Title: Technology Usage in Europe vs' North America
1Technology Usage in Europe vs. North America
- The View of a Global Corporation Operating in
Both Markets - Jenifer Ehreth, PhD
- Medtronic Europe, Sàrl, Switzerland
- Washington, DC, December 3, 2004
2What can the US and Europe learn from each other?
- Ideas for reform
- DRGs from US to Europe
- HTA from Europe to US
- Impact of funding mechanisms
- Anticipated and unanticipated effects
- Factors that effect success
3Healthcare Funding Dynamics
Western Europe
Eastern Europe
USA
74 million 6.2
381 million 8.1
286 million 13.2
Population of GDP on Health
600B
600B
Public
Direct control
Indirect control
20B
Direct control
lt5B
lt200B
Private
?
?
900B
4Key Conclusions
- Differences
- Resources
- Medical need
- Structure
- Similarities
- Scientific understanding
- Expectation that services
- meet clinical guidelines
5Resource Differences
- GDP/capita
- Source OECD 2002
6Health Care is a Luxury Good
- The demand for health care increases as wealth
increases - The wealthier a society is, the larger the
proportion of its resources go to health care
7Healthcare Spending vs. Pacemaker Use
of GDP on Health Services
US
Germany
France
Canada
Australia
Spain
Japan
Italy
UK
Implants/million
8Medical Need Percent of Population over 65
Source OECD 2002
9US vs. Europe Hip ReplacementsOlder technology,
elderly population
Country Number/1000 Inhabitants/Year United
Kingdom 0.91 Scandinavia 1.04 Benelux 1.52 Germany
1.73 France 1.64 Spain 0.61 Italy 0.99 Total for
the EU 1.26 US 1.04
10Structure Response to European Challenges
- Governments want to control growth in costs
- Health care reforms
- Introduce mechanisms to limit growth
- Pressure for health care expenditure as
- GDP to grow
- Demographics
- Patient involvement expectations
- Developments in technology
- Major Reforms in Progress
- Health Technology
- Assessment
- DRGs
11Structural Differences
- Healthcare budgets insufficient, rationed and
capped - Constraints on private insurance
- Labor force difficult to downsize
- Procurement systems cost not value
- Physicians/patients not actively involved
- Direct-to-patient communications restricted
- Minimal liability if new therapies not adopted
12Health Technology Assessment (HTA)
- Government sponsored
- Key question
- Is the technology cost-effective?
- HTA process always takes additional time
- Real world data
- learning curve phenomenon
- Positive HTA does not guarantee any funding
- Negative HTA will preclude funding
13Impact of HTA
? slowest adopters
? medium adopters
? quick adopters
- Key Finding of 13 October London Management Forum
Meeting European countries with the most
developed health technology assessment schemes
are the slowest to adopt new technologies. - 29 Oct 2004 Clinica 11305
14Structural Change in Europe
- Europe is following the US lead DRG Diagnosis
Related Groups - One payment per patient admission
- Incentive for efficient allocation of hospital
resources - Wave of Reform in Europe
- Existing Italy, Scandinavia (4), Netherlands,
Spain (regions) - Implementing Germany, France, UK, Portugal
- Incorporate some elements of the US system, but
- Overriding goal appears to be cost savings
- No incentive to use efficiency producing
technologies - Difficult to launch DRG systems getting good
data and adjusting payments for new technologies
15Impact Diffusion of Technology
- Angiography/100K Population
Source OECD 2002
16Diffusion of CRT Therapy in Europe
17Learning
- Europe and North America share an understanding
of what is good medicine - The US spends more on new technology
- Europe has broader access to old and barriers to
new technology - If barriers to access are lifted, people choose
to use more technology
18Technology Usage in Europe vs. North America
- The View of a Global Corporation Operating in
Both Markets - Jenifer Ehreth, PhD
- Medtronic Europe, Sàrl, Switzerland
- Washington, DC, December 3, 2004
19Efficiency Hospitals
Source OECD 2002
20Impact RD Spending as of Sales
New Europe
Old Europe