Innovation in European healthcare â what can Sweden learn? - LIF

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Health services in England are mainly financed through taxes • Primarily funded by general taxation and National Insurance contributions. • Some care is funded privately through private medical insurances (PMI), – some user charges, cost sharing and direct payments for health care delivered by NHS and private providers. • Health expenditure in the United Kingdom has risen significantly in recent years, with total spending on health care as a proportion of gross domestic product (GDP) increasing from 5.6% in 1980 to 8.7% in 2008. • Each year, the Department of Health allocates around 80% of the total NHS budget to PCTs using a weighted capitation formula. • Since 1999, there have been significant changes to the way in which PCTs pay for health services, particularly in the hospital sector, with the introduction in 2003–2004 of activity- based funding – developed in England as a system known as Payment by Result (PbR). • The NHS spends about £1,980 for every man, woman and child in the UK per year • In 2009–2010, of estimated total NHS current expenditure of £99.8 billion, £88.5 billion (88.7%) was expenditure on NHS bodies (e.g. NHS trusts, GPs, dentists), £9.7 billion (9.7%) was on centrally-managed budgets (e.g. Connecting for Health), and £1.5 billion was on funding personal social services (1.5%); in addition the NHS had a capital budget of £5.5 billion. • In terms of out-of-pocket payments, while most NHS health care is free at the point of use, some services are either not covered by the NHS and patients must, therefore, pay themselves (direct payments) or are covered by the NHS but are subject to cost sharing, usually in the form of copayments. • Most out-of-pocket payments by individuals are direct, with some 41% devoted to over-thecounter medicines, while user charges for NHS services are the largest part of co-payments, accounting for 13% of the total. 118
Today the PCTs are the main purchaser of healthcare in the UK – tomorrow it will be the GPs - Clinical Commissioning Groups Department of Health NHS Executive NHS Regional Offices Department of Health NHS commissioning Board Special Health Authorities 83 per cent of the total NHS budget controlled by primary care trusts (PCTs) Strategic Health Authorities Primary Care Trusts Foundation Trusts Local authorities Local Health Boards Regional Outposts Money flows via GPs Care Quality Commission Clinical Commissioning Groups Monitor Care Trusts Mental health Trusts Acute Trusts Ambulance Trusts Care Trusts Mental health Trusts Acute Trusts Ambulance Trusts PCTs reduced from 300 a few years ago, 150 recently, 50 today 119 Foundation Trusts Foundation Trusts Foundation Trusts
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Innovation in European healthcare -
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Introduction If it was up to the NI
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GDP per capita 2011, thUSD Annual G
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Import Technology uptake Export End
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Venture capital flight away from li
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Issues in Sweden: clinical research
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Issues in Sweden: communication and
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Issues in Sweden: reimbursement for
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Summary - the innovation challenges
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InDex Pharmaceuticals InDex Pharmac
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Addressable Patient Population in E
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What conclusions can be drawn from
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Elekta has established a model for
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The five European countries 27
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German healthcare system • German
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Role of important Government and Of
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Role of important Government and Of
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Germany needs more healthcare for t
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37 DRG was developed in the US in t
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The base rate varied during the con
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There are public, private for profi
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Financing System of the German SHI
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Central Changes in the German healt
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Innovations in the German Health Ca
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Cost of Pharmaceuticals and Medical
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Three steps for Integration of New
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NUB Process in the German DRG Syste
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Innovative drugs in the outpatient
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Implementation and use of innovativ
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Innovations in the outpatient secto
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Implementation and use of innovatio
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Page 67 and 68: New possibility of testing potentia
Page 69 and 70: Structural Innovations in the Inpat
Page 71 and 72: Structural Innovations in the Outpa
Page 73 and 74: During the last ten years two centr
Page 75 and 76: France The healthcare system in Fra
Page 77 and 78: Financing of the French health care
Page 79 and 80: The French medical device industry
Page 81 and 82: The French Medical Devices Market:
Page 83 and 84: The average time necessary to get a
Page 85 and 86: Shortening the reimbursement proces
Page 87 and 88: A successful solution to provide ad
Page 89 and 90: 2. Pharmaceuticals 89
Page 91 and 92: Hospitals carry out more and more o
Page 93 and 94: ATU System: Off label use Exemption
Page 95 and 96: 3. Financial incentives and reimbur
Page 97 and 98: The evaluation of new products by t
Page 99 and 100: Some particularly expensive drugs a
Page 101 and 102: In hospitals, expensive and innovat
Page 103 and 104: The impact of T2A on innovation Act
Page 105 and 106: The Support for Innovative and Cost
Page 107 and 108: Financing innovation through the Pu
Page 109 and 110: 8 clusters specialised in the healt
Page 111 and 112: Medical Devices’ Patenting: less
Page 113 and 114: The example of the SAAT Conectus Al
Page 115 and 116: The UK The healthcare in the UK is
Page 117: The NHS is underpinned by a set of
Page 121 and 122: Prior to the Health and Social Care
Page 123 and 124: Primary Care Trusts (PCTs) have pla
Page 125 and 126: The new national level bodies overs
Page 127 and 128: The NHS, must deliver efficiency sa
Page 129 and 130: PbR was first introduced in 2005/06
Page 131 and 132: The design of HRG4 reflects a signi
Page 133 and 134: PbR is being incrementally reformed
Page 135 and 136: NHS-funded primary care is provided
Page 137 and 138: The Quality of Outcomes Framework (
Page 139 and 140: The Health and Social Care Act (201
Page 141 and 142: The United Kingdom is a major produ
Page 143 and 144: £m Healthcare industries are clust
Page 145 and 146: Several bodies aim to improve the k
Page 147 and 148: National Institute for Health and C
Page 149 and 150: Overview of key NICE assessment pro
Page 151 and 152: NHS National Technology Adoption Ce
Page 153 and 154: “Innovation” has central place
Page 155 and 156: Bodies to support innovation in hea
Page 157 and 158: The UK is a world-leader in life-sc
Page 159 and 160: There still exists large regional v
Page 161 and 162: UK rankings and usage as a percenta
Page 163 and 164: Multiple structural layers within N
Page 165 and 166: NHS lacks control mechanism for imp
Page 167 and 168: Short-term budget-cycles often are
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Actions described by respondents du
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Actions described by respondents du
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Actions deriving from the review
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The following measures were suggest
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The planned compliance regime is ge
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Actions to incentivise innovation t
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NICE’s HTA process: NICE’s stan
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The implementation of NICE guidelin
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Implementation: A recommended proce
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The NHS Technology Adoption Centre
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The Government has invested a recor
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The Government’s funding has also
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Case 2: AstraZeneca and NIHR Cancer
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The NIHR has also established Healt
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As part of the Government’s Life
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All applications for the Biomedical
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NOCRI has worked together with MRC
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Academic Health Science Centres (AH
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What can Sweden learn from the UK?
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Facts - the proportions of Danish h
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The Danish healthcare system is pri
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Public-private investments in R & D
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The Danish healthcare industry is a
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Public investments in the future st
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The public renewal fund is meant to
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With the responsibility for adminis
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Organisational chart - the capital
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The Innovation environments invest
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Overall the innovation environments
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Sara established a successful busin
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Infrastructure for Innovation - The
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The networks consist of 22 innovati
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The overall Danish Innovation infra
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The new market maturing-fund will h
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The new Danish Innovation strategy
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Subsidy for new outpatient medicame
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The evaluation and assessment of ne
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Cost reduction in expensive hospita
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The public procurement of Medtech -
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Innovative public procurement of Me
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What can Sweden learn from Denmark?
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The Netherlands are spending more o
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Health insurers are allowed to make
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Financial flows in the Dutch health
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Impact of the reform on providers
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Impact of the reform on patients/in
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Impact of the reform The Dutch heal
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Innovations in the Dutch healthcare
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The reimbursement system should all
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Summary and conclusions 277
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There is a correlation between a co
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Conclusions - what can Sweden learn
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Two general recommendations and one
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Innovation in European healthcare â what can Sweden learn? - LIF

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