1. EUROPEAN INSTITUTE OF MEDICINE E O M European Academy of Sciences and Arts Health is Wealth Strategic Visions for European Healthcare at the Beginning of the 21 st Century Felix Unger Health connex ’05 Vienna, September 30 th, 2005

2. Baseline EU 25 Member states with 460 million inhabitants General:European Health Care Market 25 % GNP, largest employer Medicine:Cultural endeavour, how we deal with man Costs:A function of aging population with increasing retirees, progress of medicine and economy European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

3. Goal: - Health for all Europeans based to solidarity - The decision to select a medical treatment depends primarily on the benefit to the patient and not on the cost - Deliver optimal medicine based on the State of the Arts European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

4. - Consider mobility of the patient - Clear Healthcare system in Europe - based to solidarity and evidence - reliable standards according the State of the Arts - easy adjustable and applicable European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

5. Report to the European Parliament „Health is Wealth“ (4.12.2003): Patient–orientated and driven by medical professionals Cluster III Medical Financing Patient – Doctor – Nucleus Cluster I Medical Arts Cluster II Medical Organization European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

6. Patient – Doctor – Nucleus Patient:- responsible for his own lifestyle and habits - contributes by himself by prevention - motivated to therapy - increasingly mobile - complies with medical recommendation Doctor:- provides information - informs and guides on therapeutic choices - provides medical services European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

7. Cluster I - Medical Arts: Prediction – Prevention – Diagnosis – Therapy - Prognosis Standards in all diagnostic / therapeutic procedures Class I: efficient and evident Class IIa:efficient, but empirical Class IIb:less efficient and empirical Class III:not efficient Basis for: - understanding diseases and new cures by process orientated research - quality control - medical outcome studies - control of the Health Care System - basis for reimbursement (primary, secondary and tertiary costs) European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

8. Cluster II - Medical Organization: Homecare: - General Practitioner, clearing function for hospitalization - Specialists Hospital: - to be sized to supply and demand by quality control - Stimulation for Centers of Excellence Long term care: - chronic ill, disabled, etc. Full reimbursement according the classification I – III European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

9. Cluster III - Medical Financing: Dichotomy Results in medicine Financing in medicine f (Demography and progressf (economy [taxes and income in the Medical Arts) of employees]) Systems in Europe dual: - insurances mono: taxes - taxes - co-payment Financing in medicine is a pure political decision European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

10. Central Fund Social Insurances Fund Classification Total reimbursement of expenses Medical Financing (National task) Medical Arts (EU task) Medical Organization (EU task) European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M Taxes Patient - Doctor-Nucleus

11. Consequences of the concept “Health is Wealth” 1.Clear and simple reimbursement in Europe 2.Standards for health professionals 3.Establishing of regional centers of excellence and reference 4.Exchange of Health assessment - homogenous high level in Europe 5.Benefit to the patients European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M

12. Main conclusions -Depoliticizing of medicine -Professionalism of medical organization Comment: -Quadrature of the circle is easier European Academy of Sciences and Arts EUROPEAN INSTITUTE OF MEDICINE E O M