1. EuroHealth Consumer Index Health Consumer Summit Brussels, June 15, 2005 Dr. Arne Björnberg arne.bjornberg@healthpowerhouse.com

2. © 2005-06-13 2 EuroHealth Consumer Index Version 1.0 Why? God did not create the good and bad streaks of European healthcare systems – men did!

3. © 2005-06-13 3 EuroHealth Consumer Index  Created by selecting a number of indicators describing the “user-friendliness” of national healthcare systems  Presents a ranking list of the different national systems  Intended users:  opinions brokers and policy makers like journalists, experts and politicians  gradually; health consumers, healthcare providers, payors and authorities

4. © 2005-06-13 4 EuroHealth Consumer Index, version 1.0 Indicator areas considered and researched  Information to the healthcare consumer  Treatment accessibility  Medical standards and safety  ”System information”  ”Legal position”  ”Risk information” (can patients access information about)  Service/attention  Accessibility

5. © 2005-06-13 5 EuroHealth Consumer Index, version 1.0 Scope  Initially comparing the healthcare systems of twelve states: Belgium, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Spain, Sweden, United Kingdom, and Switzerland ”running outside EU competition”.  A limited number of indicator areas, which in combination can present how the healthcare consumer is being served by the respective systems:  Patient rights and information  Waiting time for treatment  Outcomes (medical quality)  Customer friendliness  Pharmaceuticals

6. © 2005-06-13 6 EuroHealth Consumer Index, version 1.0 Semi-quantitative analysis only  Indata not symmetric for all countries  Multiple data sources superimposed  "Objective hard facts" (statistics, decided policies, regulations, legislation)  "Soft data" (interviews, patient surveys)  Country scores in three grades under each indicator: + (green): good3 points = (amber): intermediate2 points – (red): not-so-good 1 point

7. © 2005-06-13 7 EuroHealth Consumer Index, version 1.0 Area: Patient rights and information IndicatorIndicator threshold values Patients' Rights Law – is there national healthcare legislation clearly based on the rights of the patient? + = Yes = = not really, but there are various kinds of patient charters or similar byelaws – = No Provider catalogue with quality ranking – can patients easily access lists of care providers? + = Yes = = not really, but nice attempts under way – = No Direct access to specialist care – without a referral from a GP + = Yes = = not really, but quite often in reality – = No No-fault malpractice insurance – can patients get compensation without the assistance of the judicial system to prove that medical staff made mistakes? + = Yes = = Fair; > 25% invalidity covered by the state – = No Right to second opinion – for nontrivial conditions + = Yes = = yes, but difficult to access due to bad information, bureaucracy or doctor negativism – = No Access to own medical record – for patient + = Yes = = yes, restricted or with intermediary – = No Access to healthcare in another member state: Country position on “Health care to be treated as a service included in the proposed Service Directive” is used as indicator. + = Yes = = undecided – = No

8. © 2005-06-13 8 EuroHealth Consumer Index, version 1.0 Areas: Waiting times and outcomes IndicatorIndicator threshold values Knee/hip joint replacement operation + = 90% <90 days = = 50-90% <90 days – = > 50% > 90 days Cancer radiation or surgical treatment + = 90% <21 days = = 50-90% <21 days – = > 50% > 21 days Heart bypass/ PTCA; waiting time between diagnosis and surgery + = 90% <90 days = = 50-90% <90 days – = > 50% > 90 days Heart infarct mortality <28 days after hospitalisation + = <18% = = <25% – = >25% Maternal deaths/100 000 live births + = <5 = = <10 – = >10 Breast & colon cancer mortality, arithmetic mean + = <30% = = <35 % – = >35 % MRSA infections; EARSS statistics - % of patients admitted for surgical procedures + = <5% = = <20% – = >20%

9. © 2005-06-13 9 EuroHealth Consumer Index, version 1.0 Areas: Customer friendliness and Pharmaceuticals IndicatorIndicator threshold values Convenience of payment deferral for care not paid for by basic public systems. + = financing an operation as convenient as financing a major capital expense = = financing an operation is available, but with some difficulty – = financing an operation means unattractive debt plans, relying on charity or selling your house Prescription renewal without doctor appointment + = Yes = = yes, but dependent on local conditions/doctor’s temper – = No Web or 24/7 telephone healthcare info + = Yes = = yes, but not generally available – = No Rx subsidy % - share of prescription drug cost borne by public subsidy + = >90% = = 60-90% – =<60% Access to new drugs – average time between registration of new drug, and inclusion in subsidy plan + = >120 days = = <300 days – = >300 days

10. © 2005-06-13 10 EuroHealth Consumer Index Version 1.0

11. © 2005-06-13 11 EuroHealth Consumer Index Version 1.0, cont.

12. © 2005-06-13 12 EuroHealth Consumer Index Lack of European Data Map of the USA, with amputation frequencies per 1,000 Medicare enrollees (65+) with diabetes. Similar statistics for Europe simply not available/accessible

13. © 2005-06-13 13 EuroHealth Consumer Index Lack of European Data Slide from Eur Society of Cardiology – no country identities. Would European healthcare benefit from more of American openness?

14. © 2005-06-13 14 EuroHealth Consumer Index Version 1.0 Results Healthcare systems, traditionally based on pluralistic financing solutions, which do not discriminate between public or private providers, seem to be doing well in a Consumer Index.

15. © 2005-06-13 15 EuroHealth Consumer Index Version 1.0 Compatibility with similar studies 1.Germany 2.Netherlands 3.France 4.Belgium 5.Finland 6.United Kingdom 7.Spain 8.Ireland 9.Luxembourg 10.Sweden 11.Italy 12.Portugal 13.Greece Social Health Insurance Systems in Western Europe, European Observatory on Health Systems and Policies (2004), page 97, (Ortiz et.al.). Based on patient survey methodology. Inequality of ”responsiveness” of healthcare systems

16. © 2005-06-13 16 EuroHealth Consumer Index Version 1.0 Practical usefulness  Inspiration for learning and improvement; a healthcare system which combines:  Dutch customer friendliness  Swedish medical quality  British information services  Estonian reformation speed  etc etc etc would be pretty close to Heaven!