Investigacion Biomedica, Bienestar Social y el Valor estrategico del Sistema Nacional de Salud

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Investigacion Biomedica, Bienestar Social y el Valor estrategico del Sistema Nacional de Salud. Bernat Soria i Escoms. Curso de verano Calidad e Innovacion en el SNS (Santander, ago. 2009)

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Investigacion Biomedica, Bienestar Social y el Valor estrategico del Sistema Nacional de Salud

  1. 1. Investigación Biomédica, Bienestar Social y el Valor Estratégico del Sistema Nacional de Salud Universidad Internacional Menéndez Pelayo, 21 Agosto 2009 y , g Bernat Soria, MD, PhD CABIMER (Centro Andaluz de Biología Molecular y Medicina Regenerativa) C/ Américo Vespucio s/n, Isla de la Cartuja, 41092 Sevilla bernat.soria@cabimer.es bernat soria@cabimer es bsoria@msc.es
  2. 2. 1.- Research and the search for a solution of the economical crisis
  3. 3. 1771 “Industrial Revolution agnation n 1829 Steam engine and railways Sta 1875 Steel , Engineering 1908 Oil, cars Oil cars, mass production 1971 Informatics, Computers and Telecommunications Five Technological Revolutions in 230 years
  4. 4. XXth century 1900 2000 Steel St l 1 Computers, Communications Oils, Cars, Mass Production 1908-1918 1908 1918 Depression 30’sand 1rst World War MATURITY 1960-74 Social Crisis MATURITY W 1rst World War cession 1943-59 Social Crisis VietNam War SYNERGY Rec SYNERGY 1920-29 “Belle Epoque” Frenzy development Depre 1987-2000’s (20´s) Frenzy 1908-1920 1971-87 development Birth Financing Regulations Birth “Bretton Woods/Keynes” Welfare /Marshall Mass Production 90’s Informatics 1971 1908 Crash Micro- Ford Model-T 1929 processor ? Intel
  5. 5. Two Phases in a Wave INSTALATION PERIOD SPREAD PERIOD MATURITY Politics R SINERGY Production E Diffusion S E A R C FRENZY H Finance BIRTH Finance “of its own accord” Technology Biased prosperity Bubble Explosion of novelty Decline of the old Time Big-Bang Siguiente big-bang CRASH
  6. 6. 2.- Scientific Research as a value and its impact in society and its values
  7. 7. Value is defined as the degree to which one’s ideas have contributed to knowledge and impacted the thinking of others Evolution of science contributes to social social, Both B th society and i t d political and political, economical economical and legal systems development influence the development of science
  8. 8. Science and Society: towards a new alliance of values Research as a service to society implies p Freedom for Communication with its citizens. development Identify their needs
  9. 9. Science and Society: towards a new alliance of values A global society needs universal access to therapies derived from research Ethics: Service to Economics: mankind Decrease of innovation costs, because of increase of beneficiaries
  10. 10. Aggregated Value of Products Productivity P d ti it = Costs Options: 1. Decrease Costs 2. Increase Value= Innovation However, Innovation Is Not Enough
  11. 11. Investigación Biomédica y Bienestar Social (una relación biunívoca que no siempre se cumple)
  12. 12. RESEARCH IN HEALTH: GUARANTEES WELFARE Increase in R+D+i I i Improvement of welfare I t f lf Concepts NOT always linked
  13. 13. Health Indicators USA SPAIN 1986 2005 1986 2005 Life expectancy Females 78,2 80,4 79,9 83,7 Males 71,2 75,2 73,4 77,0 Infant I f t mortality t lit 10,4 10 4 6,9 69 9,2 92 3,8 38 Deaths/1.000 live births Potential years of life lost y 6.471 4.965 4.968 3.201 All causes <year/100.000 Causes of mortality 261,1 144,6 104,9 77,9 (ischaemic h t di (i h i heart diseases males deaths/100.000)
  14. 14. HEALTH STATUS LIFE EXPECTANCY AT BIRTH Source: Health at a Glance 2007: OECD Indicators
  15. 15. SPAIN NHS: AN EFFICIENT SYSTEM Expenditure Perinatal (aprox)/ Mortality inhabitant i h bit t per year: SPAIN 2.000 $ 4,9 x 1000 (1.300 €) USA 6.000 6 000 $ 6,7 6 7 x 1000 (4.500 €) OECD Health Data 2008.
  16. 16. RESEARCH IN HEALTH: GUARANTEES WELFARE Increase in R+D+i Improvement of welfare Concepts NOT always linked USA NEEDS HEALTH STRUCTURE World N. 1 in R+D+i WHICH TRANSFORMS KNOWLEDGE WELFARE Lacks a good health system Bad health indicators THE NATIONAL HEALTH SYSTEM
  17. 17. 3.- Strategic Value of the National Health System
  18. 18. SPANISH NATIONAL HEALTH SYSTEM SPANISH CONSTITUTION, 1978 General Health Act 1986 NATIONAL HEALTH SYSTEM • Universal Coverage (including immigrants) • Financed through taxes g • “Federal-like” system (17 autonomous regions) • Extensive portfolio of services
  19. 19. UNIVERSAL COVERAGE SOCIAL SECURITY NATIONAL HEALTH Coverage SYSTEM (UNTIL SYSTEM (SINCE 1986) 1986) Insured population All citizens covered (Includes Restricted to active immigrants) employees and their p y families 1986 2006 Primary First 13.091 Primary Healthcare Primary Healthcare Healthcare Centres built Centres
  20. 20. SPANISH NATIONAL HEALTH SYSTEM • I. Among the best in the world • - Ranked 4th among the 19 most developed countries • Health Affairs ( Health Affairs 27: 58-71 (2008);) • -R k d Ranked 6th among 191 countries ti • British Medical Journal (Evans DB & cols. Comparative efficiency of national health systems: cross national econometric analysis. BMJ. 2001 Aug 11;323(7308):307-10) • - Ranked 7th among 191 countries • WHO (World Health Report 2000. Health Systems. Improving performance ) • II. Number one in the world in organ transplantation FIRST IN THE WORLD IN CADAVERIC ORGAN DONATION. SPAIN, EU-27 AND USA , COUNTRIES SPAIN EU-27 USA Population (million inhabitants) 45.2 492.3 303.9 Cadaveric Organ Donor 1,550 8,293 8,089 (Rate –pmp-) (34.4) (16.9) (26.6)
  21. 21. SPANISH NATIONAL HEALTH SYSTEM STRATEGIC VALUE (I) 1. Warrants the state of health of the country's workforce 2. Since healthcare is covered, citizens may take on other economical risks (buying houses etc.) houses, etc ) 3. Provides of direct high-quality employment that cannot high- be delocalised Labour Force Survey: 5.85 % of total employment ( (1,119,200 employees, women > men) y )
  22. 22. SPANISH NATIONAL HEALTH SYSTEM STRATEGIC VALUE (II) 4. Direct source of wealth generation with a Return on Investment Factor (Drag Factor) = 40% 2006 Expenditure €82,064 million → Return €32,825 million 5. Niche for the traditional business fabric's diversification : Biotechnology, Pharmacy Industry, Services and Tourist Industry (our first industry: 60 million visitors/year)
  23. 23. 4.- Spanish NHS: an efficient system
  24. 24. HEALTH EXPENDITURE 2006 82 billion euros billi PUBLIC HEALTH PRIVATE HEALTH EXPENDITURE EXPENDITURE 58,5 billion euros 23,5 billion euros 6.0 % of GDP 2.4% of GDP - Spain: €1,800/inhab. per year ($2,500) - USA: $ $6,000/inhab. per year 8.4% of GDP Source: Ministry of Health and Consumer Affairs. Public Health Expenditure Statistics, 2006
  25. 25. BOTH PUBLIC AND PRIVATE HEALTHCARE CARE CO-EXIST CO EXIST _ ∼ 23,000 M€ FREE PRIVATE HEALTH CARE or - Hospital CONCERTED/CONTRACT - Service - Diagnosis + PUBLIC HEALTH CARE _ PUBLIC ∼ 60,000 M €
  26. 26. SPANISH NATIONAL HEALTH SYSTEM EXTENSIVE BENEFITS Public Health Primary Health Care Specialised Health Care Socio-sanitary Care Emergency Pharmacy Orthoprosthethic devices p Nutritional complements Transport (ambulances)
  27. 27. SPANISH NATIONAL HEALTH SYSTEM EXTENSIVE BENEFITS PRIMARY HEALTH CARE General benefits Specific benefits Family Doctor Women healthcare Paediatrics Children healthcare Nursing Care Emergencies Elderly Dental healthcare (in process-50%)
  28. 28. SPANISH NATIONAL HEALTH SYSTEM EXTENSIVE BENEFITS SPECIALISED HEALTH CARE - Hospitalisation -“Day hospital” - Outpatient Care - Emergencies - Mental Health and Psychiatric Care - Transplants
  29. 29. SPANISH NATIONAL HEALTH SYSTEM 1 million consultations /day 13.091 PC Centres 325 Hospitals 38.913 GPs 112.000 Beds 27.000 Nurses 82.000 Physicians 300 million consultations/year 111.000 Nurses 70 million Consultations/year 4 million Discharges/year
  30. 30. OVERALL SATISFACTION ON THE WAY THE PUBLIC HEALTH SERVICE WORKS (SCALE 1-10) 10) 10 9 8 7 6.1 6.3 6,3 6.0 6,1 rcentage 6,0 6 5 Per 4 3 2 1 2003 2005 2007 Year Source: Ministry of Health and Consumer Affairs. Health System Barometer
  31. 31. PERCEPTION OF CITIZEN. USER SATISFACTION SATISFACTION WITH THE HEALTHCARE SYSTEM, SPAIN 4.4 4,4 0.9 0,9 25.025 Well: 50.5% 50.5 50,5 Fairly well: 19.2% 69.7% 19,2 19.2 Works well though needs changes Works fairly well Needs fundamental changes It's so bad it needs to be redone completely Don't k D 't know / no reply l Year 2007 Source: Ministry of Health and Consumer Affairs Health System Barometer Affairs.
  32. 32. 5.- Quality & Innovation • Health care strategies • e Health e-Health • Key indicators
  33. 33. Back to the future: Quality and Innnovation Strategies 5 GOALS.12 STRATEGIES 189 PROJECTS HEALTH STRATEGIES CLINICAL EXCELLENCE e-HEALTH KNOWLEDGE MANAGEMENT
  34. 34. 6.- 6 Fighting the Crisis a) Innovation • Organ donation & transplantation • Stem Cell therapies • eHealth b) Creating Structures that convert knowledge in wealth and welfare
  35. 35. Spain up to 2004 Restrictions to Research Freedom Legal restrictions Religious, ethical, Religious ethical cultural Lack of budget Rare diseases Orphan drugs
  36. 36. Legislation in force before 2007: insufficient for the development of research •Medicament Act (1990) •Code of Medical Ethics and Deontology OMC (1999) •Guarantees and Rational Use of Medicaments Act (2006) Guarantees •Patient Autonomy Act (2002) •Assisted Reproduction Techniques Acts (35/1998 and 14/2006) •Donation and Use of E b D ti dU f Embryos and Human Foetuses or dH F t their Cells •RD 1301/2006 on Quality and Safety Regulations for Donation, Obtention, Evaluation, Processing, Preservation, Storage and Distribution of Human Cells and Tissues •Several Acts on Organ and Tissue Donation, Extraction and Transplant, and Regenerative Medicine (Act 30/1979, RD 426/1980 RD 411/1996 RD 2070/1999 RD 174/2004 426/1980, 411/1996, 2070/1999,
  37. 37. ACT 14/2007 ON BIOMEDICAL RESEARCH Legal framework regulating biomedical research in Spain Use of human embryonic cells and tissues Invasive procedures Genetic testing Biological samples and biobanks REGULATES: Requirements for donation and use of human embryos and foetuses for research Authorizes nuclear transfer
  38. 38. hESC Nuclear N l Number f N b of Orphan Drugs and Rare Research Transfer Projects Diseases 2004 Forbidden Forbidden 0 2 2008 Allowed Allowed 65 36
  39. 39. RESEARCH •stem cell research •orphan drugs h d •others
  40. 40. NEED FOR THE INTRODUCTION OF ADVANCED THERAPIES •Genetic and oncological diseases Genetic -Gene Therapy •Neurodegenerative diseases •Parkinson’s, ALS -Cellular Therapy Cellular •Alzheimer’s, Friedrich s Ataxia Alzheimer s, Friedrich’s Somatic cells: •Autoimmune diseases Embryonic cells or •Multiple sclerosis Reprogrammed cells (IPS) •Diabetes •Spinal injuries -Tissue Engineering •Burns •Bone reconstruction
  41. 41. STEPS UNDERTAKEN 1. 2008, 1 - 2008 DG for Advanced Therapies and Transplants 2.- Legal regulations Assisted H man Reproduction Act 2006 Human Reprod ction Act, Biomedical Research Act, 2007
  42. 42. STEPS UNDERTAKEN 3.- Non-regulatory actions g y - Training - E l ti Evaluation, A th i ti and R i t Authorization d Registry - Support Office for Independent Research - Creation of the Advanced Therapies European Forum - Development of productive infrastructures (white rooms) 4.-Financing
  43. 43. Seville (Spain) ( p ) Cartuja 93- Scientific and Technological Park
  44. 44. Muchas gracias

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