Euro Health Consumer Index Health Consumer Summit Brussels

Euro. Health Consumer Index Health Consumer Summit Brussels, June 15, 2005 Dr. Arne Björnberg arne. bjornberg@healthpowerhouse. com

Euro. Health Consumer Index Version 1. 0 Why? God did not create the good

Euro. Health Consumer Index 4 Created by selecting a number of indicators describing the “user-friendliness” of national healthcare systems 4 Presents a ranking list of the different national systems 4 Intended users: 4 opinions brokers and policy makers like journalists, experts and politicians 4 gradually; health consumers, healthcare providers, payors and authorities 3 © 2005 -06 -13

Euro. Health Consumer Index, version 1. 0 Indicator areas considered and researched 4 Information to the healthcare consumer 4 Treatment accessibility 4 Medical standards and safety 4 ”System information” 4 ”Legal position” 4 ”Risk information” (can patients access information about) 4 Service/attention 4 Accessibility 4 © 2005 -06 -13

Euro. Health Consumer Index, version 1. 0 Scope 4 Initially comparing the healthcare systems of twelve states: Belgium, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Spain, Sweden, United Kingdom, and Switzerland ”running outside EU competition”. 4 A limited number of indicator areas, which in combination can present how the healthcare consumer is being served by the respective systems: 4 Patient rights and information 4 Waiting time for treatment 4 Outcomes (medical quality) 4 Customer friendliness 4 Pharmaceuticals 5 © 2005 -06 -13

Euro. Health Consumer Index, version 1. 0 Semi-quantitative analysis only 4 Indata not symmetric for all countries 4 Multiple data sources superimposed 4 "Objective hard facts" (statistics, decided policies, regulations, legislation) 4 "Soft data" (interviews, patient surveys) 4 Country scores in three grades under each indicator: + (green): good = (amber): intermediate – (red): not-so-good 6 3 points 2 points 1 point © 2005 -06 -13

Euro. Health Consumer Index, version 1. 0 Area: Patient rights and information Indicator + = Yes = = not really, but there – = No Provider catalogue with quality ranking – can patients easily access lists of care providers? Direct access to specialist care – without a referral from a GP + = Yes = = not really, but nice – = No + = Yes = = not really, but – = No No-fault malpractice insurance – can patients get compensation without the assistance of the judicial system to prove that medical staff made mistakes? + = Yes = = Fair; > 25% – = No Right to second opinion – for nontrivial conditions + = Yes = = yes, but difficult to – = No Access to own medical record – for patient + = Yes = = yes, restricted or – = No Access to healthcare in another member state: Country position on “Health care to be treated as a service included in the proposed Service Directive” is used as indicator. + = Yes = = undecided – = No Patients' Rights Law – is there national healthcare legislation clearly based on the rights of the patient? 7 Indicator threshold values are various kinds of patient charters or similar byelaws attempts under way quite often in reality invalidity covered by the state access due to bad information, bureaucracy or doctor negativism with intermediary © 2005 -06 -13

Euro. Health Consumer Index, version 1. 0 Areas: Waiting times and outcomes Indicator Knee/hip joint replacement operation + = 90% <90 days = = 50 -90% <90 Cancer radiation or surgical treatment + = 90% <21 days = = 50 -90% <21 Heart bypass/ PTCA; waiting time between diagnosis and surgery + = 90% <90 days = = 50 -90% <90 Heart infarct mortality <28 days after hospitalisation days – = > 50% > 90 days – = > 50% > 21 days – = > 50% > 90 days + = <18% = = <25% – = >25% Maternal deaths/100 000 live births + = <5 = = <10 – = >10 Breast & colon cancer mortality, arithmetic mean + = <30% = = <35 % – = >35 % MRSA infections; EARSS + = <5% = = <20% – = >20% statistics - % of patients admitted for surgical procedures 8 Indicator threshold values © 2005 -06 -13

Euro. Health Consumer Index, version 1. 0 Areas: Customer friendliness and Pharmaceuticals Indicator Convenience of payment deferral for care not paid for by basic public systems. + = financing an = = financing an – = financing an Prescription renewal without doctor appointment + = Yes = = yes, but – = No Web or 24/7 telephone healthcare info + = Yes Rx subsidy % - share of prescription drug cost borne by public subsidy + = >90% Access to new drugs – + = >120 days = = <300 days – = >300 days average time between registration of new drug, and inclusion in subsidy plan 9 Indicator threshold values operation as convenient as financing a major capital expense operation is available, but with some difficulty operation means unattractive debt plans, relying on charity or selling your house dependent on local conditions/doctor’s temper = = yes, but not – = No generally available = = 60 -90% – =<60% © 2005 -06 -13

Euro. Health Consumer Index Version 1. 0 10 © 2005 -06 -13

Euro. Health Consumer Index Version 1. 0, cont. 11 © 2005 -06 -13

Euro. Health Consumer Index Lack of European Data Map of the USA, with amputation frequencies per 1, 000 Medicare enrollees (65+) with diabetes. Similar statistics for Europe simply not available/accessible 12 © 2005 -06 -13

Euro. Health Consumer Index Lack of European Data Slide from Eur Society of Cardiology

Euro. Health Consumer Index Version 1. 0 Results Healthcare systems, traditionally based on pluralistic financing solutions, which do not discriminate between public or private providers, seem to be doing well in a Consumer Index. 14 © 2005 -06 -13

Euro. Health Consumer Index Version 1. 0 Compatibility with similar studies Inequality of ”responsiveness” of healthcare systems 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Germany Netherlands France Belgium Finland United Kingdom Spain Ireland Luxembourg Sweden Italy Portugal Greece Social Health Insurance Systems in Western Europe, European Observatory on Health Systems and Policies (2004), page 97, (Ortiz et. al. ). Based on patient survey methodology. 15 © 2005 -06 -13

Euro. Health Consumer Index Version 1. 0 Practical usefulness 4 Inspiration for learning and improvement; a healthcare system which combines: 4 Dutch customer friendliness 4 Swedish medical quality 4 British information services 4 Estonian reformation speed 4 etc etc would be pretty close to Heaven! 16 © 2005 -06 -13