1. Paradigm Shift in Healthcare – From Curative Care to Preventive Care Dr. Karl-Jürgen Schmitt Chairman of Task Force Structural Funds, COCIR

2. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 2 In healthcare we have a problem in service delivery not in revenue People are willing to pay for transparent quality (Example: Germany) Expenditures for Cars Expenditures of Compulsory Health Insurance Source: Destatis and DIW 2008 *incl. employers’ share: € 67.5 bln **incl. remidies, additives and dental prothesis € 135 bln* € 179 bln

3. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 3 Prevention is far better than healing The goal of healthcare should be to keep people healthy rather than to fight against acute diseases The results has to be measured, compared and published ‘Adverse Events’ Actual (without ‘Adverse Events‘) Prevention and Early Detection DiagnosisTherapyCare Source: Institute of Medicine, To Err is Human, 1999. Hospital Statistics. Chicago. 1999; RAND study, Sep. 2005 US$ Ideal … every year in the US:  90,000 Deaths  2,000,000 Adverse Events Situation today (without “Accidence’‘) ‘Adverse events’

4. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 4 Prevention means far more than healthy living 1.Prevent medical and medication errors (quality management and transparency) 2.Prevent illness through early diagnoses (screening and risk factors, e.g. breast and colon screening, procam score) 3.Prevent acute cases of chronic patients (screening and monitoring, e.g. diabetic retinopathy screening, chronic heart failure monitoring) 4.Prevent illness through healthy life style (education and life style change)

5. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 5 Patients‘ acceptance of telematic monitoring in % Efficiency regarding clinical and economical aspects % Source: Oberender and Partner, VDE Position paper “TeleMonitoring in der Prävention von Herz-Kreislauf-Erkrankungen”  Better health status  Faster help  Risk reduction  Better care  Higher safety  Less physician contact  Manage anxiety  Hospital stays / year / Pt.  Length of stay  Emergency cases  Hospital stays >3 / year / Pt.  Discharge to admission Hospital costs  Intensive care costs  Medication costs Telematic Services – Great Acceptance and Impact Tele-Monitoring at patients with chronic heart failure

6. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 6 Member States and the EU should cooperate to complete this paradigm shift 1. Healthcare European guidelines for breast screening (Goal: to reduce the mortality of this disease) 2. Education Bologna Process (Goal: to increase competitivnes of European universities) 3. Economic, Social, Enviroment Lisbon Strategy (Goal: to make Europe the most competitive, dynamic and knowledge based region of the world) Light House examples are: Healthcare is the smallest, but most successful initiative in this compilation, adopted in 17 out of 27 Member States

7. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 7 Healthcare as an Economical Factor Healthcare could support the goals of the Lisbon Strategy Europe: Expenses for health: 8.6 % of GDP in EU-15 Employment: around 10 % of European workforce 10% increase in average life expectancy means 0.35% increase of GDP per year* Germany: New Jobs in 2003: 25 000 Start-ups in 1995 – 2002 9 500 (Medical Technology) *Source: Macro-Economics and Health, J. D. Sachs, WHO, 2001

8. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 8 How can we define incentivs for preventive measures, keeping people healthy ?

9. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 9 An integrated approach is necessary to achieve healthy systems EU Health Ministers have to conclude about the framework Care institutions, providers and payers have to make a joint effort defining services, procedures and reimbursement models to keep their clients healthy Clinical pathways have to be defined, committed and followed Transparency of care and quality measurements have to be established Only a competitive healthcare market serves the needs of people Potentially a population based approach is necessary

10. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 10 Let’s throw a glance over the ocean to Kaiser Permanente  Breast cancer screening: 79%  Chlamydia screening in women age 16-25: 64%  Childhood immunizations: 86%  Controlling high blood pressure: 76%  Persistence of beta-blocker treatment after heart attack: 85%  Comprehensive diabetes care, LDL-C screening: 95% Quote: Every unexpected hospital admission is a failure of the system

11. Dr. Karl-Jürgen Schmitt, Screening for Diabetic Retinopathy in Europe, Amsterdam, May 30, 2008, 11 Potentially it is as simple as the fundamental equation in physics 1.Get the Health Ministers to conclude about the framework 2.Define organizations where healthcare providers are becomming drivers of quality and efficiency within their professional and economic interest for the benefit of citizens.