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Naomi chambers: The Techniker Krankenkasse Experience


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Naomi chambers: The Techniker Krankenkasse Experience

  1. 1. The Techniker Krankenkasse ExperienceLessons from a successful German statutory health insurer Naomi Chambers 19 October 2010
  2. 2. Summary• Learning lessons from other healthcare systems: problems & opportunities• Healthcare provision in Germany• Healthcare outcomes in Germany• Characteristics of TK• Weaknesses of the system• Questions for the English & UK NHS
  3. 3. Learning lessons• Path dependency ?• Country specific cultural contexts ?• Uncritical adoption of ‘bright ideas’ ?But…• Commonality of pressures• Convergence of policy responses• Examination of policy options
  4. 4. German healthcare system• Population = 83 million• Oldest statutory health insurance system (1883)• Principles of solidarity and subsidiarity• Mixture of collective & selective contracting• Free choice of providers• Reduction in numbers of sickness funds from >1200 (1992) to < 200 (2010)
  5. 5. Healthcare provision (OECD 2008) Germany UK% GDP 10.5 8.7No of physicians 7.8 5.9(per 1000 population)No of nurses 10.6 9.5(ditto)No of beds 8.2 3.4(per 100k pop)Av length stay 7.6 7.1
  6. 6. Health status and outcomes (OECD 2009) Germany UKLife expectancy 80.0yrs 79.5yrsObesity prevalence 14% 24%Diabetes prevalence 8.9% 3.6%Diabetes admissions 14/ 32/100kAsthma complications 21/ 75/100k
  7. 7. Characteristics of TK• 7.3 million members (10% market)• 11,000 staff• Turnover of 17.6 billion euros• Rated as ‘best’ by German Institute of Quality in Health Care (IQWiG) & Focus Money magazine• Particular strengths: benefits, service & availability
  8. 8. Patient experience of TK• 24/7 phone service• Direct access to outpatient specialists• Some co-payments• Short or no waiting times for elective care• Additional benefits package• Some long waits in GP surgery• Long waits for psychotherapy• No continuous medical record
  9. 9. TK Integrated care contracts• Along care pathways across more than one provider• Enables intensive treatment eg for back pain, mental illness, heart conditions• Results in earlier returns to work thereby saving on sickness benefit
  10. 10. TK data mining• To discover patterns & relationships in morbidity, uptake and quality of care• To predict future demand & regional differences• To carry out predictive modelling to select patients for preventive services ( eg health coaching)
  11. 11. TK customer relations management• 24/7 call centre & medical advice line; 8 million contacts per year• Staff recruited and trained to match diversity of their insurants• First contact solution rate = 82%
  12. 12. Weaknesses of the system• Funds have little control over providers• Some long waits• Weaknesses in primary care• Lack of continuous medical record• Financial risks of over performance• ‘Unfair’ health fund risk-adjustment system
  13. 13. Questions for the NHS• What is the added (financial, clinical, personal) value of GP gatekeeping ?• How much specialist care can we deliver outside hospital?• What are the opportunities for a more customer- oriented approach?• How can we develop stronger incentives to keep patients well?• What are the specific health conditions where German / others performance is better and are we learning from their examples?