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I G E S I n s t i t u t G m b H · w w w. i g e s. d e Friedrichstraße 180 · 10117 Berlin · Germany  +49 30 230 80 90 ·  +49 30 230 80 911 Reducing Health.

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Presentation on theme: "I G E S I n s t i t u t G m b H · w w w. i g e s. d e Friedrichstraße 180 · 10117 Berlin · Germany  +49 30 230 80 90 ·  +49 30 230 80 911 Reducing Health."— Presentation transcript:

1 I G E S I n s t i t u t G m b H · w w w. i g e s. d e Friedrichstraße 180 · Berlin · Germany  ·  Reducing Health Inequalities What Do We Really Know About Successful Strategies? Berlin May 9, 2009 IGES Institut Bertram Häussler Early inequality in access can heighten efficiency in health care supply mid-term

2 Reducing Health Inequalities | Seite 2 Berlin | May 9, 2009 Constant increase of life expectancy (at birth in Germany from ) Source: OECD 2008

3 Reducing Health Inequalities | Seite 3 Berlin | May 9, 2009 Life expectancy in Germany by gender and east/west female male west east west east

4 Reducing Health Inequalities | Seite 4 Berlin | May 9, 2009 Impact of health care on increase of health status / life expectancy?  Thomas McKeown 1976: The role of medicine: Dream, mirage oder nemesis?  "Health results from a combination of social, economic, and psychological as well as purely biological phenomena. Most doctors now understand this and so increasingly do politicians; this enhances their reluctance to invest heavily in health services when they have only a small effect on health." (Morrison und Smith 1994)  Contrary to what has been suggested by some authors, there appears to be a significantly positive relation between health expenditure and health, particularly for women. (Or, Z, 2000)

5 Reducing Health Inequalities | Seite 5 Berlin | May 9, 2009 Health care is not a static factor  Evidence-based Medicine:  „Burn your textbooks because knowledge renews every few years.“  Straus SE, Richardson WS, Glasziou P, Haynes RB (2005)

6 Reducing Health Inequalities | Seite 6 Berlin | May 9, 2009 Progress in pharmaceutical care (Germany, 1975: West Germany) proven efficacy, life saving proven efficacy, not life saving efficacy not proven, benzodiazepines

7 Reducing Health Inequalities | Seite 7 Berlin | May 9, market shares of TOP25 drugs prescribed in 1975 market share in 1975 market share in 2008

8 Reducing Health Inequalities | Seite 8 Berlin | May 9, 2009 „War against heart disease“: Cardiovascular causes of death decline much faster since mid 80s (West Germany) Herz-Kreislauf-Erkrankungen Andere Todesursachen - 49% - 23% All other COD Cardiovascular COD DMDR (deaths per 100, % - 31%

9 Reducing Health Inequalities | Seite 9 Berlin | May 9, 2009 Health care costs strongly influenced by expen- ditures for innovative services (here: biologicals) Noch unbekannte AM Autoimmun- krankheiten Krebs Orphan Diabetes Wachstum Epo 1,5 2,4 2,3 0,4 0,3 0,4 1,9 expend. in 1,000,000 Euros

10 Reducing Health Inequalities | Seite 10 Berlin | May 9, 2009 Cost containment strategies frequently based on assessment and apraisal of new services (drugs) price regulation after utility assessment no yes „high equity countries“

11 Reducing Health Inequalities | Seite 11 Berlin | May 9, 2009 Countries with strong regulations („high equity countries“) show late penetration of new drugs Danzon and Furukawa, 2003 market penetration of new molecules relative to USA

12 Reducing Health Inequalities | Seite 12 Berlin | May 9, 2009 Late penetration deprives patients of (proven) health benefits (e.g. statins) proof of efficacy

13 Reducing Health Inequalities | Seite 13 Berlin | May 9, 2009 equity little choice health for all early penetra tion (for few) stimu- lus for innova- tion limited choice late penetra tion (for all) finan- cial limits

14 Reducing Health Inequalities | Seite 14 Berlin | May 9, 2009 From a different world: How the airbag penetrated the car market 1981 Airbag verfügbar DM (nur Fahrer-Airbag) 5 % von DM Airbag NICHT verfügbar (1.800 DM entsprächen 15 % von DM) 1991 Airbag seit 10 Jahren verfügbar Airbag ERSTMALIG verfügbar DM (Fahrer + Beifahrer) 6% bzw. 3% von DM 2001Airbag = Serienausstattung

15 Reducing Health Inequalities | Seite 15 Berlin | May 9, 2009 How „high equity countries“ can stimulate the innovation process  Allow early use of services only for out-of-pocket-payers  Establish innovation insurance scheme as add on  Allow choice within public health care systems

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