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Archive for WHCC Europe



Jack Lord on consumer engagement

by Lloyd Davis

Jack Lord, Humana Inc.Background: CEO, Humana Inc., USA
Theme: Consumer Engagement: A Model for Shared Decision-making
A US insurer’s perspective on reform in commissioning in the UK NHS

The challenge: achieving financial balance while delivering national targets.

Commissioning ensures that the NHS provides equity, choice, information transparency, and optimal care pathways within resources allotted. Commissioning depends on assessing providers, managing them, recruiting, capability, fostering local partnerships, and ensuring a system of accountability, so that people know that the monies they raise through taxes actually go towards what they want in the health system.

We’ve made data more available and improved links between health professionals. Allows for real time multi-payer services.

In engaging consumers we take the role of a cultural anthropologist to understand people first rather than getting people to understand us. For example, an emblem of the health care system is the hospital gown - no consumer-oriented operation would create it.

I have a USB device that tracks all of my activities - it’s a sort of “frequent flyer” program that provides incentives for people for what they do for their health. What we recognize is that health is co-created, not something that doctors do to patients. We also want to make things fun - traditionally we tell people what they shouldn’t do, don’t want to hear, prod, probe them, and make them wait for hours, and never make anything fun or engaging. If we’re really going to work on these things we have to truly engage them rather than just giving them information.

We’ve also focused on using information for predictive modeling - looking for predictive signals that you’re at risk for a heart attack and seeing what we can do to prevent that.

We did work with families doing diaries and this helps us to give them back information in a useful way. Everyone gets a statement from their bank often with suggestions of how you could improve your financial health, but you don’t get something like that from the health system - we’re starting to that with our “smart summary”.

Taking this to the UK means blending the best of both worlds, understanding the local culture and what’s important to people so that you can better engage with them. At the end of the day it’s in order to positively influence health inflation.

Q: Providing information back to the patient is very interesting - how are patients reacting?
A: We’ve approached it by saying you should have equal symmetric information. One of the problems in the U.S. is that no one doctor knows what other doctors have done. We give people a card so so they can see all of the medications they’ve been prescribed. It’s made practice easier especially with over-65-year-olds who are generally on 5+ medications.

Q: How do you measure the impact?
A: Our #1 focus is compliance with medication - we’ve seen a 12% increase since we’ve provided messages as well as statements. And now we’re also thinking of financial incentives.

Q: Who will drive the uptake of wellness programs in the U.S.?
A: We the health insurers are responsible for everything. We believe that more activity means more health and so we’re trying hard to get people over 65 active and promoting fitness clubs. It’s in our interest over time to have healthy people. We’ve just started a brain gym too and that is having a positive effect too.

Q: How do we have to change the payment systems to support preventive care?
A: You have to have a vision and culture that is focused on health as opposed to illness. Our industry has developed differently so we don’t always have good systems for looking after health. It’s not a bureaucratic change as much as a cultural change. If you take an ecologist’s view, we have the levers inside of our systems but we have to work out which ones work and we have to celebrate diversity and engage with people differently accordingly - remember that consumers are people too.



John de Zulueta on the balance of public & private provision

by Lloyd Davis

John de Zulueta, SanitasJohn is Chairman, Sanitas, the Spanish arm of the BUPA Group, Britains largest private healthcare provider.

Theme: Balancing State and Private Contributions in European Healthcare Systems

I’ve been in the health business for 16 years - this is my penance for selling fast food snacks and soft drinks earlier in my career :)

If you look at an ideal health system, you want low cost, high quality and easy access and if you can do all three you’re doing well. Spain is good at cost and quality but access isn’t easy, they have crowding and waiting lists.

When Spain reached a population of 40m all predictions were that it would reduce, but now thanks to immigration, particularly in the last five years it’s gone up to 44m. We have universal coverage for people who live here, provided by 17 autonomous regions. Catalonia, where we are today was one of the earliest and so one of the most developed but still services are characterised by budget deficits and patient dissatisfaction.

We offer complementary services - eg adult dental care or IVF where the public services can’t or won’t provide but we also play a substitute roles where public services are farming out their services to private provders. In Spain we have the equivalent of PFI (Private Finance Initiative) both in terms of construction of a hospital, or as in the Valencia model the private provision of the core clinical practice. 7 new hospitals are being built this way in Madrid and others in the Balearics. Valencia is doing PPP in 5 hospitals and 1 such hospital is coming in Madrid.

Our investement so far is 144m euros and we expect an 80m euro per year turnover or 1,200m over 15 years. The challenge for us is that we are responsible for *all* the medical care.

We have oportunities in long term care too. In long term care, public and private have been working together since the start. Most nursing homes are privately owned and managed with a 60:40 ratio of private to public funding, although public funding is set to increase soon.

There’s a range of ways to cooperate with the public system.

Direct management of publically owned care homes.
Private ownership, private management, public offer
An allocation of a quota of publically funded beds within a private home
PFI project to build and manage for the provincial government.

I believe there’s quite a potential for us to work as partners with the public system. Because we can do things cheaper, because we control our costs and are willing to work with a capitative price. Theres been more interest in conservative-controlled areas, but it’s increasing in all the regions because the advantages are so clear.

Q: I’ve had responsibility for PPP and one difficult thing is service levels - who sets the clinical criteria by which you decide, say, how many transplants get done (or not)?
A: We haven’t really started on that battle yet as we’re just starting building. But it’s a joint decision. In the ones that are operating there is a dialogue - if we don’t have capacity then sometimes it will be picked up by public but occasionally, we will lose money and then we cry :(

Q: How does a public system deal with profits or gains in productivity.
A: Profits are capped, so gains in productivity are immediate for the public purse. They allow us a certain margin but above that it goes back to them.

Q: Why was it necessary for this mix of public and private? (Why not just private?)
A: It’s a political objection, since it’s based on universal coverage and politicians are very unwilling to give the whole pie away because privatising the public system is a vote-loser.



Jennifer Dixon on predicting risk of emergency admission

by Lloyd Davis

Jennifer is Director, Health Policy at the King’s Fund in the UK and is a board member of both the Audit Commission and the Healthcare Commission

Theme: risk segmentation and identifying populations at risk

We want to reduce preventable admissions, particularly among older people. There’s been a lot of guidance from NICE and elswhere and there have been funds for interventions. Meanwhile commissioners have been mandated to employ community matrons to carry out case management (though we’re not sure on what evidence this decision was made!)

So what we saw a real need for was a way to identify high risk, high cost patients and intervene before they got to a point of crisis.

We set up a project to find ways of predicting future high-risk patients. We did a literature review, confirming that the clinician’s hunch is probably not the most robust method of prediction, the best ways are statistical.

So we developed a first predictive model using inpatient data which we then developed using multiple sources.

Our model known as PARR uses HES and census data. We took two approaches: PARR1 focusing on emergency admissions for avoidable conditions (CHF, COPD, Diabetes, CAD, Sickle cell etc) that often lead to re-hospitalisation and then a second approach, PARR2 to broaden that to prevent emergency admissions.

We used statistical techniques to come up with a risk score from 0 to 100 (where 100 is certainty of admission). We took 5 years of data looking at year 4 we looked back at the previous 3 years and then correlated that data with actual admission in year 5.

No model works with 100% certainty but we were pleased to see that the proportion of false positives reduces at higher risk levels.

Not surprisingly we found that the high risk group contained a high preponderance of people over 75 and people from ethnic groups and a high proportion of people with chronic illness.

We’ve built an interactive tool now that you can use it in real-time so we’re suggesting to commissioners that they identify high-risk patients and interview them to find out why they have been admitted and then working with patients and their families to design a better intervention. We’re also encouraging PCTs to build evaluation methods into their adoption of the tool. The tool is freely available and downloadable from the internet. At least half of English PCTs are now using it

The final phase is to try to improve the model by adding in other data about individuals - eg A&E GP, Pharmacy and Outpatient activities

We looked at half a million patients from two PCTs, we split the sample to test, using logistic regression to model the predictive factors using 850 variables. With this one we just looked at the previous 2 years data.

This approach does identifiy new patients who had had no prior admission, so adding more data improves the prediction. It’s better but we have to consider whether it’s worth the cost of linking the data.

The highest risk patients have 20 times the average admissions and 24 times the average of emergency bed days so if you target your interventions lower down the pyramid you can make more of an impact than with the highest risk. We recommend that you don’t just focus on high risk patients.

The model also allows you to include your costs, so that you can predict savings and look for the most cost-effective risk management strategies.

PARR is now used across the country and the combined model is in a smaller number of PCTs because it’s so data intensive. The interventions are currently being evaluated. PARR is of growing usefulness for commissioners and regulators and we’re now looking at risk-adjusted person-based resource allocation which until now in the UK we’ve not been able to do.

Read more about this project on the King’s Fund website.

Here’s Jennifer talking to me between walking off stage and dashing to the airport, putting the project in a nutshell: http://www.worldhealthcareblog.org/lloydd/whcc-dixon.wmv

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Dr Hans Jürgen Ahrens on responsiblity and solidarity

by Lloyd Davis

Dr. Ahrens is Chairman, AOK-Bundesverband, Germany
Theme: The Mature Patient: Between Personal Responsibility and Solidarity

We have already discussed that the health system in Germany is in a major period of reform, but in spite of this we have to determine what the health service is and where the balance of solidarity and responsibility have a place.

Solidarity is one of the pillars of our healthcare system - it is a fact that we have the healthy taking care of the ill and rich taking on the expenses of the poor. This is a basic principle for us. In this morning’s reform the goal is to find a balance between what the community should be doing and what individuals are responsible for.

We don’t have a state system but we don’t have a private system either. It’s a system where everyone together has to find agreement on how much solidarity.

We need to ensure that financial support goes where it is needed. And if we take solidarity as a pillar, then everyone has to take responsibility in the risk structure for making it all work. We also have the right to make better use of spaces provided for by this new law which just went into effect. We think that competence can’t be restricted to 10% of the population. Solidarity is irreplaceable, it needs to be cared for and maintained and that’s the responsibility of everyone.

Responsibility is only considered as financial involvement, but it means more - taking on a personal responsibility for your actions and behaviors. One idea: beginning to employ bonuses and premiums. Our budget is 3,200 millon Euros per year so we have lots of leverage to influence people’s behavior. Bonuses can have unintended consequences. Insured parties have to take on some costs, e.g. over-the-counter medicines. Yesterday we talked about who had to pay what, but now we have a contribution of 9% which should help us to reduce the costs. We have seen that co-payments lead to a reduced number of visits - they make patients think twice. Of course, patients shouldn’t get to the point that they don’t see a doctor because they can’t afford it - this would be contrary to what we’re doing.

Personal responsibility must also try to underwrite private insurance for things that require a particular hospital or therapy. So now thanks to this new law there has been an increase in the personal responsibility. Asking people to do something is worthless if they don’t see the benefit. We offer different rates - if you’re willing to do something for your health, exercise, and you pay part of the costs, we can offer you a special price rate which may be up to one month’s payment. The reform has the advantage that we now have a greater playing field or margin to offer different incentives and price rates so we see that by doing this we also generate greater selection and choice but also that people need to be better informed in order to make that choice. That’s why we have an independent consulting department that offers information and transparency regarding quality - there are some competitive restrictions, but we can say A has X number of operations and B has Y - we can’t say yet, but we want to, that 10 out of X didn’t work. We think this is important.

We’re also looking at what the rights are of individuals against the rights of unions and associations.

We have different programs for disease management that we offer because we think it gives us the possibility of bringing more benefits and promoting competition.

We’ve seen that the personal situation of the patient improves if the patients feel better informed. Physicians also think, according to our surverys, that they are more able to influence patients and to care about them. I’ve seen that not only are subjective criteria important but objective studies are important too. We see that the training that we do is positive -patients feel that they are subjects that are given something, but we help promote their responsibility.

We also pay attention to self care. Not only do we have demographic problems like everyone else. When we looked at the physical state of children, we saw their ability is reduced 10-15%. Imagine what will happen to the German football team! We are concerned about this, but generations to come will not support these projects and will create a long term problem.

I think the most important thing is financial support and incentives. We have to think of how we can continue along this path of providing support and incentives. This probably involves private insurance. Do we go for public or private? What we say is that expenditure in recent years increased 67% and for private 122% because they were not able to control their costs.

We have also seen that we shouldn’t go for state solutions alone. I do think that we’ll be able to broaden this and carry on the road to a better balance betwwen personal responsibility and solidarity but we need information and transparency and competition which enables us to stand out from the rest.

Solidarity and Responsibility may seem contradictory, but we have to find this balance.

Questions

Q: You have a market share of 40% while others have a share of 10% and it’s becoming more and more difficult to get in. Traditionally AOK is 10% cheaper than others. There are extremely high statutory differences and that’s the reason for your success.
A: You’re right of course… I have no problem with the fact that some pay more and so they’re supporting the systems. I’m against treating a patient worse in public service than through private insurance.

Q: How do you ensure the principle of universal coverage is maintained for people who can’t afford co-payments?
We’ve got certain limits on co-payments of 2% and on the other hand, in the case of chronic patients, there’s an additional reduction of co-payments and some don’t pay any at all.



Peter Gilroy talks about tele-health in Kent

by Lloyd Davis

I caught a moment with Peter Gilroy after he spoke to get a brief description of his tele-healthcare project in Kent, but also to find out what he thought of the conference as a whole.

Download:
http://www.worldhealthcareblog.org/lloydd/whcc-pgilroy.wmv

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icon for podpress  Peter Gilroy talks about tele-health in Kent [1:21m]: Play Now | Play in Popup | Download (131)


Franz Knieps on disease management programmes

by Lloyd Davis

Background: Director General for Public Health Care, Health Insurance and Long Term Care Insurance,
Federal Ministry of Health Germany
Theme: Role of disease management programmes in overall health care reform

We’re having a difficult time in Germany but today’s a good day as we’ve just had our reforms signed off by the president.

Principles
Universal coverage for nearly everyone; in the new system no-one will be excluded.
Wide ranging benefit package; a lot of doubt that everything offered is medically necessary
Free access and consumer choice; you can have the provider you like, no referral required
Pluralism and competition; public and private
Power sharing between government and self administration
Balance between solidarity and self responsiblity is shifting towards strengthening patients
Decentralization; the federal level is the law maker, but everything is managed at a local level.

We’ve had social health insurance for 90% of the poulation where the rich pay for the poor, the healthy pay for the sick, singles pay for the families and the young pay for the elderly. And private insurance for 10% of population - the self eimployed, civil servants, and high income individuals - based on risk-related premiums offered by some 40 private companies.

It’s a pluralistic health care delivery system employing 4.3 million people - the financial resource allocation system is very complicated which means that co-operation often suffers.

There’s a complex organizational framework - state authorities are weak, with the regulation done by associations of providers, professions, funds, and companies. The power of patients and users within the framework is expanding, combining decision making with empowerment. And competition is growing - every one says they support it but in practice, they don’t like it.

The primary challenges: the disintegration of care separation between ambulatory and hospital care, medical, social and nursing care, the lack of communication, coordination cooperation, and a lack of incentives promoting managed care. We put our focus on acute care, disregarding chronic care - the medical view dominates and there is a lack of case of care mangement - it’s not evidence based, but eminence based. Also, risk selection by funds and providers; variations in the quality of care, which gets shrugged off; overuse and undersupply especially in rural areas where most of the elderly live; regulation and bureaucracy - detailed laws that don’t suit healthcare well; lack of transparency - patients don’t get to know anything about the quality of their doctors or hospitals; resistance to change.

Challenges that face us as everyone - aging population and more chronic disease, a lack of human resources, cost containment leading to priority setting and rationing, finding complementary funding sources and investing in the management of care and diseases.

The first attempts in Disease Management programmes were made by regional funds in early 90s, using experience from the former East Germany and the US. The lack of financial incentives led to little progress, with doctors calling it “cook book” medicine. Which led to a state of uncertainty for doctors and patients. A fundamental change happened in 2001 when we introduced a real link between managed care and redistribution of sicknss fund revenues - funds then became increasingly interested. This act also defined categories for risk adjustment.

Some of the criticisms and needs:
Link to risk structure compensation scheme - risk of incentives for doctors to enroll healthy people.
Data protection concerns - we’ve since satisfied the data commissioner
Additional monetary input
Uniform requirements for accreditation and documentation
Focus on ambulatory care

The Future
We’ll include more diseases and address consideration of multi-morbidity. We’ll link with new models of population-oriented and integrated care across the U.S. and Europe. And we want to look at the evaluation results to improve quality, involve patients more, and reflect on evidence-based medicine so that disease management programmes are an important step to evidence-based health policy and improvement across Europe.



Cor Spreeuwenberg on models of care

by Lloyd Davis

Bio: Dean, Faculty of Health Sciences, Professor, Department of Integrated Care, University Maastricht, Netherlands
Theme: Developing a care model for disease management in Europe

We’ve been discussing the growing number of people with chronic diseases, but i want to focus on morbidity, lifestyle changes, prevention of complications, and changing the role of people with chronic diseases.

The four models to be considered:
Integrated Care
Chronic Care Mode
Kaiser Permanente Model
Disease Management

People are asking whether we can use these in Europe and whether we can work to have one european model and I say we don’t need one.

Integrated Care
Bringing together inputs management and organization together with diagnosis, treatment, rehab and health promotion with an aim at improving services. It’s really the integration of content and structure. We deliver care, but we can’t do that if we don’t pay attention to expertise, infrastructure, academic research and QA.

The Chronic Care Model
Focuses not on patient satisfaction but on functional and clinical outcomes, interactions between a prepared proactive team and an informed activated patient supported by the health system and the community - implies interation at all levels. The background assumption is that better informed patients have better outcomes and so the team have to support self-care, but also measure progress and ensure follow-up and deal with changes in the intensity of care as necessary.

Kaiser Permanente Model
All aspects are integrated - outreach from hospital to commuity, active planning and management, promotion of self-responsibility and self-care, shared care between professionals and each other and with patients and their families. The role of doctros as leaders and organizers of care - they need data to steer care improvements. What is interesting here too is the learning network. The model has a hierarchy but simplified they have 80% who are helped by supported self care. 15% need disease management and then a few have more intensive care management.

Disease Management
Coordinated, health care with interventions and communication for populations with conditions in which patient self-care efforts are significant. Management based on data and information with an aim of efficiency (improving outcomes and ROI).

Comparing these models with Europe, we have to recognize that insurers are public, that innovations focus on providers, that Europe lacks data infrastructure, and expected ROI is less than in USA. The complex relationships between governments, providers, insurers and patients make it easy to escape from ‘letting it happen’.

Some examples:
Sweden - heavily decentralized in counties and micipalities - payment by taxes, small co-payments, low productivity, and less urgency about a need to change.

France - heavily dominated by the state and very centralized. Cheaper facilities limited to 30 chronic diseases. They are taking on the chronic care model but still focus on caregivers, small networks and a small number of initiatives.

England- national system with delegation to regions, a lot of variation, and involvement of private providers. The have also adapted Kaiser Permanente model in many counties. Increasing focus on self-care and self managment.

Germany - 90:10 social to private insurance. Disease Management programs have been introduced step by step, voluntary participation, a lot of cooperation between hospitals and community sector - lots of incentives but physician-dominated and not sure how much active participation of patients there is.

Netherlands - mandatory private insurance this year. “Let 1000 flowers flourish” policy. Since 2006, have implemented Disease Management programs that have to meet requirements to function as contractor, as a motor for restructuring GPs, this doesn’t encourage involvement of medical specialists. Support of self-management still weak. Disease management programs will be introduced in primary care. Prevention and patient participation have developed.

Lessons Learned
Nationalization doesn’t seem to matter, the role of insurers is still weak, there are many helpful decentralized intatives, and I like the mentality of managed competition. The focus lies on influencing providers and not patients. GPS are dominant. There’s room for improvement in self-management, information benchmarks, and incentives.

We’ve developed the Maastricht Chronic Care Model which nicely parallels the Kaiser Permanente model - the majority get treated by GPs and nurses; high risk patients see a nurse specialist and a few see the medical specialist.

We believe and have evidence that we have made the allocation correctly and that it’s effective - the nurses are much better suited to dealing with high-risk patients than the GPs. We’ve seen improved clinical outcomes overall, brought down overall costs, and have more satisfied patients. The results are mainly attributable to nurses. This year, we’ll move to GP contracting, more focus on clinical role of nurse practitioners. Specialist nurses as consultants for practitioners, improving self management, developing instruments and technology.

So I think that Chronic Care Management can be combined with Disease Management. Care patterns must be based on complexity of health problems and readiness of patients for self-management - we need more powerful systems for self management. Physicians may function as consultants for complex situations. And encouraging managed competition between regional providers may contribute to effectiveness and quality of care.



Ministerial Roundtable

by Lloyd Davis

Key to Participants

NM: Dr Nata Menabde, Denmark Moderating
MG: Marina Geli i Fàbrega - Catalonia, Spain
BK: Bernard Kouchner - France
TJ: Dr. Tomás Julínek - Czech Republic
AK: Andrea Kdolsky - Austria
FT: Flavio Tosi - Veneto Region, Italy
GLC: Guillem López-Casasnovas, Universitat Pompeu Fabra, Spain

Ministerial Round TableNM: Reflecting first on challenges with financial sustainability, health system performance, payment and quality which are all very important. I also hear that there are predictions of increasing expenditure around the world. Should we be talking about expenditure or rather investment to show how health contributes to social development. It’s a substantial amount of resources, playing a substantial role in our economies

AK - I’m new in this function, I’m a doctor who’s become a politician. All of these points we’ve been looking at have been around for a long time. I think we have to look at our structures - the separation between health and social care for example. Now we’re trying to bring them together while decentralising power to the regions. We also need better IT structures - we’ve been told that politicians should care more - I care a lot - my problem is with the medical doctors, not politicians, not communities or patients but clinicians. We have a big discussion going on about data security - i liked Harry’s picture of collapsing paper systems - I’m hopeful that e-health can thrive in the next 20 years making the system more effective, improving networking and communication between people and better sensibility to the patients because we know them better. We also have to modernise our finance - we’ve tried public private partnership, we must be open to new ways of doing things.

NM: Yes we see better progress in some societies and less elsewhere.

MG: (translated & summarised by GLC): I challenge the earlier comment that the forecasts are harsh. We need to count differently because we know that spending money on health is important for our economic development and for the developing world.

NM: It’s important too to develop outcome-based indicators to see how that’s working - we’re all struggling with it but we’re making progress - we need good management information systems to help with this. The models aren’t importatn, what’s important is that they deliver - you can deliver equity in different ways, so we can’t promote specific models and generalise across contexts

BK: Don’t separate so much medicine with politics - we need a common ground for health in europe, it should be one of the next benchmarks in the setting up of europe - in the previous treaties, we can’t work together because of the different access to social funding. the people believe that we have commong ground, but it’s not true at all. I’m not bothered by which system we choose, but I want us to have something more common to us all - after all we’ve got a common currency, let’s make this an adventure for the next generation.

GLC :the discussion is not how we do that, but how we understand the financing of these systems. So far we’ve closed down the debate around innovation in finance - if it can only be funded by taxes it’s difficult to get equity.

NM: we’re seeing lots of good co-operation not only for emergency but also routine procedures. but it does have financial and economic repercussions and an ethical dimension.

FT: we have some cooperation with other countries - we have collaboration with Catalonia and other neighbouring states but the problem is that there are different models of government with different levels of autonomy and independence. We want to have cooperation but we have to modify our health system standardising our model and making it more generous, but we have a lot of different rules. If I have to sign a protocol with someone else, I need authorisation from cetnral government, I can change my own system, but it is limited by the national system and changes have to be decided together. In the future it will be more simple to debate between the 250 regions rather than the 27 nation states.

TJ: I want to talk about future of healthcare finance - the current problems of growing demand and a shrinking tax base cannot be solved with the existing financing arrangements. So how do we preserve access, renew responsibility for costs and ensure that citizens have consumer rights. Our next steps are to increase efficiency via comptetition, increase the flow of private money without threatening the poor and looking at different approaches to financing and cross border provision. The systems across Europe are very different and act against free movement.

NM: interesting to hear the perspective of a new member of the EU. Aging population is true also about health service professional and there is an issue of having an adequate workforce - which is expensive and time-consuming. Migration is an issue here too, people are moving to get more money and better conditions. What do ministers think of this?

MG: there is an important shortage in doctors and nursing and doctors feel badly paid and demotivated, we need to move forward on integrating health and social care exploring micropayments and the consequences of “brain-draining” from developing countries

AK: We have no problem with not enough doctors in Austria, but we do have a problem iwht the quality of education - older people need different kinds of treatment, new kinds of illnesses are appearing and we have to look at educating our professionals. Our other problem is too many acute beds and not enough in rehabilitation - we have to focus on change and not throw up our hands and say it’s too difficult.

Questions from the floor

Q: What is the future of competition of healthcare in europe?
A: BK - I believe that in 20 years all patients will be allowed to cross borders and get help in all countries, this is difficult but do-able. France is different from UK - we can’t harmonise but we can compete, in a good way, by encouraging specialism, not by quickly trying to harmonise our social welfare systems but step by step finding a way through.

Q: as demand outstrips resources, will there be an integrated healthcare system across europe:
A: AK - Hopefully but it’s a long way off - the next step is to work on pilots at the borders. I think it’s a good idea so that we can lose the “white spots” - this is one thing the EU can do.
MG - We should go for common training programmes and find a common european space

Q: Ministers come and go, but patients and people stay around, so what influence do you truly have?
A: AK - Some patients die, some ministers stay longer :) we need a new kind of politician - ones who know what they’re talking about (she’s a doctor) we need to talk to the people and see what they need.



Tele-health in Kent, UK

by Lloyd Davis

Peter Gilroy, Chief Executive of Kent County Council in the South-East of England just gave a great presentation focusing on their Tele-health pilot which is making a huge differenct to people’s lives. Patients describe it as “having a doctor in the house 24 hours a day”

Peter’s presentation included the following video:

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icon for podpress  Tele-health programme from Kent CC [3:01m]: Play Now | Play in Popup | Download (90)


Harry Cayton tells me about his work

by Lloyd Davis

Harry Cayton spoke earlier in the day about the UK Department of Health’s progress on Electronic Health Records. I asked him to tell us about that and we also touched on the importance of data privacy and ethical information management. Harry finished by talking about his experience of the conference so far.

Download: http://www.worldhealthcareblog.org/lloydd/whcc-cayton.wmv

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icon for podpress  Harry Cayton from UK Department of Health [3:22m]: Play Now | Play in Popup | Download (99)
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