Digitalization an an important factor to ease the access to Services of general interest. The case of E- Health Presentation within the framework ...

Digitalization an an important factor to ease the
access to Services of general interest. The case of E-
Health

Presentation within the framework of EUSALP-
conference „Digital Alps Conference“, 27th Mai 2021

By Prof. Dr. Gabi Troeger-Weiß

Approaches
    to (semi-digital and digital) health care from the perspective of
                      the baby boomer generation

2

Access

         Equivalent living conditions
                Demography
             Supply of rural areas
    New challenges posed by the pandemic

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Services of general interest
               - broad spectrum
    with only partial access to digitiziation

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   Retail and everyday supply/local supply
       Education (schools, kindergartens)
       Water and energy supply
       Waste and sewage disposal
       Public and private local and long-distance transport
     Postal and telecommunications (including broadband) and credit
        institutions
     Social services (e. g. care for the elderly and children)
     Health and medical care
     Emergency services, civil protection and fire protection
     Recreational facilities, community facilities (e.g. culture, sport).

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6

Demography

 Ageing of the population
 Small increase in younger population groups due to an increase in births –
  slight positive trend in natural population development
 Emigration, especially of younger population groups
 Decrease in net migration in all age groups, but especially in the 30-50
  age group

Pandemic
     Importance of decentralised structures (e.g. hospitals – small houses as
      reserve supply (overflow function – services of general interest)
     Changing behaviour
     Mobility behaviour
     Working behaviour – home office – independent work – mobile work – office
      buildings
     Migration behaviour – trend towards second residence in rural areas
     Leisure and travel behaviour (German holiday regions; bicycle boom)

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Initial situation from a regional and local perspective:
     • Digitalisation of all areas of life and structure
     • High dynamism in many economic and social areas
        Ageing and new needs in the field of services of general interest and mobility
        Shortage of skilled workers, including doctors

        Differentiated and individually different migratory movements with different effects on rural
         areas and metropolises

    Challenges for regions:
    • Creation of equal living conditions

    • Safeguarding services of general interest in various areas

    • Increasing the attractiveness of regions

    • Maintenance of local (especially medical) care structures

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Initial situation in the (German) healthcare sector
                         - an overview

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Outpatient and inpatient services
              - 3 large areas

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Ambulante allgemeinmedizinische und fachmedizinische Versorgung

   Medical practices with a doctor: (age-related) Closure of practices of
    general practitioners and specialists without succession arrangements
    (lighter density of practices – longer distances to travel – challenge for
    older population groups)

   Medical care centers (MVZ) with (mostly) employed doctors (team
    orientation) and connection to a hospital: due to economic considerations,
    usually in upper centres, if necessary also in middle centres

   Medical practices in a network – medical centres offering general and
    specialist medical services (different medical disciplines partly with
    operative services) based in upper and middle centres, partly also in rural
    areas

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Public or private inpatient medical care

• Hospitals with different levels of care (in Germany I-IV):
          - University hospitals and maximum care
          - Hospitals of regular care
          - Hospitals of primary care

   Different types of sponsorship: state, municipal special purpose associations,
    private

   Maintenance of small municipal hospitals and district clinics (“overflow”
    function – catching function)

   Privately run clinics, mostly specialized in 2-3 areas (e. g. cardiology, orthopaedics,
    etc. ), with high numbers of cases – in Germany oligopoly market (Helios, Rhön,
    Asklepios, Schön, Mediclin, Sana and others)

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Reha-clinics and Medical Services

   Reha-clinics of different disciplines in public funding (German pension
    insurance or health insurance funds)
   Private rehabilitation clinics (Medical Park, Schön Kliniken, and others)

   Pharmacies: stationary pharmacies and digital pharmacies (DocMorris)
   Medical/health services (physiotherapies) and others)
   Nursing services (e.g. care of the elderly)

The (general) medical care
     - Current challenges, especially in rural areas

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Special problems of medical care:
        10,000 missing family doctors in Germany (source: KBV*)
        50% of all family doctors in Germany will retire by 2030 (source: KBV*)
        Threatened and decided hospital closures

     Result
      Medical care Threatened, especially in rural areas

     The need of action:
      Policymakers at local and regional level must also act regulating and pro-active

      Local decision-makers need to develop a set of measures to: To influence the location
       decisions of young doctors

      Active acquisition of doctors (resettlement and decision to stay/maintain a location
                                                                                   *Federal Association of Cashers

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Decision criteria of doctors for practice locations:

       Quelle:
       Survey among doctors according to relevant criteria of the practice location from 10 th September 2019 to
       13th october 2019 by Civey-Institut Berlin

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Digital ambulatory medical services of general interest:
              Target group Baby Boomer Generation

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Initial situation from the perspective of a
     population group - Baby boomer:

     In the coming years, the baby boomer generation will become an “ageing
     social cohort/social group” with specific socio-economic structures and
     behaviours:
         - Good education/high level of education/skilled workers
         - High quality standard of living
       - favourable income situation - e. g. through private pension provision
       - high (individual) mobility both in the family area and in the area of leisure
         and recreation (car ownership)
       - High health awareness (nutrition, regular precautions) and others)

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Initial situation:

      Regional Perspective:
      Ensuring efficient and financially sustainable services of general interest (including
      health care) as part of ensuring equal living conditions for the baby boomer generation

      Behavioral view:
      • Differentiated migration behaviour of the baby boomer generation
      • over 90% want to “live at home until last” according to empirical results - this means
        comprehensive medical and nursing services required at the municipal level
      • Residential locations vary greatly: Trend towards reurbanization? , living in large living
        spaces in suburban areas; trend towards a return to rural areas (e. g. Wunsiedel
        district in northern Bavaria)
      • Trend towards “split living” – winter and summer living

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Theses

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Thesen

     These 1:
     The group of baby boomers exhibits specific behaviours compared to other
     population:
     - groups (mobility, care, leisure, education, housing, health, etc. ).

     These 2:
     Due to the high level of mobility of the baby boomers (through leisure, holidays, family
     commitments, educational and cultural opportunities) digital forms of provision are
     becoming more important, especially in the field of healthcare.

     These 3:
     Digital services in the field of health Medical care is a determinant of the residential
     behaviour of baby boomers in rural areas. Health service providers (doctors, nurses,
     pharmacies, etc. ) and decision-makers at regional and local level need information
     on the residential behaviour of the baby boomers in order to be able to make
     demand-oriented and target-group-oriented decisions on the offer.

21

Percentage of
      50 to 60 year olds in
      the population by
      district, 2016

     https://www.koerber-stiftung.de/fileadmin/user_upload/koerber-
     stiftung/redaktion/koerber-demografie-
     symposien/pdf/2018/Broschuere_Koerber-Demografie-
22   Symposium_2018.pdf, page 5; 26th february 2020

Questions

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Questions
     Questions from the point of view of demand (baby boomer generation)

     • What is the role of (general) medical care for the baby boomer generation?

     • What role does (general) medical care play in the residential behaviour of the baby
       boomer generation in the face of mobile behaviour?

     • Which acceptance of digital forms of medical care exists among the baby boomer
       generation? Can the quality and accessibility of healthcare be improved by including
       telemedicine services?

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Questions
     Supply-side issues (policy makers)

     • What system criteria are used to locate doctors (in the case of resettlement,
       relocation and residence considerations)?

     • What is the relevance of medical care infrastructure for municipal development?
       Which choices and decisions made by doctors are relevant for municipal decision-
       makers?

     • What are the possibilities for influencing the location of medical care services
       (doctors, nursing facilities, municipal and private clinics)?

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Analysis steps:
     Analysis of patterns and structures of residential behaviour of baby boomers –
     Analysis of relevance for rural areas (see selection of region types)
      Analysis of the importance of outpatient, semi-digital and digital
       medical/medical services for the residential choice of baby boomers

      Analysis of patterns for the location selection of physicians

      Analysis of readiness to semi-digital and digital medical services by doctors
       in rural areas

      Analysis of the acceptance of the use of (semi-) digital medical services by
       baby boomers

      Analysis of the support of local authorities for the location selection of
       doctors and baby boomers

              Multifactorial, indicator-based Decision Support System

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Digitisation in the healthcare sector Digital ambulatory medical
      services of general interest - an example of future health care
                      for the baby boomer generation
                        - a project from Oberfranken

      The following project has been funded by the Bavarian State Ministry for Economic Affairs, Regional
      Development and Energy since 2018 and is being implemented by the regional development agency
                 Oberfranken Offensiv e. V. (project leader: Dipl. -Geographer Matthias Fischer)

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E-Health: Medical care as a basis of services of general
     interest in rural areas

     Initial situation in the health sector:
     • Old age of family doctors

     • Practice closures

     • Absence of succession arrangements

     • Long waiting times for a doctor’s appointment and at the doctor’s appointment (crowded
       practices)

     • No new general medical care in case of change of residence (rejection by doctor’s office)

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Project: Society 4. 0 – E-Health in Rural Areas: Objectives

            Ensuring efficient and financially sustainable services of general interest in the event of
             population decline

            Ensuring equal living conditions, in particular quantitative and quality assurance of services
             of general interest

            Cooperation in the form of cooperation and value chains as an opportunity, to maintain
             services of general interest

            Safeguarding the choice of place of residence of population groups essential services of
             general interest

            Improving the quality and accessibility of health care by including telemedicine services

Seite 29

Society 4. 0 – Healthcare 4. 0

           Source: Oberfranken Offensiv e.V., July 2018

Seite 30

Healthcare 4. 0: Advantages for users

            Time-independent response to messages
              No “disruption” of the process by calls
              Answer can be given “time-shifted”

            Time saving, as no phone calls are necessary

            Time savings by eliminating “travelling time”

            Video consultation enables direct contact with
             the patient, even without a home visit

            Cost savings
           (travage time, gasoline, etc. )

Seite 31

Healthcare 4. 0: Existing partners

                                                - Pflegeheim       (Phase 1)

                                                - Pflegeheim       (Phase 2)

                                                - Ambulante Pflege (Phase 2)
                                                - Pflegeheim       (Phase 3)

                                                - Arzt
                                                - Ärztehaus

Seite 32                                        - Klinik / Krankenhaus

Healthcare 4. 0: General benefits

            Use of the same digital solution in inpatient and
             outpatient care

            Use of the software independently of others IT
             structures possible

            “Grey areas” of medical communication are replaced
             by data-encrypted communication

            Usage independent of large players (health
             insurance companies, software companies, private
             providers)

            Usability-optimized and download options in the App
             Store, Playstore, etc.

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Health care 4.0

Seite 34

Approach to the solution:

     Linking sectors of services of general interest
     by e-health application of an online consultation

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Further measures

        Further Roll Out on
          Doctors
          Specialists
          Clinics
          rehabilitation clinics

        Certification of the digital solution by the
         Association of Medical Insured

Seite 36

Further measures: GREEN BUS

            GREEN BUS – Patient bus/ Senior bus

            Mobility Concept Fichtelgebirge

            Partners:
              Siemens AG (in the design phase)

               Landkreis Wunsiedel
               Landkreis Bayreuth

                                                                                                                                   © Wikimedia / Aktron | CC BY-SA 3.0
                                                                                                           Mercedes-Benz O 530 Citaro BZ mit Brennstoffzellenantrieb in Brünn, Tschechien

                                                  https://de.wikipedia.org/wiki/Wasserstoffantrieb#/media/File:Brno,_Autotec,_Mercedes_Citaro_na_palivov%C3%A9_%C4%8Dl%C3%A1nky_II.jpg

Seite 37

Extension E-Health for further applications – value creation and
     Ensuring services of general interest at municipal level
     • Mobility applications

       Patient bus/senior bus directly bookable from digital
       e-health application

                                                                                                                                                 © Wikimedia / Aktron | CC BY-SA 3.0
                                                                                                                         Mercedes-Benz O 530 Citaro BZ mit Brennstoffzellenantrieb in Brünn, Tschechien

                                                               https://de.wikipedia.org/wiki/Wasserstoffantrieb#/media/File:Brno,_Autotec,_Mercedes_Citaro_na_palivov%C3%A9_%C4%8Dl%C3%A1nky _II.jpg

     • Local care

       Ordering food and medicines directly from digital e-
       health application

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Further measures: Delivery service

             Delivery service

             Supply of medicines and food

             Partners:
               Landkreis Wunsiedel
               Landkreis Bayreuth
               Bayerischer Apothekerverband Bezirk Oberfranken
               Edeka – Gruppe Nordbayern

Seite 39

Extension E-Health for further applications
     • Linking with E-Gov applications
      Examples:
       Travel grants
       Transport of sick people
       Services provided by health offices

     • Interfaces to other systems
      Examples
       Patient file, care software and medical software
       Digital applications of services of general interest, e. g.
             Public transport plans
             Municipal Platforms

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Further measures: : Ambient Assisted Living

           AAL- Information platform

           Linking with applications of the DigiDorf,
           E-Nurse and Digital Village (Bayer. Wald)

           Partner:
            Fraunhofer IIS Erlangen

            Landkreis Bayreuth (Lead-Partner)

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Further measures: Digital interface management

           Special support
            Regional projects for the future
             (Project start: 1st January 2020)

            Usability-optimization
            Interfaces to other systems
              Care software
              Software for doctors
              Digital applications of services of general
               interest
                E-Nurse Hof
                Digital mobility and transport projects in
                 Landkreis Wunsiedel
                Smart City systems in
                 Landkreis Hof und Wunsiedel (BMI)
                DigiDorf Oberes Rodachtal

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Project results and benefits

            Improving services of general interest through the use of digital solutions

            Possibilities for easy distance crossing through digital applications

            Increase in efficiency among users

            Networking of different partners in the field of services of general interest:
                 Mobility
                 Local care
                 eGovernment

            Improving the quality and accessibility of health care through telemedicine services

            Creating efficient, user-friendly digital applications of services of general interest

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Use of e-health and its digital links to secure municipal services of
     general interest
     • Improving services of general interest through the
       use of digital solutions

     • Possibilities for easy distance crossing through
       digital applications

     • Increase in efficiency among users

     • Networking of different partners in the field of
       services of general interest:
        Healthcare providers
        Mobility
        Local care
        eGovernment

     •   Improving the quality and accessibility of health
         care through telemedicine services

     •   Creating efficient, user-friendly digital applications
         of services of general interest

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Prospects for the way forward

Seite 45

Thank you very much for your attention!

Seite 46