eHealth: what is the potential for better integration, delivery and cost effective care across Europe?


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eHealth: what is the potential for better integration, delivery and cost effective care across Europe?. McDaid D. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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eHealth: what is the potential for better integration, delivery and cost effective care across Europe?

  1. 1. eHealth: what is the potential for better integration, delivery and cost effective care across Europe? David McDaid eHealth Week 2010, Barcelona, March 2010 European Observatory on Health Systems and Policies and LSE Health & Social Care, London School of Economics
  2. 2. Structure • Challenges to health care systems in Europe • The potential role of eHealth in better integration and delivery of care • Making an economic case for investment • What do we know? • How can economic incentives be used to aid in the facilitation of eHealth solutions?
  3. 3. Challenges to health care systems
  4. 4. Total health expenditure as % of gross domestic product (GDP) 12 11 Austria Belgium Bulgaria Cyprus 10 Czech Republic Denmark Estonia 9 Finland France Germany 8 Greece Hungary Ireland Italy 7 Latvia Lithuania Luxembourg 6 Malta Netherlands Poland 5 Portugal Romania Slovakia Slovenia 4 Spain Sweden United Kingdom 3 EU 2 1970 1980 1990 2000 2010
  5. 5. Population distribution EU25 1950-2050 Source: European Commission 2008
  6. 6. 77% of disease burden in Europe on Personal Costs non-communicable, often chronic disease Many socio-economic impacts Educational opportunities curtailed Reduced chances of employment Reduced chances of career progression Impacts on families/informal carers
  7. 7. The potential role of eHealth in integration & delivery of care
  8. 8. Integrated care • Shared care: integrated care across primary, secondary and specialist care services • Continuity of care: aided by better integration of care delivery between health and non-health sectors – e.g. social care • Person centred: Provision of services that best meet individual needs • Team orientated: Need for collaborative working relationships, frequent communication, and flexibility of practitioners
  9. 9. eHealth and Integrated care • Shared electronic health records • Electronic messaging systems • Opportunities for iterative dialogue between clients and physicians • Systems to help facilitate rapid access to clinical services • Telehealth applications to help maintain independence and community based living
  10. 10. Hillestad et al , Health Affairs, 2005
  11. 11. Making an economic case for investment
  12. 12. Economics Economics is an important input into decision making process in health policy Resources are not unlimited; economic information can help determine how best to make use of resources but…… Cannot be used in isolation; many other factors (fairness, equity, political concerns etc) influence decision making
  13. 13. Economic questions that can aid decision making • Costs of inaction: What are the economic consequences of not tackling chronic diseases? • Costs of action: What would it cost to intervene by investing in eHealth measures? • Cost-effectiveness of action: What is the balance between what cost to intervene and gains in outcomes, e.g. health status, quality of life etc? • Levers for change: What economic and other incentives can encourage more use of those interventions that are thought to be cost-effective and less use of those interventions which are not?
  14. 14. Making the case So is there an economic case for investment in eHealth to promote better integrated care?
  15. 15. What do we know? • Mixed evidence base and limited cost data • Potential benefits not just to health sector, but to other payers e.g. social care, social welfare • Evidence for interventions in specific settings and targeted at specific population groups – e.g. diabetes, mental health, high risk pregnancy monitoring, heart failure and cardiovascular disease • Focus on return on investment rather than on health related impacts • US dominated: relatively few studies conducted in other settings; relatively little focus on broader implementation context issues
  16. 16. Electronic Health Records • AHRQ systematic review in 2006 • Link between EHR and better performance of providers in 3 US and 1 Dutch Studies • All cost benefit analyses reported substantial savings, but up to 13 years to break even • But conservative: very few studies reported economic benefits from improvements in health outcomes Shekell, Morton & Keeler 2006
  17. 17. Electronic Health Records • Long standing EHR system in primary care practices in Denmark • Admission into hospital automatically triggers notification to primary care services • 50 minutes saved per day in primary care practice, telephone calls to hospitals reduced by 66%, and €2.3 saved per message, of which there are 60 million per year. • The cost of a typical EHR is about €4 (US$6) per patient per year, which includes network connectivity charges Protti & Johansen 2010
  18. 18. Telehealth • Relative paucity of economic evaluations, or even discussion of cost • Focus on cost offset rather than health benefits • Systematic review 1990 – 2007 [Bergmo 2009] • 33 economic evaluations – cost & health outcomes • Inconsistent use of economic evaluation methods; sometimes poorly reported – making comparison difficult • E.g. only 25% looked at costs of lost productivity
  19. 19. The Scottish Telecare Development Programme (TDP) • Country-wide TDP from 2006. • 7900 had telecare packages by March 2008. • Costs avoided of £11 million. – increased speed of discharge from hospital once – clinical need is met, as well as reductions in unplanned hospital and care home – admissions, nights of sleepover care purchased, home check visits and waking – night cover Beale, Sanderson & Kruger 2009
  20. 20. Decision Support Systems • Can, if well implemented, improve prescribing practices, avert costs and promote better health outcomes • Model of cost benefit of DSS within acute hospital in England. [Karnon et al 2008] – Not cost effective if focus solely on health care costs – But highly cost saving – £31 million over 5 years if value of health losses averted included • Guideline driven DSS for blood tests in primary care in Netherlands [Poley et al 2007]. – €670 per practice – development & installation costs – €847 costs from blood tests avoided in 6 months
  21. 21. Facilitating the implementation of cost effective eHealth interventions
  22. 22. Better use of evidence • Better synthesis and marshalling a better of existing evidence from large scale pilots and mainstream implementation - what works, and what context. • Need to strengthen economic case – Estimating full costs of implementation, prospective & retrospective economic analysis, modelling longer term costs and benefits
  23. 23. Changing incentive structures • Tackling barriers to uptake and co-ordination across sectors • Financial incentives to help encourage uptake – E.g. in Denmark physicians and specialists paid for e- mail communications with patients. The fee for e-mail consultations, which are primarily about lab results, is twice that for telephone calls. • (Voluntary) joint budgeting arrangements – remove disincentives to invest across sectors - SOSCAM partnerships in Sweden between employment and health services
  24. 24. Facilitating implementation • Establishing mechanisms for awareness raising, dialogue and exchange of information • National health system integrator e.g. MedCom in Denmark • Pursue process-led innovation – adaptation or re-engineering of organisational flows, involving many professionals, all working for different organisations but coming together to offer one integrated pathway in health and social care to support continuity of care. • Improving the usability and interoperability of technology
  25. 25. In Summary – Potential for eHealth interventions to aid in better integration of care but…… – Need better understanding of evidence and context for implementation – Critical to identify • Costs of implementation • Costs averted • Economic benefits of improved health outcomes – Economic incentives can be used to influence uptake – Look to ensure developments are an integral element of care delivery process
  26. 26. WHO Health Evidence Network Policy Briefs Series on e-health issues 1:3:25 Format Highlight policy challenge Brief review of evidence Sets out policy options indicating strengths and weakness’ Look at ways to facilitate implementation in different contexts and systems across Europe