1. How to empower Polish patients - experience from the Euro Health Consumer Index (EHCI) Johan Hjertqvist Founder & President, HCP Ltd. johan.hjertqvist@healthpowerhouse.com NCQA Conference, Cracow May 23, 2016

2. Healthcare measurement – why? Healthcare is a complex service industry that reacts on rational incentives and measures Efficiency and productivity can be improved, offering better care to more people Measuring performance the key method Open comparisons and benchmarks empower patients, support the profession and provide payers/authorities with reality checks.

3. “We know the Euro Health Consumer Index (EHCI) is today the leading public measurement of how national healthcare systems perform...We have recently learned that the European Commission after assessing various benchmarks has found the EHCI to be the most accurate and reliable comparison". Dr. Vytenini Andriukaitis, 2015 (today the EU health commissioner) Following the HCP example, during 2016 the European Commission will start developing a system to monitor and assess the cost-efficiency of member state health systems In the next step, the aim will be to form and implement a EU best practice and guidelines. The HCP example

4. 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. About Health Consumer Powerhouse Europe Euro Health Consumer Index 2005, 2006, 2007, 2008, 2009, 2012, 2013, 2014, 2015 Euro Consumer Heart Index2008, 2016 Euro Diabetes Care Index 2008, 2014 Euro HIV Index2009 Euro Patient Empowerment Index2009 Nordic COPD Index2010 Tobacco Harm Prevention Index2011 Euro Headache Index2011 Euro Hepatitis Index2012 Euro Vision Scorecard2013 Euro Pancreatic Cancer Index2014 Sweden, others Health Consumer IndexSweden 2004, 2005, 2006 Diabetes Care IndexSweden 2006, 2007, 2008 Breast Cancer IndexSweden 2006 Vaccination IndexSweden 2007, 2008 Renal Care IndexSweden 2007, 2008 Smoke Cessation IndexSweden 2008 COPD IndexSweden 2009, Nordic 2010 Advanced Home Care IndexSweden 2010 Euro-Canada Health Consumer Index Canada 2008, 2009 Provincial Health Consumer IndexCanada 2008, 2009, 2010 All Hospitals IndexSweden 2011

6. Areas covered by EHCI Top country/countries Sub-discipline ScoreMaximum score Netherlands, Norway 1. Patient rights and information 146 150 Belgium, Switzerland 2. Accessibility 225! 225 Iceland, Netherlands, Norway 3. Outcomes 240 250 Finland, Netherlands, Sweden 4. Range and reach of services 144 150 Norway 5. Prevention 113 125 Finland, Germany, Ireland, Netherlands, UK 6. Pharmaceuticals 86 100

7. EHCI: Outcomes heavier than policy

8. The European healthcare performance map The European healthcare performance map

9. The ranking in 2015 Euro Health Consumer Index (EHCI)

12. 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 34th (2015), behind Albania and Serbia The Polish economic growth suggests that money hardly is the real problem HCP recipy: “In acute need of a total health systems overhaul”.

13. savoure@scp-avocats.com

14. 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 – can start dynamic process Can facilitate the necessary radical overhaul.

15. Learn from proven success! Booking on-line of consultations E-prescriptions Full access to medical records, second opinion Open ranking of clinics and hospitals – performance data Patient satisfaction and views Competition among alternatives Together, forming a demanding patient environment, driving transparency, better services and outcomes Hardly the solution, but a first step towards curing today´s dire situation.

16. Thank you! All index information available for free at www.healthpowerhouse.com www.healthpowerhouse.com

17. HCP fundaments Assessing performance and repeatedly publishing the outcomes drives improvement Healthcare is a most complex activity, generally (still) hampered by lack of data Patient/consumer empowerment requires transparency in every field; HCP takes the consumer side Health systems outcomes are more important than plans and policies.