Germanys experience version 2[1]

574 views

Published on

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
574
On SlideShare
0
From Embeds
0
Number of Embeds
91
Actions
Shares
0
Downloads
10
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Germanys experience version 2[1]

  1. 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. 2. Contents1. Demography and Health2. Strategies3. Conclusion
  3. 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. 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. 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. 6. Reason 2: medical progressLife Expectancy [years] Women [years] Men [years]
  7. 7. Consequences: NCDssusceptibility NCD birth 10 20 … 50 60 70 80 time [years]
  8. 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. 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. 10. 1.2 Aging: a blessing• 1514: • 2011 :• 63ys old woman • 77ys old woman
  11. 11. „Young old“
  12. 12. 1.3 Aging: a curse
  13. 13. Health Care Cost and Age
  14. 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. 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. 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. 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. 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. 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. 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. 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. 22. 2.2 Combat infectious diseases• Old people have more infectious diseases – Sepsis – Pneumonia –…• “Young” old people have new risks: – HIV and Viagra
  23. 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. 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. 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. 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. 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. 28. Germany is gaining experiences with its agingpopulation and their NCDs – can we share insights?

×