Health economic assessment tool (HEAT) for cycling and walking

That is a great tool WHO/Europe has developed. Try it yourself, a good way to estimate the financial benefits of walking and cycling. It also gives you the choise to perform cost-benefit analysis, in case you are thinking of investing money in the promotion of cycling/walking

Original post here

HEAT is an online resource to estimate the economic savings resulting from reductions in mortality as a consequence of regular cycling and/or walking. It is based on best available evidence, with parameters that can be adapted to fit specific situations. Default parameters are valid for the European context.
HEAT calculates the answer to the following question: if x people cycle or walk y distance on most days, what is the economic value of mortality rate improvements?
HEAT can be applied in many situations, for example:

• to plan a new piece of cycling or walking infrastructure: it models the impact of different levels of cycling or walking, and attaches a value to the estimated level when the new infrastructure is in place (this can be compared to the costs to produce a benefit–cost ratio (and help make the case for investment), or as an input into a more comprehensive cost benefit analysis);

• to value the mortality benefits from current levels of cycling or walking, such as benefits from cycling or walking to a specific workplace, across a city or in a country;

• to provide input into more comprehensive cost–benefit analyses, or prospective health impact assessments: for instance, to estimate the mortality benefits from achieving national targets to increase cycling or walking, or to illustrate potential cost consequences of a decline in current levels of cycling or walking.

Examples of applications are available from several countries.
Acknowledgements
The development of HEAT was carried out within the Transport, Health and Environment Pan-European Programme (THE PEP) and in close collaboration with HEPA Europe. It was supported by an international advisory group of economists and experts on health, physical activity and transport.
We gratefully acknowledge the financial support received by Austria (Federal Ministry of Agriculture, Forestry, Environment and Water Management), Sweden (Swedish Expertise Fund), Switzerland (Swiss Federal Office of Public Health) and a consortium of donors from the United Kingdom under the leadership of Natural England and the European Union in the framework of the Health Programme 2008–2013 (Grant agreement 2009 52 02).

Public Healthcare needs Sustainable Economies

Public expenses for healthcare in countries of the EU are usually measured as a rate of GDP. In order to have a sustainable economy, this rate has to be big enough for healthcare needs, but also small enough for other parts of the economy. So, the rationale is simple. When healthcare expenses rise, then this rate will also probably rise, so the growth rate of the economy (and GDP) has to be equal or bigger, in order to absorb this rise and maintain balance between parts of the economy.

In European Union trends have shown that healthcare expenses will rise even more in the future. According to the prediction of Economic Policy Committee 2001; Economic Policy Committee and European Commission 2006 the growth rates were also expected to be very high, so the expenses rise would be absorbed. And then the recession came. And unfortunately only half of the prediction came true. The expenses have raised significantly, but the growth rates didn’t. And this is how the fairytale of sustainability problems begins.

What we see in the above graph (taken from Eurostat) is the Real GDP growth rate through time. OK. Now let’s compare it with Healthcare expenses for the same time period in EU. The expenses in every single country go up.

What is needed to achieve economic sustainability??? How can we match the lines?? The GDP growth rate can not be influenced that easily. Unless you have a secret formula to stabilize euro. So, the expenditures have to follow the lines of real GDP growth. This means that public expenditure on healthcare should be cut to equivalent rates. This is not that simple. There are multiple factors that affect cost o healthcare. These factors will be discussed in the next post.

European governments don’t just face the problem of economic sustainability. Fiscal sustainability is something critical to worry about. What is fiscal sustainability in simple words? It is when a country has enough income to cover its expenses. Maybe fiscal sustainability is the greatest challenge of Member States. According to Willem H. Buiter, 2003 growth strategies will fail in the absence of fiscal sustainability. So, what member states do in order to cover their needs, is cutting expenses, raising taxes and borrowing for liquidity. The third creates a growing debt for them, and it makes it even harder to achieve fiscal sustainability in the future. IMF (2010) predicts that the rate of gross debt of general government to GDP will rise from 91% in the end of 2009, to 110% until 2015. It is quite simple to understand that all the above shrink the GDP of Member States. Less GDP means less for each part of the economy, including healthcare. The biggest question is if it also means lower level of health services quality. Maybe cross border care and medical mobility within Europe can increase competition, and lead to better prices and higher quality. Policy makers will show the way, and time will show whether sustainability is achievable or not. 

EUROPA - Press Releases - Health: driving forward the uptake of e-Health with a new network for European Co-operation

EUROPA - Press Releases - Health: driving forward the uptake of e-Health with a new network for European Co-operation:
The original post here

Brussels, 22 December 2011 – Today the European Commission adopted a Decision establishing an eHealth Network, as foreseen by the Directive (2011/24/EU) on Patients' Rights in Cross-border Healthcare. For the first time, EU legislation includes provisions on eHealth with clear objectives to find modern, innovative solutions for providing better and safer healthcare for all Europeans.

European Commissioner for Health and Consumer Policy, John Dalli said:"eHealth has the potential to deliver better healthcare to more people in a more sustainable manner. I am confident that the eHealth network will play a key role in making eHealth a reality across Europe: so that routine medical checks are performed in the comfort of our homes via telemonitoring; so that we take our ePrescription along with our eTicket when we travel, with the confidence that our medical information follows us everywhere in the EU; so that all Europeans can access the best possible healthcare wherever they are". To conclude : "I encourage all Member States to join the eHealth Network so that our joint efforts can reap benefits for all."

Neelie Kroes, European Commission Vice President for the Digital Agenda said The new eHealth Network promises to bring the health benefits of the digital economy to citizens across Europe. Interoperable eHealth can help improve the safety and efficiency of care of millions of Europeans who travel within the EU every year.

The Network's mission
The Network will bring together the national authorities responsible for eHealth on a voluntary basis to work on common orientations for eHealth. The aim is to ensure EU wide interoperability of electronic health systems and wider use of eHealth. The eHealth Network is expected to translate the results of numerous research projects and pilot projects into real-life accessible services for European citizens.

Background

eHealth is healthcare practice supported by electronic processes and information communication technologies (ICTs) .

eHealth can play a central role in making health systems more efficient and effective by allowing for example remote diagnosis, remote monitoring of patients' conditions and secure sharing of patient records between healthcare professionals. The eHealth Network will play a key role in facilitating the future development of such services across Europe.

Council Conclusions in 2009 called for an alignment of eHealth with health strategies both at EU and at National level. In 2010 a Joint Action and Thematic Network were launched under the Health Programme and the Competitiveness and Innovation Programme.

To ensure coordination, coherence and consistency of work on eHealth at EU level and to avoid duplication of work, article 14 of the Cross-border Healthcare Directive (2011/24/EU) of 9 March 2011 sets up the voluntary eHealth Network adopted by today's Decision.

The eHealth network is mandated to draw up guidelines on a minimum set of common data to be included in patients' summaries; on methods to enable the use of medical information for public health and medical research; and on common identification and authentication measures to ensure transferability of data in cross-border healthcare.

Comparison of some Medical Tourism Organisations

Well, I am a patient and I am willing to travel abroad for a surgical operation. How do i find a hospital? I need some advise and information. Well google has all the answers... Theese are some of my findings and my description and comments on the purpose and role of each of the below organisations. All the information was obtained from their websites.  

 

Started in 2002-It is AA rated by Better Business Bureau since then.

Services: They arrange everything needed to travel in a country for medical reasons. This includes transport, hotel stay, hospital care and insurance. They also offer advise to help you choose the appropriate country and hospital to receive quality care in reasonable cost.

Insurance Offered:

• CATA (Complication risk, Accidental death and Dismemberment, Travel Risk, Aftercare)
• Diaspora (It is the insurance product that Planet Hospital launched. Not much relevance with Medical Tourism. It focuses on treatment in the US where health insurance is mandatory to receive complete medical care)

Partners Specifications: Planet Hospital does not certify its partners. As an assessment tool they use:

• Online reviews for Surgeons and Healthcare Professionals
• They actively review all partners in each country. Partners include hospitals, hotels, airlines etc.

Comments: Planet Hospital seems to mainly focus on reputational partners to gain trust, not all of them are accredited. However, in non-developed or non-reputational countries hospitals are JCI accredited. So there are not clearly stated specifications for hospitals to join the partners network. The network and procedures range seems to cover most cases, but it could be stated that there is a gap in quality assurance.

One of the partners is the Fertility Crete Centre (Greece)

General info: Based in Columbia-South Carolina

Member of: ISQua and SIIA*

*SIIA stands for Self Insurance Institute of America

Services: They arrange everything needed to travel in a country for medical reasons. This includes transport, hotel stay, hospital care and insurance. They also offer advise to help you choose the appropriate country and hospital to receive quality care in reasonable cost.

Insurance offered:

• Medical Travel Insurance from independent Insurance company named “Global Protective Solutions”. Same cover as CATA
• Insurance for medical care within the US

Partners Specifications: All Hospital facilities of the network are JCI Accredited.

“The American Medical Association (AMA) advises that companies recommending overseas health care only work with facilities that have been accredited by the Joint Commission International (JCI).”

Comments: The business offers a medium range of medical procedures, but with high quality specifications. Not much is mentioned about medical professionals, but quality is assured since all partner facilities are JCI accredited.

The website also offers an online tool to compare costs of procedures between hospitals worldwide.

Comparison of the procedures covered from Planet Hospital and Companion Global Healthcare

This table is used to indicate that there are different strategies among medical tourism organizations. Planet hospital covers more medical procedures, but the specifications for partnership with providers are lower than Companion Global’s. 

Procedures Comparison Table	Planet Hospital	Companion Global Healthcare
Obesity
Obesity	●
Post Bariatric	●
Ortho / Neuro
Hip Surgery	●	●
Knee Surgery	●	●
Shoulder	●	●
Spine	●	●
Dental
Cosmetic Dentistry	●	●
Basic Dentistry	●	●
Elective
Cancer	●
Eye and Vision	●
Gynecological	●	●
Kidney / Liver / Pancreas	●
Liberation Treatment for MS	●
Radiation / Proton Beam	●
Heart
Cardio Testing	●
Heart Procedures	●	●
Lung Procedures	●
Cancer
Cancer	●
Radiation / Proton Beam	●
Surgical Oncology	●
Cosmetic
Breasts	●
Butt / Thigh Lift	●
Face	●
Genitalia	●
Liposuction	●
Other Cosmetic	●
Post Bariatric	●
Sex Change	●
Total Makeover	●
Tummy Tuck	●
Medicine of Tomorrow
Knee Cartilage Replacement	●	●
Liberation Treatment for MS	●
Radiation / Proton Beam	●
Stem Cell Therapies	●
Fertility
IVF & Surrogacy	●
Vasectomy / Tube Ligation Reversal	●
Not Listed-Other
0-10 Special Procedures		●
10-20 Special Procedures

Bupa started in the UK in 1947 with 38.000 customers.

Services: The business offers insurance products in multiple countries, Medical travel advice services, Healthcare services, and also does medical research.

The protection and risk business part of the organization (Bupa Health Assurance Ltd) is about to be sold to Resolution Ltd for £165,15million.

Comments: Bupa International has developed a quality assurance programme with the assistance of Joint Commission International (JCI).

The organisation offers only advice and insurance. There is a map with approved providers (including professionals, medical centres, hospitals) over the world, with contact info. Hygeia, Athens Medical Centre and Interbalkan European Medical Centre are partners.

 

The Blue Cross and Blue Shield Association (BCBSA) is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies. The Organisation started 80 years ago and the headquarters are in Chicago.

Insurance offered: AskBlue Health Insurance

                                AskBlue Medicare

Services: Most services have to do with insurance. However there are some interesting advice tools used:

• Blue Doctor or Hospitals finder. An application with body graphs and checklists that helps to find the appropriate provider (in National level)

·        Blue Distinction® is a designation awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare. The designation is based on rigorous, evidence-based, objective selection criteria established in collaboration with expert physicians' and medical organizations' recommendations. Its goal is to help consumers find quality specialty care on a consistent basis, while enabling and encouraging healthcare professionals to improve the overall quality and delivery of care nationwide.

Blue Distinction Example Criteria

Selection Criteria Category	Examples Include	Why This Matters to You
Patient Results (or Patient Outcomes)	Complication rates Readmission rates Mortality rate	Published averages for these measures often exist. Facilities are evaluated on how they compare to these averages to assess how well they do, overall, relative to their peers.
Treatment Expertise	Physician credentials Dedicated team focused on providing the particular area of specialty care Length of time a facility has performed a procedure	Processes like advanced training programs for physicians in certain specialty areas and having patient care teams dedicated to one type of specialty care may lead to better overall care and outcomes for patients.
Procedure Volume	Number of times a particular procedure has been completed	Experience counts. Like the old adage, “Practice makes perfect,” research has shown that the more a facility performs a particular procedure, the better the overall outcomes for patients. It is worth noting, however, that this does not guarantee positive outcomes for individual patients.
Structure	Type of services provided (ER, diagnostic testing abilities) Supporting departments (radiology, nutrition, social services, rehabilitation, etc.) Use of clinical registry data systems	Expert input and guidance suggest that for various specialty care services, a distinguished level of care and management of patients requires the availability of key clinical services, such as diagnostic, medical and collaborative services.
Process	Use of evidence-based care (e.g., use of beta blockers or aspirin for cardiac patients, which typically results in better outcomes) Systematic follow-up of patient results after procedures Quality improvement processes	Adherence to evidence-based (or clinically based) care processes, as well as a demonstrated focus on quality improvement, often relate to improved overall outcomes.

Comments: This organisation could be used as an example for advice that may be given to European citizens that wish to look for health related services within Europe.

Cross Border Healthcare in Europe and Diagnosis Related Groups: A series of Unfortunate Questions

Diagnosis Related Groups- DRGs are used to categorize patients according to the resources needed for their medication or hospitalization and their clinical characteristics. The groups the patient belongs to, determine the cost of the health services offered. The first grouping systems where developed in the early 80s from Robert Barclay Fetter και John D. Thompson in Yale University.

DRGs are also used in European Union and they are now considered as a tool to create homogeneity among the health systems of member states. But what does this mean?

A simple example is to pick an Italian, a Spanish, a British and a German patient. All of them  suffer from the same illness and each one of them chooses a hospital in his county. All of the previews hospitals may offer the same level of services and use same medical equipment and resources. So the cost will be the same. Obviously not. But why? Are the functional expenses of each organisation the reason? Maybe the pricing policy? Maybe the health policy of each government? There are various different reasons in each state that determine healthcare costs. And this creates opportunities such as Medical Tourism. Now my tooth hurts. Well, I have to visit a dentist, and I don’t mind travelling to another country to do so. Should I travel to the UK or Hungary? Let’s check prices first. Treatmentabroad has the following comparison table on its website.

	UK price	Hungary price
Tooth extraction	£90.00	£30.00
BriteSmile® Tooth Whitening	£475.00	£280.00
Root Canal Treatment	£200.00	£60.00
Porcelain Veneer	£500.00	£180.00
Branemark Dental Implant	£1,900	£800.00
Porcelain Crown	£500.00	£180.00

The price differences are significant. But it is still hard for me to choose.

Reinhard Busse (Prof. Dr. med. MPH FFPH) makes a similar price comparison in his presentation in EuroDRG final conference, Berlin, Germany (17/11/2011) Then he asks "If costs differ so much with treatment, what about the quality of care???". DRGs are not only a tool to homogenize costs, but also quality of services.

Most people say that “What you pay is what you get”. Others say, “Value for money”. That is totally right. Value for money, and not money for value. Price can not affect Quality in real. It only affects the perceived Quality. The best example is the JCI accredited hospitals in India, that offer perfect services, and they are 5-10 times cheaper than a European hospital.

So DRGs are the secret to achieve high quality of services and competitive pricing? No.

DRGs offer something very important for healthcare systems. They help with standardization of services. Each healthcare professional can use DRGs for his purpose, physicians to determine the procedures needed, financial managers to determine costs, operations managers to apply metric and benchmark with other organizations. So DRGs homogeneity is important, in country and in European level.

The EuroDRGproject may lead to pan-European DRGs, and my opinion is that this is one more step to common European health policy.

Greek DRGs at a glance.

DRGs are totally new in the greek health system. They are known as “KEN” and consist of 700 groups. These groups resulted from combining DRGs and  ICD-10 (International Classifications of Diseases). The Greek Ministry of Health intends to use DRGs for costing purposes, and they are also expected to decrease bureaucracy between public or private healthcare organizations and insurance organizations. The aplication project of DRGs in Greece has started in October 2011 for public hospitals, and private hospitals will have to join the project in the beggining of 2012. Change management is not easy in this case. Efforts towards Greek NHS reformation should also focus on Integration of Information Systems, and extensive training of healthcare professionals. 

So much discussion on DRGs and almost nothing about ICD-10. I am sure the video will explain ICD-10 better than me.