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

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Summary and conclusions – five European countries • There are two main systems for financing on healthcare in Europe: through statutory health insurers, or through taxes. The method for financing influences the preferred instrument to support innovation: – Countries with statutory health insurance tend to rely on the reimbursement system – Countries with tax financed healthcare put emphasis on the infrastructure for innovation. • All European countries are struggling to improve the productivity of healthcare, and they have all experienced that the consequence of this is that the room for innovation in the healthcare system has shrunk. • Germany is an interesting example of a country that introduced reforms for increased productivity – while at the same time opening up new channels for innovation. • Countries with statutory health insurance have a multitude of providers and innovation is part of the individual provider’s competitiveness. • Countries with tax based healthcare have large variations in the technology uptake and innovation. • The effects of measures to support innovation are difficult to detect and evaluations of innovation policies are based on proxies. The UK is the only of the five countries that has made a serious attempt to evaluate results. • There are lessons to be learned from each of the analysed countries, the two most important being: – The reimbursement system should be used to drive innovation – The healthcare system must consider innovation and clinical research to be part of their overall objectives. 278
There is a correlation between a country’s system for financing of healthcare and the preferred mechanism for innovation Statutory health insurance Healthcare financing Tax Countries with a statutory health insurance have been found to be more inclined to use structured financial incentives and reimbursement to promote innovation and create a desired behaviour. In tax based systems, local budgets tend to take precedence over national recommendations Countries with a statutory health insurance generally have diversity in healthcare provision, with a multitude of providers – private and public Infrastructure Reimbursement Preferred mechanism for innovation 279
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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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New possibility of testing potentia
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Structural Innovations in the Inpat
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Structural Innovations in the Outpa
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During the last ten years two centr
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France The healthcare system in Fra
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Financing of the French health care
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The French medical device industry
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The French Medical Devices Market:
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The average time necessary to get a
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Shortening the reimbursement proces
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A successful solution to provide ad
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2. Pharmaceuticals 89
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Hospitals carry out more and more o
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ATU System: Off label use Exemption
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3. Financial incentives and reimbur
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The evaluation of new products by t
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Some particularly expensive drugs a
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In hospitals, expensive and innovat
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The impact of T2A on innovation Act
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The Support for Innovative and Cost
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Financing innovation through the Pu
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8 clusters specialised in the healt
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Medical Devices’ Patenting: less
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The example of the SAAT Conectus Al
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The UK The healthcare in the UK is
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The NHS is underpinned by a set of
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Today the PCTs are the main purchas
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Prior to the Health and Social Care
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Primary Care Trusts (PCTs) have pla
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The new national level bodies overs
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The NHS, must deliver efficiency sa
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PbR was first introduced in 2005/06
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The design of HRG4 reflects a signi
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PbR is being incrementally reformed
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NHS-funded primary care is provided
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The Quality of Outcomes Framework (
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The Health and Social Care Act (201
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The United Kingdom is a major produ
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£m Healthcare industries are clust
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Several bodies aim to improve the k
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National Institute for Health and C
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Overview of key NICE assessment pro
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NHS National Technology Adoption Ce
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“Innovation” has central place
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Bodies to support innovation in hea
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The UK is a world-leader in life-sc
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There still exists large regional v
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UK rankings and usage as a percenta
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Multiple structural layers within N
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NHS lacks control mechanism for imp
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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
Page 227 and 228: Sara established a successful busin
Page 229 and 230: Infrastructure for Innovation - The
Page 231 and 232: The networks consist of 22 innovati
Page 233 and 234: The overall Danish Innovation infra
Page 235 and 236: The new market maturing-fund will h
Page 237 and 238: The new Danish Innovation strategy
Page 239 and 240: Subsidy for new outpatient medicame
Page 241 and 242: The evaluation and assessment of ne
Page 243 and 244: Cost reduction in expensive hospita
Page 245 and 246: The public procurement of Medtech -
Page 247 and 248: Innovative public procurement of Me
Page 249 and 250: What can Sweden learn from Denmark?
Page 251 and 252: The Netherlands are spending more o
Page 253 and 254: Health insurers are allowed to make
Page 255 and 256: Financial flows in the Dutch health
Page 257 and 258: Impact of the reform on providers
Page 259 and 260: Impact of the reform on patients/in
Page 261 and 262: Impact of the reform The Dutch heal
Page 263 and 264: Innovations in the Dutch healthcare
Page 265 and 266: The reimbursement system should all
Page 277: Summary and conclusions 277
Page 281 and 282: Conclusions - what can Sweden learn
Page 283 and 284: Two general recommendations and one
Page 285: www.vascoadvisers.com Supported by
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