Nanna Skovgaard's (Danish Ministry of Health) presentation about Health Economics in the Danish Ministry of Health.

1. Presentation Title Goes HereHealth Economics in the Ministry of Health
Nanna Skovgaard, Head of Division
Visit from Belgium
April 20, 2015

2. “What, how and why” of health economics
Long term
structural changes
More value for
money
Economic
incentives
Coordinated changes
in organisational,
physical and
technical
infrastructure and
capabilities
Promote
transparency
Activity
Resources
Results
What we
work with
How we do it
Short term Long term
Why we
do it

3. 1. Key figures
2. Expected gains
3. Main areas of change
4. Initial challenges
5. Reshaping the landscape of health
care in Denmark
The Super Hospital Programme

4. Key figures – budget and number of projects
Government
€ 3,6 billion
€ 6 billion budget - 16 building projects
Region of
Southern
Denmark
North
Denmark
Region
Central
Denmark
Region
Region
Zealand
Capital
Region of
Denmark
Regions
€ 2,4 billion 20 per cent of budget reserved
for investments in ICT and
medico-technical devices

5. Key figures – expectations
Expected developments in hospital activity 2007-2020
- Reduction in average bed days from 3,5 to 2,9
- 50 per cent increase in outpatient treatment
- 20 per cent reduction in number of beds

6. Key figures – expectations vs. actual developments
4,000
4,500
5,000
5,500
6,000
6,500
7,000
7,500
Numberofbeds
Year
Number of beds, 2007-2020
Actual development, 2007-2013
Linear extrapolation of actual development
Initial expected development (-20% 2007-2020)
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
10,000,000
11,000,000
Outpatienttreatment,no.ofcases
Year
Outpatient treatment, 2007-2020
Actual development, 2007-2013
Linear extrapolation of actual development
Intial expected development (+50%, 2007-2020)

7. Unique patients vs. bed days (2009 = index 100)
80
85
90
95
100
105
110
115
120
2009 2010 2011 2012 2013
Uniquepatients
Year
Cancer
Patients
Bed days
80
85
90
95
100
105
110
115
2009 2010 2011 2012 2013
Uniquepatients
Year
Cardiovascular diseases
Patients
Bed days
80
85
90
95
100
105
110
2009 2010 2011 2012 2013
Uniquepatients
Year
COPD
Patients
Bed days
80
90
100
110
120
130
140
2009 2010 2011 2012 2013
Uniquepatients
Year
Type II diabetes
Patients
Bed days

8. Main areas of change
Three areas of change
- New hospital structure: 50 per cent reduction in number of
emergency departments
- New organisation: The specialist in front
- New division of labour in the health care system

9. Expected gains
We expect improvements in
- Patient flow
- Patient safety
- Efficiency
- Quality
By spending
- more resources on early diagnosis and
treatment
- Less resources on hospitalisation

10. Initial challenges and drivers of change
Initial challenges Actions
Funding dependent on
regional commitment to
structural reform
Strict supervisory regime
Efficiency gains as condition
for approval of project
Closing local hospitals
”Over time, over budget,
over and over again”
Secure return on
investment
Regions as partners in
structural reform
Promotion of innovation
Opportunity to rethink
what we do and how
Drivers of change

11. Expected efficiency gains
% of total efficiency gains
100
80
60
40
20
0
Total for 6 building
projects
756
38
16
6
32
9
7
2
3
11
4
Optimised patient journeys/length of stay
Logistics/IT
Satisfaction among staff
Patient safety
Centralisation of funktions (not mergers)
Energy and water consumption
Building maintenance
Cleaning
Transport
Mergers
Fewer sites
2
1
3
Optimised patient journeys make up 38%
of the total savings
The projects see different efficiency
possibilities
65%
20%
15%
% of total efficiency gains
100
80
60
40
20
0
Hvidovre
58
26
16
21
17
17
Gødstrup
158
322
191
Herlev
62
65
214
15
47
20
4
6
15
8
43
46
Kolding
8
0
Aalborg
15
6
13
12
OUH
26
7
157
10
295
10
71
13

12. Logistics and tracking technology
Electronic registration boards for emergency care in all hospitals

13. Reshaping the healthcare landscape
- From castles to lighthouses

14. Telemedicine – an example
Telemedical ulcer assessment: The method
- The nurse photographs the ulcer with her cell phone and
mails the image to the doctor.
- The doctor prescribes new treatment or new medication.
- Communication between nurse and doctor is based on a
shared web based patient record.
- Positive Business case:
- 30 per cent reduction of healing time
- fewer visits by the municipal nurse
- fewer outpatient visits to the hospital
- 50 per cent reduction in number of amputations

15. Telemedicine – an example
Telemedical ulcer assessment: The pay-offs
Patients:
- High satisfaction
- Less travelling
- Can log on to shared web record, monitor own treatment
Nurses
- High satisfaction
- Improved ulcer care skills from the direct communication
with the experts in hospital
Doctors and specialists in hospitals
- Only see the most complicated ulcers
- More exciting jobs, better use of public resources

16. New eHealth strategy 2013-2017
22 initiatives within 5 focus areas:
1. Better use of e-health systems - ”no
more paper” with in hospitals
2. Connected care: Better cross sector
cooperation
3. Better use of health data
4. Patient empowerment - treatment at
home and patient-centred data
5. Transparency on progress/commitment

17. Shared Medication Record
• One national database:
updated information about
prescription medicine for all
patients in Denmark
• Access for all doctors, nurses,
pharmacists and hospitals.
• Viewing access for citizens
(own data)
• Fully implemented in all
hospitals and GPs in 2014, all
municipalities in 2015
Background:
• Reducing number of medication errors
• Better communication about medicine
between all involved parties
• Improving quality of the treatment

18. Use of Shared Medication Record
Working with transparency – an example

19. New North Zealand Hospital

20. Thank you for your attention