germanys experience version 2[1]
TRANSCRIPT
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Germany’s experiences in tackling NCDs in the context
of an aging population
Prof. Dr. Steffen Flessa Department of Health Care Management
University of Greifswald
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Contents
1. Demography and Health 2. Strategies 3. Conclusion
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1. Demography and Health 1.1 Aging: concept
• Aging: Aging is a multidimensional process of physical, psychological, and social change over time.
aging is not only a question of age – but it has a lot to do with it!
Germany: one of the
oldest populations
in the world!
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Demographic Transition
Rate
Phase II Phase III Phase IV Phase
Gross death rate
1 %
Gross brith rate
5 %
Phase V time
Germany: • crude birth rate:
8.8/1000; • crude death rate:
9.2 /1000;
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0
2
4
6
8
10
12
14
16
18
20
1950 1960 1970 1980 1990 1998 1999 2000
Life
Birt
h pe
r 100
0
Year
Reason 1: Low Birth Rate
Germany Total Old States New States
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Reason 2: medical progress
Women [years]
Men [years]
Life Expectancy [years]
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Consequences: NCDs
80 70 60 10 20 50
susceptibility
time [years] … birth
NCD
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Epidemiological Transition
0
20
40
60
80
100
0 20 40 60 80 100 120
Incide
nce an
d prevalen
ce [%
]
Time of Epidemiological Transition [year]
Incidence, Infectious diseases Incidence, NCD
Prevalence, infectious diseases Prevalence, NCD
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Causes of Death (Men 2007)
150472; 38%
113405; 29%
30219; 8%
21029; 5%
19067; 5%
56947; 15%
Cardio-‐Vascular
Cancer
Respiratory
Digestive
Accidents
Other
http://de.wikipedia.org/w/index.php?title=Datei:Todesursachen_01.svg&filetimestamp=20100227122441#file
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1.2 Aging: a blessing
• 1514: • 63ys old woman
• 2011 : • 77ys old woman
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1.3 Aging: a curse
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Health Care Cost and Age
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Increase of Demand (Western Pomerania, 2005-2020)
NCD Increase of Demand
Hypertension +6.2%
Diabetes +21.4%
Myocardial infarction +28.3%
Stroke +18.0%
Osteoperosis +19.5%
Dementia +91.1%
Cancer (total +22.6%
Cancer (rectal) +31.0%
Source: Hoffmann 2011
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• Direct Cost of Dementia in Germany [€ p.c. p.a.]
Source: Schulenburg et al. 1998; Jönsson/ Berr 2005.
1.4 Example: Dementia
Medical cost
ca. 1.935 €
Non-medical cost
(accommodation, counselling etc.)
ca. 11.685 €
~15%
~85%
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• Strongly increasing cost in stages
Source: Schulenburg et al. 1998; Quentin et al. 2009.
Prognosis
Mild (MMSE 20-25)Moderate (MMSE 11-15)
Severe (MMSE <= 10)
02.0004.0006.0008.000
10.00012.00014.00016.00018.00020.000
Schweregrad
Kos
ten
[EU
R]
Cost
p.a
. p.
c. [€]
Severity
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2. Strategies
• Overview: – Social Insurance: Long-term Nursing – Training of specialists in geriatrics (doctors, nurses,
etc.) – Homes of the elderly und mobile care – Life-long learning of human workforce – Deferred Retirement – Combat infectious diseases – Individualized Medicine und paradigm shift: Multi-
Cause-Multi-Effect Paradigm – Strengthen Prevention
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2.1 Deferred Retirement
0
10
20
30
40
50
60
70
80
90
Zeit 1960 1970 1980 1990 1995 2000 2010 2020 2030 2040
time [year]
popu
latio
n Ge
rman
y [m
illion
]
< 20 years 20-<60 years >59 years
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0
10
20
30
40
50
60
70
2000 2010 2020 2030 2040 2050
work
ing
popu
luat
ion
time [year]
20-35 years 36-50 years 51-65 years
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0
10
20
30
40
50
60
70
2000 2010 2020 2030 2040 2050
work
ing
popu
luat
ion
time [year]
20-35 years 36-50 years 51-65 years
We must keep our key-agent of production in the process – but this requires investments!
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Investments in Health
• Physical – Focus on Prevention – Fostering health promotion
• Mental – Keeping workers creative requires transitional
leadership! • Spiritual
– A sense of meaning, appreciation and contribution! Aging is not simply a medical problem – it requires a new paradigm of leadership!
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2.2 Combat infectious diseases
• Old people have more infectious diseases – Sepsis – Pneumonia – …
• “Young” old people have new risks: – HIV and Viagra
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2.3 Individualized Medicine und paradigm shift
• Old patients are multi-morbid – >65: average more than 6 drugs, max. 21 – Side-effects: unpredictable
• Treatment depends on many factors: there is no “one-fits-all-medicine” anymore! – Genomics – Proteomics – Metabolomics – …
• A new mind-set: Chronic-degenerative diseases require a multi-cause-multi-effect paradigm of medicine!
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2.3 Individualized Medicine und paradigm shift
• Old patients are multi-morbid – >65: average more than 6 drugs, max. 21 – Side-effects: unpredictable
• Treatment depends on many factors: there is no “one-fits-all-medicine” anymore! – Genomics – Proteomics – Metabolomics – …
• A new mind-set: Chronic-degenerative diseases require a multi-cause-multi-effect paradigm of medicine!
• But: very, very expensive! • Do not use the health care system of any other country as blue-print: it is too expensive!
Develop your own cost-effective basic package of treating NCD!
Use your ressources as efficient as possible!
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2.4 Strengthen Prevention
0
5
10
15
20
25
30
35
0 20 40 60 80 100 120
Share of prevention bu
dget in to
tal
health ca
re bud
get [%]
Time of demographic transition [years]
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2.4 Strengthen Prevention
0
5
10
15
20
25
30
35
0 20 40 60 80 100 120
Share of prevention bu
dget in to
tal
health ca
re bud
get [%]
Time of demographic transition [years]
Prevention and Primary Care are not the “Medicine
of the Poor” but a very efficient paradigm for
aging societies!
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3. Conclusion
• An aging society will induce a higher share of non-communicable diseases.
• An aging society is a blessing – but it requires wise planning, political commitment, strong leadership, cost-effective interventions.
• Health care financing and social protection are crucial!
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Germany is gaining experiences with its aging
population and their NCDs – can we share insights?