1. HOW CAN THE DUTCH TOP PERFORMANCE WORK IN FAVOUR OF HEALTH CONSUMERS? Johan Hjertqvist, HCP, at CEE Prague September 24, 2012

2. Comparing healthcare systems performance in 35 countries from a consumer/patient view. Since 2004, more than 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 Euro Consumer Heart Index2008 Euro Diabetes Care Index 2008 Euro HIV Index2009 Euro Patient Empowerment Index2009 Nordic COPD Index2010 Tobacco Harm Prevention Index2011 Euro Headache Index2011 Euro Hepatitis Index2012 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

3. EHCI growth since 2005

5. Oooops….The DG Sanco internal design!

7. Upward and downward mobility Some countries seem to survive almost everything we throw at them! Netherlands, the Nordics, Belgium, … UK less stuck in waiting time swamp! Germany, Austria, Italy not doing too well on new indicators? Czech Republic, Slovakia, Croatia crawling upward! The Dutch example should provide inspiration!

8. There is (and should be!) a significant positive relationship between money and outcomes, but some countries are over-performers, and some are under- achievers! EHCI 2012 SENO ICE FI CZ LU HR CH MT AT PT

10. Healthcare somewhat affected by financial crisis? Longer waiting times for (expensive) elective surgery most noticeable in countries hit by financial difficulties!

11. A very slight tendency towards increased private payment shares Blue: 2009 Maroon: 2012

12. Healthcare quality remarkably unaffected by financial crisis? Infant deaths (per 1000 live births), WHO HfA January 2012 20 countries out of 34 score Green – up from 9 out of 29 in 2007! Actual medical outcomes keep improving – the good part of ”physician civil disobedience”?

13. Why do we not (yet) see clearer traces of the financial crisis? Healthcare traditionally weak at measuring output/outcomes. “The good old days that never were” Possible decline in services and access reported as “soft” rather than “hard” data – “patient witnesses” Underlying improvement forces are very strong!

14. ”The health consumer ladder” ”You are somebody” ”I can make a choice” ”All healthcare is not the same” ”All healthcare is not the same” ”I need to navigate and be in control” EU patient mobility directive – one year to go…

15. (Web)information to the public about which hospitals have the best results (2012)

16. Accessibility of European healthcare (EHCI 2012) Europe is divided into ”waiting list territory” (Red) and ”non-waiting list territory” (Green). This is remarkably constant over time, and independent of GDP/capita.

17. Accessibility poorly correlated with numbers of doctors Source: WHO Health for All database, January 2012

18. Access to e-Prescriptions Source: Empirica, Bonn (2012) e-Prescriptions are dependent on Electronic Patient Records to be meaningful

19. Websites with comprehensive information about all registered pharmaceuticals (OTC and Rx) Austria: www.austriacodex.at/avmain/ http://pharmaweb.ages.at/index.jsf www.austriacodex.at/avmain/http://pharmaweb.ages.at/index.jsf Belgium: http://www.bcfi.be/, www.pharma.be http://www.bcfi.be/ Croatia: http://www.almp.hr/?ln=hr&w=lijekovi http://www.almp.hr/?ln=hr&w=lijekovi Czech Republic: www.zdravotnickenoviny.cz/scripts/modules/catalogue/search.php?catalogueID=2 www.zdravotnickenoviny.cz/scripts/modules/catalogue/search.php?catalogueID=2 Denmark: http://medicin.dk/http://medicin.dk/ Estonia: www.raviminfo.eewww.raviminfo.ee Finland: www.fimea.fi/lakemedel/produktresumeer/humpl www.fimea.fi/lakemedel/produktresumeer/humpl France: www.doctissimo.fr Germany: www.onmeda.de Hungary: www.ogyi.hu/drug_database/www.ogyi.hu/drug_database/ Ireland: www.medicines.iewww.medicines.ie Italy: www.prontuariofarmaci.com www.prontuariofarmaci.com Latvia: http://www.zva.gov.lv/index.php?id=375&sa=375&top=334 http://www.zva.gov.lv/index.php?id=375&sa=375&top=334 Malta: http://medicinesauthority.gov.mt/products/search.htm http://medicinesauthority.gov.mt/products/search.htm Netherlands: www.cbg-meb.nl/CBG/en/human-medicines/geneesmiddeleninformatiebank/default.htm www.cbg-meb.nl/CBG/en/human-medicines/geneesmiddeleninformatiebank/default.htm Norway: www.legemiddelverket.no/custom/Preparatsok/prepSearch____80333.aspx?filterBy=CopyToConsumer www.legemiddelverket.no/custom/Preparatsok/prepSearch____80333.aspx?filterBy=CopyToConsumer Portugal: www.infarmed.pt/infomed/inicio.phpwww.infarmed.pt/infomed/inicio.php Romania: www.anm.ro/en/html/pharmacopoeia.htmlwww.anm.ro/en/html/pharmacopoeia.html Slovakia: www.liekinfo.skwww.liekinfo.sk Slovenia: www.zdravila.netwww.zdravila.net Sweden: www.fass.sewww.fass.se Switzerland: www.kompendium.chwww.kompendium.ch U.K.: http://emc.medicines.org.uk/http://emc.medicines.org.uk/

20. If anything, drug information available to patients seems to contain drug spending (2009)! Numbers denote total drug sales per capita (€/year) (Source: EFPIA)

21. Dutch inspiration Getting rid of politicians! Separation of funding and provision Competition Consumer choice a driver Transparency on offers and performance

22. An electronic version of this presentation is available at www.ceehpn.eu Thank you! All HCP Index information at: www.healthpowerhouse.com