 4.
6.
10. Szent Imre Kórház Szent János Kórház és 11. Észak Budai egyesített Kórházai 12. Uzsoki u. Kórház Visegrádi Rehabilitációs Hospitals maintained by the counCes Szakkórház 13. Szent Rókus Kórház Hospitals maintained by universiCes 14.
Semmelweis Egyetem
Hospitals maintained by churches 24.
Bethesda Gyermekkórház
25.
Budai Irgalmas Rend Kórház
26.
Budapesti Szent Ferenc Kórház
27.
MAZSIHISZ
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Direc/ons of developments: Within the unified governance, the professional harmoniza/on and integra/on of Municipality-‐maintained service providers might be reconsidered Omnipotent insCtuCons Pluripotent insCtuCons, (with traumatology providing high-‐level aHendance) acCve aHendance
Premises, which are competent in the field of medical profession, providing emergency abendance Securing the traumatology abendance
Their prime ac/vity is providing elec/ve medical abendance Capable of providing emergency abendance in several fields (except for traumatology)
InsCtuCons providing basic-‐level aHendance
Their prime ac/vity is providing noninvasive elec/ve and chronic abendance medical abendance Principally they provide internist-‐type abendance
Specialist hospitals
Their prime ac/vity is to provide elec/ve abendance Isolated professional abendance Measure-‐economic abendance, specialized professional knowledge
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Omnipotent ins/tu/on Possible par/cipa/ng professions:
Broad professional spectrum High progressivity Jellemzők
High diagnos/c level
Con/nuous emergency abendance
1) SBO1 2) Department of Intensive Care 3) Traumatology 4) General surgery 5) Vascular surgery 6) Orthopedics 7) Burn surgery 8) Neurotraumatology 9) Opera/ve den/stry 10) Toxicology (only in 1 or 2 municipal centres) 11) Urology 12) Obstetrics and gynecology 13) Optometry 14) Otolaryngology 15) Neurology-‐ stroke-‐ neurointensive care 16) Internist care 17) Diagnos/c imaging -‐digital RTG-‐UH -‐CT -‐MR -‐isotope diagnos/cs -‐angiography -‐telemedicina centre 18) Laboratory diagnos/cs 36) Pathology 37) Pa/ent hotel Página14
Pluripotent ins/tu/on Possible par/cipa/ng professions:
Less broad professional spectrum Lower progressivity Jellemzők
Lower-‐level diagnos/cs Emergency care (non-‐con/nuous)
1) SBO 2) Department of Intensive care 3) General surgery 4) Vascular surgery 5) Thoracic surgery 6) Orthopedics 7) Oncology, oncocardiology 8) Urology 9) Obstetrics and gynecology 10) Optometry 11) Otolaryngology 12) General neurology, stroke-‐ neurointensive abendance 13) Internist care -‐cardiology -‐gastroenterology -‐endocrinology -‐diabetology -‐nepfrology -‐angiology 14) Diagnos/c imaging: -‐digital RTG -‐UH -‐CT -‐MR -‐angiography -‐telemedicina centre 15) Laboratory diagnos/cs 16) Pathology
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Ins/tu/ons providing basic-‐level medical abendance Possible par/cipa/ng professions:
Broad professional spectrum Lower progressivity Jellemzők
Basic-‐level diagnos/cs Rehabilita/on
1. Noninvasive internist care: -‐pulmonology -‐endocrinology -‐diabetology -‐nephrology -‐angiology -‐immunology -‐heamatology -‐geriatrics 2. General surgery 3. Obstetrics 4. Neurology (except for stroke abendance) 5. Reumatology 6. Dermatology 7. General neurology 8. Infectology 9. Chronic care 10. Diagnos/c imaging: -‐ RTG -‐ UH 11. Laboratory diagnos/cs:only emergency mini-‐laboratory Página16
Thank you for your attention!
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7
Plenary Session
JUAN ANTONIO BECEIRO FRIEDMAN. GE
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Porto21 World Forum
“A SAÚDE E O BEM-‐ESTAR NA CIDADE”
Juan A Beceiro Friedmann
MarkeCng & Business Development Manager GE Healhcare Spain & Portugal 17 Abril 2013
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¿De qué deberíamos preocuparnos realmente...?
“Probabilidad de muerte– Cualquier causa: 1 de cada 1”
Ictus 1 en 24
Cáncer 1 en 7
Enf. cardiaca 1 en 5
Fuegos artificio 1 en 340,733 Inundaciones 1 en 144,156
Accidentes Vehículos Motor 1 en 84 Suicidios 1 en 119
Terremoto 1 en 117,127
Caídas 1 en 218
Rayo/Tormeta 1 en 79,746
Arma de fuego 1 en 314
Avispa/Abeja 1 en 56,789 Oleada calor 1 en 13,729
Accidente pedestre 1 en 626
Alcohol 1 en 10,048
Ahogados 1 en 1,008 Accidente Moto 1 en 1,020 Incendio/humo Bicicleta 1 en 1,113 1 en 4,919
Electrocución 1 en 9,968 Disparo accidental Arma de fuego Accidente 1 en 5,134 aéreo 1 en 5,051
National Safety Council, datos 2003 Impreso en National Geographic
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Curable/preventable diseases still • 4.7 million people dying annually kill in the EU (2002 WHO) • 56,000, parasitic & infectious diseases • 9,300: tuberculosis • 2,400: diarrhoeal diseases • 158: polio • 91: tetanus • 13,700 maternal & perinatal • 185,000 respiratory infections • 7,270 poor nutrition: 3,404 anaemia • 4.2 million non-communicable diseases • 98,000 diabetes • 2 million: cardiovascular disease • 151,000: emphysema • 20,000: ulcer • 243,858, Injuries: 62,313 self-inflicted, intentional injuries
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What Impacts Health? Examples Education •
By 1960, educa/on increased life by 1.7 years – purely a func/on of educa/on, not /me preferences (e.g., if you have a low ‘discount rate’ over /me you are more likely to invest in educa/on, the benefits for which you will reap far into the future (Lleras-‐ Muney, 2002)
Security •
Environment •
Variations in New Delhi responded statistically to the variations in pollution, if these estimates prove true then a reduction of pollution levels of about one third would reduce deaths by more than 2 percent (Cropper et al., 1997)
Lifestyle •
Taxing cigarebes leads to improved birth outcomes via its effect on smoking behaviours of expectant mothers (Evans and Ringel, 1999) and reduvces infarcts and lung cancer
•
High-‐conflict countries have extremely poor health outcomes, the bulk of which are not related to the conflict themselves, but to disease and malnourishment that come with conflict (Thoms and Ron, 2007)
Healthcare: • 40% of the gains in life expectancy between 1950 and 2000 were due to medical improvements in just two categories: -‐ low weight infant care -‐ cardiovascular disease treatment (Cutler, 2004)
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Reduce ”evitable” Chronic patients
The ticking bomb! Página23
Chronic Disease Management, CDM:
”Approximately 80% of coronary heart disease, up to 90 % of type 2 diabetes, and more than 50 % of all cancer could be prevented through Life-‐style changes, such as proper diet and exercise.”
5.Stampfer, Meir J., Frank B. Hu, JoAnn E. Manson, et al.
6 Hu, Frank B., JoAnn E. Manson, Meir J. Stampfer, et al.
2000. Primary prevention of coronary heart disease in
2001. Diet, lifestyle, and the risk of type 2 diabetes mellitus
women through diet and lifestyle. New England Journal of
in women. New England Journal of Medicine 345(11): 790-
Medicine 343(1): 16-22.
97.
7 Harvard Center for Cancer Prevention. 1996. Harvard
8 Trichopoulos, Dimitrios, Frederick P. Li, David J. Hunter.
report on cancer prevention - volume 1: causes of human
1996. What causes cancer? Scientific American 275:
cancer. Cancer Causes Control 7(Suppl. 1): S3–S59.
80–87.
9 Willett, Walter C., Graham A. Colditz, Nancy E. Mueller.
10 Harvard Center for Cancer Prevention. 1997. Harvard report
1996. Strategies for minimizing cancer risk. Scientific
on cancer prevention - volume 1: prevention of human
American 275: 88–91, 94–95.
cancer. Cancer Causes Control 8 (Suppl. 1): S5-S45.
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Why H ealth 2 020? In the WHO European Region, Health is improving overall but
not as rapidly as it could or should . Countries have different star/ng point, but share common challenges People live longer and have fewer children. People migrate within and between countries, and ciCes grow bigger.
Noncommunicable diseases (NCDs) dominate the disease burden. Depression and heart disease are leading causes of healthy life years lost.
InfecCous diseases, such as HIV and turberculosis (TB) remain a challenge to control. AnCbioCc-‐resistant organisms are emerging.
Health systems face rising costs. Primary health care systems are weak and lack prevenCve services. Public health capaciCes are outdated
The patient will own his own diagnosis and treatment ... community versus hospital Página25
Community Wellness & DI for chronics InterrelaConship between risk factors & chronic diseases
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Healthcare has reached a tipping point Enormous pressure on European governments and healthcare providers to reduce costs – current model is unsustainable given “demographic” shifts Governments looking to improve quality, lower cost, and reduce variation in care … patients want quality and improved coverage Healthcare Sustainability major issue in Europe
New solutions are required
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The Future of Healthcare in Europe What is needed/ desired? 1. 2. 3. 4. • 5. •
Technology Triumphant : 37 %
From nanotechnology to biotechnology & from material science to genomics Healthcare is viewed as a major investment, not a cost
Europe United : 24%
European naCons join forces to create a single pan-‐European healthcare system
Wellness first : 29%
European naCons shij their emphasis from healthcare to health, promoCng well-‐being of naCons
Spotlight on the vulnerable : 4% European na/ons focus their interest on vulnerable members of the society Laissez-‐faire : 5% European na/ons priva/se their en/re healthcare system Taskforce in EU looking at expectations on the healthcare of tomorrow Página28
Broad solutions for healthcare Broad-based Diagnostics
Information Technology
Life Sciences
Diagnostic imaging & Surgery
Integrated admin. & clinical
Discovery tools
Medical Diagnostics
Electronic medical records
Protein & cell sciences
Clinical Systems
Picture Archiving System (PACS)
Clinical tissue biomarkers
Dx Resolution & integration, E-health, Early Health PĂĄgina29 Â
Detect vulnerable asymtomatic people early enough…
MEN
…before symptoms… Página30
Tecnología“más allá de la báscula”, un enfoque cienrfico a la evaluación de la composición corporal Identificar las áreas objetivo
Visualizar los cambios de composición
Motivar cambios en el comportamiento “Me pesé por mi cuenta y vi que había engordado 2 kilos, me disgusté hasta que me di cuenta de que había estado entrenando en el gimnasio y había estado ganando músculo. Ver solo el peso en cifras puede resultar desalentador. Poder ver las mejoras y los cambios reales resultaría muy alentador.” “Me encantaría ver si los cambios que he hecho están modificando mi composición corporal. Si lo que estoy haciendo no ayuda a cambiar mi cuerpo, siempre podría hacer cambios que me permitan obtener mejores resultados.”
Antes de hacer 4 meses después ejercicio Peso: 95,4 kg Peso: 94,9 kg
Opiniones extraídas de la encuesta entre consumidores de 2010 (n=72)
Esta persona /ene el mismo peso pero ha reducido un elevado nivel de grasa transformándola en más masa muscular (de amarillo a verde) Posiblemente ha reducido también los factores de riesgo de enfermedades potenciales relacionadas con la obesidad Página31
Effec/ve Community Medicine in ci/es can change the way we are involved in wellness, preven/on and self-‐care… … as well as the way medicine is delivered more effec/vely for cure and chronics
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Example new service thru Pharmacies
Education, wellness, early detection, therapeutic adherence, … Osteoporosis early detection, CV EKG & Holter remote, Monitored diabetics, Spirometry for pulmonar status … Typology*
Basic Services
Category*
Services (examples of our services)
Custody of drugs
Procurement & control
Developing drugs
Master formulation
Supplying
Active supplying
Pharmaceutical indication
Pharmaceutical advice
Pharmacovigilance
Identification & notification of adverse effects
Healthcare Promotion
Promotion of healthy habits
Prevention and screening
New Services
Therapeutic adherence Pharmacotherapeutical follow-up Cooperation with hospital pharmacy
Alcoholism Prevention prevention & at schools screening Colon Diabetes Methadone cancer maintenance Monitor detection
COPD detection
Osteoporosis Detection
HIV detection
PIX
SPD outpatient
SPD institutionalized patient
Chronic Patient follow up: multimedications
Nutritional advice Smoking prevention & control
Cardiac check and monitor
Therapeutic adherence follow-up on geriatric residences
Antiretroviral of Hospital usage
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Physical inac/vity is endemic and chronic disease could cripple developed health systems
Exercise is cri/cal: sports medicine can contribute, coordinate and sustain these efforts
• Preven/on of disease
• An inac/ve person spends 38% more days in hospital, u/lises 5.5% more GP visits, 13% more specialist services and 12% more nurse visits than an ac/ve individual. • Only 39% of men and 29% of women in the UK meet minimum physical ac/vity recommenda/ons • Regular physical ac/vity is effec/ve in the primary preven/on of chronic disease
• Treatment of disease
• Effec/ve physical ac/vity prescrip/on for all those with chronic disease is a significant challenge • Regular physical ac/vity and increased cardiorespiratory fitness is an effec/ve adjunct for most chronic diseases and prevents the development of co-‐morbidity • Barriers to exercise are compounded by illness
Chronic disease
Effect of exercise therapy
Ischaemic heart disease
35-‐40% reduc/on in risk of event
COPD
Improvement in aerobic fitness, quality of life, symptoms of dyspnoea, CV risk factors 50% reduc/on RR of breast cancer death
Breast cancer Bowel cancer Cerebrovascular disease Diabetes Impaired glucose tolerance Hypertension Depression/anxiety disorders Rheumatoid arthriCs OsteoarthriCs Osteoporosis
Ref: Sport and Exercise Medicine A fresh approach; Natasha S C Jones, Richard Weiler, Kate Hutchings, Matt Stride, Ademola Adejuwon, Polly Baker, Jo Larkin and Stephen Chew
Pregnancy
50% reduc/on in bowel cancer death Improvement of tolerance of cancer treatment Improvement of aerobic capacity, sensorimotor func/on and CV risk factors 42% reduc/on in diabetes related mortality 32% reduc/on in diabetes related complica/ons 42% reduc/on in risk of developing diabetes Reduce systolic BP by 7.4mmHg and diastolic BP by 5.8mmHg Effect as good as standard pharmacological treatments for moderate depression Improved aerobic fitness, disease ac/vity, func/on and QoL Improved aerobic capacity, reduce fa/gue and pain. Improve muscle strength and func/on Reduc/on in risk of falls. Maintenance of BMD in men and postmenopausal women Reduce risk of pregnancy induced diabetes Página34
Physial Excersice as treatment adjuvant Chronics support: control & prevention of co-morbidity
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The Business of Public Wellness & DI Centers
Integrated, Preven/ve, personalized & technological focus
New providing methods
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Exercise/Sport Centers for Chronic Pa/ents Target market Non Complex Chronic PaCents 1-‐ Metabolic & Vascular diseases (Cardiovascular Heart Condi/on): Hypertension (high blood pressure), Obesity, TIA, Diabetes 2-‐ MSK: Osteoporosis, OsteoArthri/s 3 -‐ COPD
Key Benefits for paCents:
Key Benefits for HC System:
• Beber self-‐management • Being conscious • Sport & exercise as mo/vator
• Early Interven/on • Disease Management • Efficient management processes
PaCents Congregated, ‘Controlled’ & Accessible for Behavioural Change Página37
Current Public Healthcare Ini/a/ves Suppor/ng the need of a new model
Euskadi’s Strategy for the development of a Chronic Model, based on 14 proyects: Strategic Projects Popula/on Approach 1.Stra/fica/on and targe/ng the popula/on
Pa/ent Autonomy
Preven/on & Promo/on 2.Interven/ons of the main risk factors (tobacco withdrawal, Healthy Life, elderly care)
3.Selfcare and pa/ent educa/on – ac/ve pa/ent 4. Crea/on of a network of pa/ents and conec/ng them to new technologies like Web 2.0 thru Chronic Pa/ents’ Associa/ons
Ongoing Aben/on
5.Clinical history Unified
Adapted Opera/ons 11. OSAREAN: Mul/channel Center
6. Integrated clinical aben/on
12. Electronic Receipt
7. Development of Subacute Hospitals
13. Chronio Research Center
8. Nursing advanced competences 9. Social Healthcare collabora/on 10. Financing and recruitment
14 – Innova/on from clinical professionals
SM Centers: 12 projects fulfilled in one shot
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Obrigado
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EU Disease: What we also lose Heart Disease: 12,129 years Cancer: 10,273
A healthy year of life
What disease steals=64,356 years annually A year of life with a disease (DALY) Insomnia: 789 years
Psychiatric Disease: 16,024 years Depression: 4,923 years Página40
Our healthcare system…. The founda/on is changing
• Discoveries in bioscience opens new possibiliCes • Human genomics is known • Proteomics: Human Protein Atlas in the make • Biomarkers
• More than 60 % of all drugs has no effect on the prescribed disease or give side effects to the pa/ent (Responders and non-‐responders needs to be iden/fied) • The Digital revoluCon is ongoing • The paCent will own his own diagnosis and treatment • community versus hospital
• Growing lack of healthcare professionals is becoming a limi/ng factor all over the World • Chronic Disease is a Ccking bomb: • ”Approximately 80% of coronary heart disease, • up to 90 % of type 2 diabetes, and more than • 50 % of all cancer could be prevented through • lifestyle changes, such as proper diet and exercise.” **
* Prof. Borlak, Fraunhofer Institute, Hannover, Germany ** IBM Biomarlker Summit Jan 2007 in Nice
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Community Wellness & DI for Chronics Dx, medical supervision & global assesment svcs Pa/ent Flow
GP
Diagnostics
Complex Lab
CHARE 2
Diagnostics
Emergency
Centres
Basic Lab
Specialist Hospital
Emergency
Pa/ent Pathway & Referral
• Pa/ent engagement: engagement in self-‐care & fun • Lab&Imaging Dxs: Detec/on, Dx, and Monitoring svc • Convenient place: sharing experience and educa/on
Discharge Exercise/Sport Center with Dxs for Chronics Exercise/Sport Center Facili/es: trainer & nurses Página42
HC Centers re-‐invented -‐ Care system re-‐designed -‐ Integrated care delivery -‐ Empowered pa/ent
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The Business of Public Wellness & DI Centers
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Current Public Healthcare Ini/a/ves Suppor/ng the need of a new model
Vasc Country Example: The playorm will integrate health care services with Osakidetza’s systems.
The playorm will be integrated with the informa/on systems of Osakidetza and the mul/channel Health center, Osarean It is considered as necessary to enhance Primary Care and nursing model’s roles as coordinators of the healthcare resources and as regulators of pa/ents’ flow generated on the system Organiza/on Model (possibility)
OSAREAN Mul/channel Services’ Center
Chronic Pa/ents’ Playorm
Informa/on Systems
Primary Care
Health Folder New Nursing Models
Emergencies
Healthcare Services
Specialized Services
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Current Public Healthcare Ini/a/ves Suppor/ng the need of a new model
The Chronics’ care model of the Valencian CommuniCy focusses on opCmizing HC services’ Resources thru new technology
Intermediate and low risk chronic pa/ents’
High Risk Chronic Pa/ents
• Consulta/on/home care visits • Diagnos/cs • Treatment • Receipt
Specialized Aben/on • Diagnos/c • Complex Cases Management • Home Care Hospitaliza/on
• Consulta/on/home care visits • Diagnos/cs • Treatment • Receipt
• Educa/on for health • Informa/on and Health Council • Pa/ent Communica/on
Primary Care Technology Playorm
• Inclusion of pa/ents • Chronic diseases’ management • Complex cases tracking
• Administra/ve Procedures (appointment, reminders, electronic receipt…) • Remote clinical management (alerts, followed adherence, access to pa/ents’ events…)
Sharing Electronic Health Records Coordina/on (integrated healthcare services and referrals)
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The trends driving healthcare
Macro-‐economic cost of Obesity Example from Germany
Obesity costs ~€16.3B/year
… Direct and indirect costs of obesity and co-morbidities in Germany, 1998.
Source: The economic benefits of health and prevention in a high income country: the example of Germany, WHO European Office, 2007.
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DIOGO ALARÇÃO. MERCER E MMC
7
Plenary Session
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LUIS PORTELA. BIAL
7
Plenary Session
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Luís Portela
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Esperança de vida à nascença
Média Mundial
Fonte: OECD Health Data 2012. Média mundial: United Nations, Population division.
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Mortalidade infanCl por 1.000 nascimentos
Média Mundial
Fonte: OECD Health Data 2012. Média mundial: United Nations, Population division.
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Medidas restritivas na área da Saúde na Europa
• Exemplos recentes: - Imposição de redução de preços - Preços de referência - Discriminação positiva dos genéricos - Prescrição obrigatória por DCI (denominação comum internacional)
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Porto21 World Forum - Cidades e Desenvolvimento Sustentável A Saúde e o Bem-estar na Cidade
Perda de inovação das empresas farmacêuticas europeias Origem dos novos medicamentos
Fonte: The Pharmaceutical Industry in Figures, 2012 edition, EFPIA. Nota: Cálculo valores anuais com base nos dados quinquenais da Efpia.
2013.04.17
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Porto21 World Forum - Cidades e Desenvolvimento SustentĂĄvel A SaĂşde e o Bem-estar na Cidade
Novos medicamentos introduzidos no mercado, 2003-2012 (1993-2002)
Fontes: IMS e sites das empresas.
2013.04.17
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Soluções para reestimular a I&D na Saúde
• Diminuir o ciclo da I&D - estrutura mais flexível - maior envolvimento das autoridades de Saúde
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Soluções para reestimular a I&D na Saúde
• Diminuir o ciclo da I&D - estrutura mais flexível - maior envolvimento das autoridades de Saúde • Investir em nichos terapêuticos - maior especialização - novas doenças e mercados em expansão
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Soluções para reestimular a I&D na Saúde
• Diminuir o ciclo da I&D - estrutura mais flexível - maior envolvimento das autoridades de Saúde • Investir em nichos terapêuticos - maior especialização - novas doenças e mercados em expansão • Descentralizar a I&D - estruturas internas mais pequenas - parcerias com - Institutos privados de I&D - universidades - outras empresas
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Porto21 World Forum - Cidades e Desenvolvimento SustentĂĄvel A SaĂşde e o Bem-estar na Cidade
From knowledge to market 2013.04.17
74
Evolução das Ciências Biológicas, Médicas e da Saúde em Portugal :: 380 PhDs em ciências biológicas, médicas e da saúde concluídos em 2010.
Fonte: GPEARI / MCTES
:: ~5200 publicações em ciências biológicas, médicas e da saúde em 2010.
Fonte: GPEARI / MCTES
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Universidades com aposta na inovação Instituições de I&D de nível excelente Hospitais com elevado desempenho Empresas com objetivos de globalização 3.000 PhDs > 200 nas empresas
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Exportações em Saúde
(valores em milhões de euros)
não inclui: soluções e-health serviços vendas de empresas portuguesas no exterior
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Para uma área da Saúde mais sustentável
• Parar medidas restritivas / racionalizar • Facilitar o acesso às melhores soluções terapêuticas e à medicina preventiva • Incentivar a inovação envolvendo Universidades, Empresas e Serviços de Saúde • Apoiar o investimento em I&D
Para melhor servir os interesses de Saúde das populações
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luis.portela@bial.com www.bial.com
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SALVADOR DE MELLO. JOSE DE MELLO SAUDE
7
Plenary Session
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A José de Mello Saúde e os principais desafios na prestação de cuidados de saúde nos centros urbanos
Fórum Mundial Porto XXI sobre Cidades e Desenvolvimento Sustentável
Porto, 17 de Abril de 2013
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Agenda 1. Caracterização da José de Mello Saúde e sua oferta 2. Principais objecCvos estratégicos e prioridades da JMS.
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A JMS tem como objec/vo maximizar a capacidade de resposta integrada às necessidades dos clientes Rede saúdecuf
hospitalcuf descobertas hospitalcuf infante santo hospitalcuf Porto clínicacuf alvalade clínicacuf belem clínicacuf cascais clínicacuf torres vedras InsCtutocuf porto Rede de imagiologia
Dr. Campos Costa (14 Sites) Parcerias Público-‐Privadas Hospital de Braga Hospital Vila Franca de Xira
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Em 2012, a JMS teve um crescimento importante e uma melhoria do desempenho económico Capacidade instalada (2012) Camas Salas de Bloco Gabinetes de Consulta Total Colaboradores
1.392 31 422 5.874
Produção assistencial (2012; milhares)
Facturação
Altas/Doentes Saídos
68
Dias de Internamento
376
Consultas
1.439
Urgências
504
Doentes Operados Partos
Resultados económicos (2012E)
EBITDA Resultado Liquido
M€
∆ 2011
462,5
+15%
47,0
+269%
3,3
+199%
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Agenda 1. Caracterização da José de Mello Saúde e sua oferta 2. Principais objecCvos estratégicos e prioridades da JMS
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Os objec/vos estratégicos da José de Mello Saúde estão centrados no crescimento sustentável e na liderança do sector privado • Consolidar a liderança do mercado da prestação privada de cuidados de saúde
ObjecCvos estratégicos JMS
• Assegurar a criação de valor para todos os stakeholders, através de uma poliCca clara de sustentabilidade • Evidenciar a qualidade clínica em linha com os mais elevados standards
• GaranCr um serviço de elevada qualidade a todos os nossos clientes
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que visam reforçar o seu posicionamento de liderança no Conceito de rede associado a uma sector marca forte Níveis de excelência na segurança e qualidade clínica Melhor segmentação para maior personalização e nível de serviço Novas formas de interagir com os clientes Inovação como motor de criação de valor Página88
Prioridades que visam reforçar o posicionamento de liderança no Conceito de rede associado a usector ma marca forte • Aposta na interligação ao nível da prestação de serviços entre hospitais e clínicas • Criação de centros de excelência • Implementação de clínicas satélites com o intuito de serem “centros de proximidade e conveniência”
Níveis de excelência na segurança e qualidade clínica • Evidência da qualidade clínica em programas de benchmark nacionais e internacionais • Certificação e acreditação externa das unidades • Promoção de uma cultura de segurança do doente: • Aposta no registo de declaração de eventos adversos • Implementação de novas pulseiras de identificação • Formação de suporte básico de vida a todos os clínicos • Diversas campanhas de segurança Página89
Prioridades que visam reforçar o posicionamento de liderança no Melhor segmentação para melhor personalização sector e nível de serviço • Desenvolvimento contínuo de ferramentas que nos permitam conhecer mais e melhor os nossos clientes (CRM) • Alargamento e crescente especialização da oferta • Criação do Médico Assistente CUF • Disponibilização de check ups ajustados ao perfil • Criação do Gabinete de Apoio ao Cliente Internacional Novas formas de interagir com os nossos clientes • Criação do portal do médico • Mais e melhor informação aos clientes e seus familiares (SMS cirúrgicos) • Criação de gestores dedicados (gestor oncológico) • Websites mais intuitivos e com mais funcionalidades
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Prioridades que visam reforçar o posicionamento de liderança no sector Inovação como motor de criação de valor • Iden/ficação e desenvolvimento de projectos que permitem es/mular a inovação clínica, operacional e melhorar interacção com cliente, como: • Criação do check in electrónico nas unidades saúdecuf • SMS aos clientes com o tempo de atraso da consulta/exame e o novo horário face a acontecimentos inesperados
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Obrigado Salvador de Mello smmello@josedemello.pt
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WWW.PORTO21WORLDFORUM.ORG
Foro de Soria21 para el Desarrollo Sostenible Paseo de la Castellana 150, 3º D. 28046 MADRID
Tlf. +34 91 458 62 62 E-‐mail: amstdespacho@telefonica.net am@foromundialsoria21.org