WORKSHOP ON SOCIAL DIALOGUE, The system that makes patients satisfied Recommendations for Poland based on Euro Health Consumer Index 2016 Johan Hjertqvist, HCP Founder and President WORKSHOP ON SOCIAL DIALOGUE, Warsaw, September 11, 2017

What do patients value? A doctor who listens to you, with enough time A doctor who is caring and compassionate A doctor who explains well Convenient and quick access to healthcare Good interaction with other healthcare staff Good outcomes, choice, out of pocket costs etc.

Wealth explains a lot...

...but far from everything!

Doctor access is key

Who decides?

About Health Consumer Powerhouse Comparing healthcare systems performance in 35 countries from a consumer/patient view. Since 2004, +40 index editions, available for free. Index projects financed through unconditional development grants, similar to medical faculty sponsored research. Europe Euro Health Consumer Index 2005, 2006, 2007, 2008, 2009, 2012, 2013, 2014, 2015 Euro Consumer Heart Index 2008, 2016 (2017) Euro Diabetes Care Index 2008, 2014 Euro HIV Index 2009 Euro Patient Empowerment Index 2009 Nordic COPD Index 2010 Tobacco Harm Prevention Index 2011 Euro Headache Index 2011 Euro Hepatitis Index 2012 Euro Vision Scorecard 2013 Euro Pancreatic Cancer Index 2014 Sweden, others Health Consumer Index Sweden 2004, 2005, 2006 Diabetes Care Index Sweden 2006, 2007, 2008 Breast Cancer Index Sweden 2006 Vaccination Index Sweden 2007, 2008 Renal Care Index Sweden 2007, 2008 Smoke Cessation Index Sweden 2008 COPD Index Sweden 2009, Nordic 2010 Advanced Home Care Index Sweden 2010 Euro-Canada Health Consumer Index Canada 2008, 2009 Provincial Health Consumer Index Canada 2008, 2009, 2010 All Hospitals Index Sweden 2011

EHCI: Outcomes heavier than policy

Integration of European healthcare Increasing mobility of people, ideas, services and influences From patient to consumer European Union (EU) – 28 nations, 510 m. inhabitants ”Health is wealth” – economic driver Patients right to crossborder care.

Tomorrow...?

Tomorrow...?

Some EHCI conclusions Overall, European healthcare keeps improving, in spite of financial stress Better survival, access, information Patient involvement a key factor for progress Some countries loosing ground: Poland an alarming example, falling from 27th rank (2007) to 31st (2016), behind Hungary and Serbia The Polish economic growth suggests that money hardly is the real problem HCP diagnosis: “In accute need of a total health systems overhaul”.

What cure? Poland: a mean health system, with long waiting, weak prevention, poor outcomes and lack of patient influence Possible remedy: start by building tools for patient engagement, such as information sharing, navigation support and e-health applications – active patients drive reform Transparency required for measuring performance – will start a dynamic process Can facilitate the necessary radical overhaul.

Liberate healthcare financing/budgeting! 1. Introduce budgeting and management based on performance (DRG's etc), not on costs. 2. Separate decision-making on financing, from decision-making on the operation of healthcare institutions – the latter is unlikely to be done optimally by anybody who ever worked for the Health Insurance Fund for any length of time. 3. Introduce a clear “line of command” in the healthcare provision system – institutions must be protected against micro- management from financing bodies. This is the most important property of Bismarck systems. 4. Eliminate waiting lists: Acquire and implement the FYROM e- referral and e-prescription solution. 5. Open benchmarking: Commission the right institution to produce an easily Internet-accessible Slovenian version of NHS Choices, www.sundhedskvalitet.dk or Slovakian Hospital Web, showing Outcomes data for individual Slovenian clinics.

Learn from proven success! Separate funding and provision Pay for performance Independant clinical management Competition among alternatives Open ranking of clinics and hospitals – performance data Patient satisfaction and views Full access to medical records, second opinion Booking on-line of consultations E-prescriptions Hardly the only solution, but fundamental steps towards curing today´s dire situation If you refuse to reform, don´t use lack of good examples and experience as an excuse.

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