DAY 3
TUESDAY – 25th of September

08.00 – 09.00 Business Breakfast II.  
Event partner - ORACLE


09.00 – 11.00 Section 4
CONSUMER CONTROL OVER HEALTHCARE SPENDING ON THE PROVIDER MARKET

Why consumer control is important? - case studies from CEE
Pavel Hroboň
(Advance Institute,Czech republic)
 Presentation (password needed)

CV
Pavel is a founder and managing partner of Advance Healthcare Management Institute, a company specialized in executive education in healthcare. Until 2009 Pavel served as a deputy to the minister of health of the Czech Republic, responsible for health insurance and reimbursement of drugs and medical devices. In the same time Pavel was a non-executive member of the board of the General Health Insurance Fund of the Czech Republic. In 2005-2010 Pavel was a member of the European Health Innovation Leadership Network, a high level forum of payers, regulators and producers in the area of pharmaceutical policy. Pavel is co-founder and former chairman of Health reform.cz, a think-tank aiming to propose and support implementation of patientcentred improvements of healthcare systems. In 2002–2004, Pavel advised the CEO of the General Health Insurance Fund of the Czech Republic (VZP) and in 2005 worked for VZP as a director of strategy. In 1998–2002, Pavel worked as a consultant for the Prague office of McKinsey & Company. At McKinsey, he advised clients in health are, insurance and banking in several European countries.Pavel has an MD from the Charles University in Prague and a master of science degree in health policy and management from the Harvard School of Public Health. Pavel also has experience practicing medicine and teaching public health at the Charles University in Prague.

Summary
Consumer control is a possible way for increasing consumer preferences leading to higher values, reducing unnecessary care and collecting additional funds in a transparent way. Consumer control can be implemented through (1) consumer cost sharing at the point of service (copayments, coinsurance, deductibles), (2) consumer choice of an insurance product reflected by a nominal premium and (3) health reimbursement/savings accounts.
Prerequisites for introducing consumer control in a successful way are: (1) the definition of services covered by the system, (2) price transparency and (3) basic data on provider performance. For achieving transparency, an “information infrastructure” must be in place.
In the Central and Eastern European region these concepts may not be fully accepted by the public. Consumer cost sharing was a political disaster in several countries of the region. As for the choice from a wide variety of insurance products, this option may be more acceptable, however, it requires political oversight. Savings accounts are not a system-wide option in the CEE yet. 

Why are High Deductible Health Plans so popular in USA? - case study from USA
Amy Bergner
(Mercer, USA)
 Presentation (password needed)

CV
Amy Bergner is an attorney and Partner in Mercer’s Washington Resource Group where she leads a team of legal professionals helping clients and consultants on health and welfare benefits matters. Amy has a broad range of experience covering US legislative and regulatory developments affecting health and welfare benefits, and helping clients understand the strategic and practical implications of these developments. Since 2009, she has focused her attention on US federal health reform, and is one of Mercer’s federal and state health reform leaders, helping clients to understand developments, analyze the impact on their organizations, and develop strategic and operational implementation plans. She over 20 years of experience working on health and group benefit plans, including health savings accounts (HSAs) and other consumer-directed health plans, and retiree medical plan issues. Her clients have included public and private corporations, non-profit organizations, universities, state governments, third-party administrators, and business and trade associations. Before joining Mercer, she was an attorney with the Washington, DC office of global law firm Reed Smith, and a Director in Pricewaterhouse Coopers’ global human resources practice. 

Summary
Consumer-driven health plan (CDHP) refers to health insurance plans that allow members to use account-based arrangements or personal resources to pay certain healthcare expenses directly. A high-deductible health plan (HDHP) protects them from catastrophic medical expenses.
Nowadays, there is a new trend in the US that more employers are offering consumer-directed health plans. The expectation is that under the current healthcare reforms, this trend will even accelerate.
There is a positive development in the growth of total benefit cost per employee. While in 2011, this growth reached the level of 6.1% in comparison to the previous year, in 2012 this growth slowed to 5.7%. However, this growth is still greater than the rise of inflation and wages.
As a consequence of these developments, costs are being controlled and a sustainable culture of health is being implemented with the following:
• Greater individual financial responsibility
• Behavior change
• Consumer engagement and information
The result is that health savings accounts are becoming an attractive health plan, because they cost about 20% less than other medical plan types.
Furthermore, more employers are currently offering incentives in wellness and health management programs (33% of employers with 500 or more employees and 52% with 10 000 or more employees).

Consumer loans to finance healthcare services - case study Slovakia
Tomáš Jakubík
(Clinica Orthopedica, Slovakia)

 Presentation (password needed)

CV
Orthopaedic specialist with top specialisation in the field. He started his career as a sport doctor in a first-league club, improved his professional standards at the Orthopaedic Clinic in Bratislava, and at numerous professional scholarships abroad, mainly at the most famous Orthopaedic Clinic in Houston, Texas. He has focused on injuries in sport and has worked as member of the international project team studying surgical treatments of foot deformities.

Summary
In the European Union healthcare is one of the most expensive sectors of the economy and despite of this, participation of patients on co-financing is limited. In order to achieve efficiency, there is a need for (1) economization of management processes, (2) rationalization of managements between departments and (3) savings on facilities, personnel and equipment.
The business environment in the healthcare sector is featured by:
• guaranteed free provision of care
• high expenditures
• high prices of medical equipment and materials with low revenues of hospitals
• EU funds flowing mostly to facilities outside of Bratislava
• New regulations and rules with the change of government
• Criminalization of health professionals and corruption
• Decreased number of professionals
• Costly procedures and long waiting times
In this respect, private healthcare can enable an improvement through direct savings (participation of the patient) and quality of care (subsequent cost savings, swift return to jobs).
Solutions for increasing the quality of healthcare are: (1) participation of patients on the decisions in the sector, as well as (2) designing the basic benefit package.

Panel Discussion with Speakers led by Jim A. Rice
(Management Sciences for Health, USA)


11.00 – 11.30 Coffee break

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