Germanys experience version 2[1]
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Germanys experience version 2[1] Presentation Transcript

  • 1. Germany’s experiences intackling NCDs in the context of an aging population Prof. Dr. Steffen Flessa Department of Health Care Management University of Greifswald
  • 2. Contents1. Demography and Health2. Strategies3. Conclusion
  • 3. 1. Demography and Health 1.1 Aging: concept• Aging: Aging is a multidimensional process of physical, psychological, and social change over time. aging is not only a question of age – but it has a lot to do with it! Germany: one of the oldest populations in the world!
  • 4. Demographic TransitionRate Germany: Gross brith rate • crude birth rate: 8.8/1000;5% Gross death rate • crude death rate: 9.2 /1000;1% Phase Phase II Phase III Phase IV Phase V time
  • 5. Reason 1: Low Birth Rate 20 18 16 14 12Life Birth per 1000 10 8 6 4 2 0 1950 1960 1970 1980 1990 1998 1999 2000 Year Germany Total Old States New States
  • 6. Reason 2: medical progressLife Expectancy [years] Women [years] Men [years]
  • 7. Consequences: NCDssusceptibility NCD birth 10 20 … 50 60 70 80 time [years]
  • 8. Epidemiological Transition 100Incidence  and  prevalence  [%] 80 60 40 20 0 0 20 40 60 80 100 120 Time  of  Epidemiological  Transition  [year] Incidence,  Infectious  diseases Incidence,  NCD Prevalence,  infectious  diseases Prevalence,  NCD
  • 9. Causes of Death (Men 2007) 56947;  1 5% 19067;  5 % Cardio-­‐Vascular 150472;  3 8% Cancer 21029;  5 % Respiratory Digestive 30219;  8 % Accidents Other 113405;  2 9%http://de.wikipedia.org/w/index.php?title=Datei:Todesursachen_01.svg&filetimestamp=20100227122441#file
  • 10. 1.2 Aging: a blessing• 1514: • 2011 :• 63ys old woman • 77ys old woman
  • 11. „Young old“
  • 12. 1.3 Aging: a curse
  • 13. Health Care Cost and Age
  • 14. Increase of Demand (Western Pomerania, 2005-2020)NCD Increase of DemandHypertension +6.2%Diabetes +21.4%Myocardial infarction +28.3%Stroke +18.0%Osteoperosis +19.5%Dementia +91.1%Cancer (total +22.6%Cancer (rectal) +31.0% Source: Hoffmann 2011
  • 15. 1.4 Example: Dementia • Direct Cost of Dementia in Germany [€ p.c. p.a.] Medical cost ~15% ca. 1.935 € Non-medical cost ~85% (accommodation, counselling etc.) ca. 11.685 €Source: Schulenburg et al. 1998; Jönsson/ Berr 2005.
  • 16. Prognosis • Strongly increasing cost in stages 20.000 18.000 Cost p.a. p.c. [€] 16.000 14.000 Kosten [EUR] 12.000 10.000 8.000 6.000 4.000 2.000 0 Moderate (MMSE 11-15) Mild (MMSE 20-25) Severe (MMSE <= 10) Severity SchweregradSource: Schulenburg et al. 1998; Quentin et al. 2009.
  • 17. 2. Strategies• Overview: – Social Insurance: Long-term Nursing – Training of specialists in geriatrics (doctors, nurses, etc.) – Homes of the elderly und mobile care – Life-long learning of human workforce – Deferred Retirement – Combat infectious diseases – Individualized Medicine und paradigm shift: Multi- Cause-Multi-Effect Paradigm – Strengthen Prevention
  • 18. 2.1 Deferred Retirement 90 80 70population Germany [million] 60 50 40 30 20 10 0 Zeit 1960 1970 1980 1990 1995 2000 2010 2020 2030 2040 time [year] < 20 years 20-<60 years >59 years
  • 19. 70 60 50working populuation 40 30 20 10 0 2000 2010 2020 2030 2040 2050 time [year] 20-35 years 36-50 years 51-65 years
  • 20. 70 60 50 We must keep our key-working populuation 40 agent of production in 30 the process – but this 20 requires investments! 10 0 2000 2010 2020 2030 2040 2050 time [year] 20-35 years 36-50 years 51-65 years
  • 21. Investments in Health• Physical – Focus on Prevention – Fostering health promotion• Mental – Keeping workers creative requires transitional leadership!• Spiritual – A sense of meaning, appreciation and contribution! Aging is not simply a medical problem – it requires a new paradigm of leadership!
  • 22. 2.2 Combat infectious diseases• Old people have more infectious diseases – Sepsis – Pneumonia –…• “Young” old people have new risks: – HIV and Viagra
  • 23. 2.3 Individualized Medicine und paradigm shift• Old patients are multi-morbid – >65: average more than 6 drugs, max. 21 – Side-effects: unpredictable• Treatment depends on many factors: there is no “one-fits-all-medicine” anymore! – Genomics – Proteomics – Metabolomics –…• A new mind-set: Chronic-degenerative diseases require a multi-cause-multi-effect paradigm of medicine!
  • 24. 2.3 Individualized Medicine und paradigm shift• Old patients are multi-morbid – >65: •average more than 6 drugs, max. 21 But: very, very expensive! – Side-effects: unpredictable • Do not use the health care system of• Treatment depends on many factors: there is no any other country as blue-print: it is too “one-fits-all-medicine” anymore! expensive! – GenomicsDevelop your own cost-effective basic – Proteomics package of treating NCD! – Metabolomics Use your ressources as efficient as –… possible!• A new mind-set: Chronic-degenerative diseases require a multi-cause-multi-effect paradigm of medicine!
  • 25. 2.4 Strengthen Prevention 35Share  of  prevention  budget  in  total   30 health  care  budget  [%] 25 20 15 10 5 0 0 20 40 60 80 100 120 Time  of  demographic  transition  [years]
  • 26. 2.4 Strengthen Prevention 35Share  of  prevention  budget  in  total   30 Prevention and Primary health  care  budget  [%] 25 Care are not the “Medicine 20 15 of the Poor” but a very 10 efficient paradigm for 5 aging societies! 0 0 20 40 60 80 100 120 Time  of  demographic  transition  [years]
  • 27. 3. Conclusion• An aging society will induce a higher share of non-communicable diseases.• An aging society is a blessing – but it requires wise planning, political commitment, strong leadership, cost- effective interventions.• Health care financing and social protection are crucial!
  • 28. Germany is gaining experiences with its agingpopulation and their NCDs – can we share insights?