Part I – Heathcare systems
The challenges of healthcare systems
3 conflicting 1. Quality of care and healthy life expectancy
goals of 2. Solidarity & access = 2 people with the same need deserve the
healthcare same care
policies 3. Financial sustainability = if we want to offer good quality of
care to the people, then we must use the money wisely in
healthcare
Investing in health = investing in the economy health is
not a cost, it’s an investment = multiplier effect (if you
invest 1 euro, how much euros will be returned in the long
run)
In health every euro invested will be returned double in the
long term
Why are they Vb. New treatment for rare disease treatment is very expensive
conflicting - Would increase quality of care
- Problem with financial sustainability patient can’t pay for it
so that would be a problem in solidarity too
Conflicting circle: we want to improve quality bad sustainability
make the personal patient input bigger issue with solidarity
Economic Needs are ‘infinite’ and budgets are limited
reality - We must make choices the right choices with the healthcare
money
- Crisis make this conflict even more sharp (vb. Covid)
Budget - GDP = the value of all the products and services produced in
one your in a country (in euro)
- There is an increase in GDP that is spent on healthcare:
New technology
Demographic changes
Crisis (vb. Covid)
Recommend Optimize the health of the population within the limits of the
ed approach available resources and within ethical framework built on equity and
solidarity principles
- Health economics = people who deal with wise investments in
health
- Equity = two people with the same healthcare needs deserve
the same care so people who are more poor deserve more
help (not equality)
The current 5 1. Fragmentation of care (waste, less quality of care)
challenges of Healthcare providers are not working together (vb. GP to
most specialist)
healthcare 2. Overuse/misuse/abuse (waste, less quality of care) (!!)
systems (!!) Overuse = too much of the same pt with chronic heart
disease should see a cardiologist two times in a year but
they do 4 times
Misuse = pt needs a clinical evaluation but gets an RX
(unnecessary)
Abuse = cheating the system some nurses were charging
a pt in the weekend while they didn’t see a pt in the
weekend
3. Unprecedented demographics (threat for the budget)
Never seen before demographics = aging population, more
, multimorbidity, more chronic diseases,…
4. Technology push (threat for the budget)
New devices, new cost is more then the current medicine,
pressure on the budget
5. Unequal access to care (lack of solidarity and threat for the
budget)
Lack of solidarity people with more money have more
access
Additional challenge
6. Quality of life of healthcare providers (declined further since
covid)
Correlation between QoL on the job (vb. Burnout) and safety
of patients
Examples of Expensive
new health - Regenerative medicine
technologies - Genetic treatments
- 3D-printing
Helps save a lot of money
- Robotization
- Virtual techniques
- Augmented reality
Typical 1. Uncertainty
characteristi Becoming sick is uncertainty or if you are better or worse
cs of the tomorrow
health care Need for health insurance
system In Belgium we are all insured insured against the
financial loss if we would become sick
Some people show moral hazard = having no problem
with getting more care than you actually need (vb.
Visiting 4 different specialists for the same problem)
Solution: ask to pay at least a little part of the cost =
REM-geld
Too little = doesn’t do the job it was made for
Too high = some people drop useful care
But: within chronic patients the shift of financial
responsibility leads to an underuse of potential important
medications BUT also an increase in appropriate use and
adherence of drugs
In Belgium: 20% out of pocket
2 kinds of countries
Bismark system = health insurance (Belgium)
Beveridge system = government led health system (UK)
2. Asymmetric information
The supplier knows much more about it then the demander
(patient)
Risk = supplier-induced demand: risk of overuse and
unnecessary health care for personal wealth: more
money if they induce demand
Main factors of supplier-induced demand
1) Reason = poor monitoring and control when there’s
heavy control, there is more difficulty to do it
2) Free-for-service payments system
3) Asymmetrical information = when clinicians know more
then pt’s
, Where is the highest risk for supplier-induced demand
Recommending health services by another professional
Recommending health service performed by themselves
ANSWER: they can make themselves more wealthy
Example: in the last 30/180 days of a cancerpatient, how
many did they spend in
the hospital Belgium
scores the highest
= difficult
temptation to attract
people increases
nurses already have an
overload vicious
circle
Vicious circle of this problem (!!)
Hospitals started saving on staff (less staff for more
patients)
Attract more patients to maximize patient admissions
(empty bed doesn’t give any money) increase
revenues (= inkomsten)
Optimizing the patient coding = giving patients worse
coding then the patient actually was (more severe then
how it was), so they got more money per patient
Policy see this healthcare costs us more money
starting policies to save even more money in healthcare
3. Externalities
We are not only concerned about our own health, but also
with the health of others – 3 reasons why:
1) Paternalistic reason (vb. We pay for it, so we want good
health)
2) Altruistic reason (vb. Because we care about others)
3) Egoistic reason (vb. So people don’t infect you when
they’re sick)
Ppl with the lowest income have a 50% higher chance to die
then the highest income quintile (+ more chance to be
disabled, hospital admissions, psychiatric admissions, less
screening, les dental care)
AROP (at risk of poverty = 15%) = 13% more chance to
postpone cancer treatment due to the financial reasons
20% of the total costs of healthcare is due to inequity
The possible policy response
6 things 1. Selecting the right healthcare system
policy 2. Integrated care
makers can 3. Strong primary care
do 4. Change financial incentives
5. Influence out of pocket payments
6. Invest in prevention
Selecting the right healthcare system
Belgium - Compulsory income-related contributions (taxes) higher
earners contribute more
The challenges of healthcare systems
3 conflicting 1. Quality of care and healthy life expectancy
goals of 2. Solidarity & access = 2 people with the same need deserve the
healthcare same care
policies 3. Financial sustainability = if we want to offer good quality of
care to the people, then we must use the money wisely in
healthcare
Investing in health = investing in the economy health is
not a cost, it’s an investment = multiplier effect (if you
invest 1 euro, how much euros will be returned in the long
run)
In health every euro invested will be returned double in the
long term
Why are they Vb. New treatment for rare disease treatment is very expensive
conflicting - Would increase quality of care
- Problem with financial sustainability patient can’t pay for it
so that would be a problem in solidarity too
Conflicting circle: we want to improve quality bad sustainability
make the personal patient input bigger issue with solidarity
Economic Needs are ‘infinite’ and budgets are limited
reality - We must make choices the right choices with the healthcare
money
- Crisis make this conflict even more sharp (vb. Covid)
Budget - GDP = the value of all the products and services produced in
one your in a country (in euro)
- There is an increase in GDP that is spent on healthcare:
New technology
Demographic changes
Crisis (vb. Covid)
Recommend Optimize the health of the population within the limits of the
ed approach available resources and within ethical framework built on equity and
solidarity principles
- Health economics = people who deal with wise investments in
health
- Equity = two people with the same healthcare needs deserve
the same care so people who are more poor deserve more
help (not equality)
The current 5 1. Fragmentation of care (waste, less quality of care)
challenges of Healthcare providers are not working together (vb. GP to
most specialist)
healthcare 2. Overuse/misuse/abuse (waste, less quality of care) (!!)
systems (!!) Overuse = too much of the same pt with chronic heart
disease should see a cardiologist two times in a year but
they do 4 times
Misuse = pt needs a clinical evaluation but gets an RX
(unnecessary)
Abuse = cheating the system some nurses were charging
a pt in the weekend while they didn’t see a pt in the
weekend
3. Unprecedented demographics (threat for the budget)
Never seen before demographics = aging population, more
, multimorbidity, more chronic diseases,…
4. Technology push (threat for the budget)
New devices, new cost is more then the current medicine,
pressure on the budget
5. Unequal access to care (lack of solidarity and threat for the
budget)
Lack of solidarity people with more money have more
access
Additional challenge
6. Quality of life of healthcare providers (declined further since
covid)
Correlation between QoL on the job (vb. Burnout) and safety
of patients
Examples of Expensive
new health - Regenerative medicine
technologies - Genetic treatments
- 3D-printing
Helps save a lot of money
- Robotization
- Virtual techniques
- Augmented reality
Typical 1. Uncertainty
characteristi Becoming sick is uncertainty or if you are better or worse
cs of the tomorrow
health care Need for health insurance
system In Belgium we are all insured insured against the
financial loss if we would become sick
Some people show moral hazard = having no problem
with getting more care than you actually need (vb.
Visiting 4 different specialists for the same problem)
Solution: ask to pay at least a little part of the cost =
REM-geld
Too little = doesn’t do the job it was made for
Too high = some people drop useful care
But: within chronic patients the shift of financial
responsibility leads to an underuse of potential important
medications BUT also an increase in appropriate use and
adherence of drugs
In Belgium: 20% out of pocket
2 kinds of countries
Bismark system = health insurance (Belgium)
Beveridge system = government led health system (UK)
2. Asymmetric information
The supplier knows much more about it then the demander
(patient)
Risk = supplier-induced demand: risk of overuse and
unnecessary health care for personal wealth: more
money if they induce demand
Main factors of supplier-induced demand
1) Reason = poor monitoring and control when there’s
heavy control, there is more difficulty to do it
2) Free-for-service payments system
3) Asymmetrical information = when clinicians know more
then pt’s
, Where is the highest risk for supplier-induced demand
Recommending health services by another professional
Recommending health service performed by themselves
ANSWER: they can make themselves more wealthy
Example: in the last 30/180 days of a cancerpatient, how
many did they spend in
the hospital Belgium
scores the highest
= difficult
temptation to attract
people increases
nurses already have an
overload vicious
circle
Vicious circle of this problem (!!)
Hospitals started saving on staff (less staff for more
patients)
Attract more patients to maximize patient admissions
(empty bed doesn’t give any money) increase
revenues (= inkomsten)
Optimizing the patient coding = giving patients worse
coding then the patient actually was (more severe then
how it was), so they got more money per patient
Policy see this healthcare costs us more money
starting policies to save even more money in healthcare
3. Externalities
We are not only concerned about our own health, but also
with the health of others – 3 reasons why:
1) Paternalistic reason (vb. We pay for it, so we want good
health)
2) Altruistic reason (vb. Because we care about others)
3) Egoistic reason (vb. So people don’t infect you when
they’re sick)
Ppl with the lowest income have a 50% higher chance to die
then the highest income quintile (+ more chance to be
disabled, hospital admissions, psychiatric admissions, less
screening, les dental care)
AROP (at risk of poverty = 15%) = 13% more chance to
postpone cancer treatment due to the financial reasons
20% of the total costs of healthcare is due to inequity
The possible policy response
6 things 1. Selecting the right healthcare system
policy 2. Integrated care
makers can 3. Strong primary care
do 4. Change financial incentives
5. Influence out of pocket payments
6. Invest in prevention
Selecting the right healthcare system
Belgium - Compulsory income-related contributions (taxes) higher
earners contribute more
