THE THREE MAIN DIAGNOSES
The three main diagnoses in the western healthcare systems
According to the latest statement (2013) of yearly healthcare expenses, the Danish healthcare system cost a total of DKK 152.4 billion (€ 20.3 billion) that year. The expenses are divided into the following categories:
- State: DKK 1.0 billion (€ 134 million)
- Region: DKK 112.6 billion (€ 15 billion)
- Municipality: DKK 38.8 billion (€ 5.2 billion)
- In total: DKK 152.4 billion (€ 20.3 billion)
It might be slightly difficult to estimate the cost of each individual diagnosis; however, the three main and very expensive patient categories in Denmark and in other western healthcare systems do stand out, and what they have in common is that the treatment of the actual illness is not the biggest expense, rather the follow-up treatment, training and care.
Treatments are continuously improved through new methods, new medicine and other factors but the biggest part of the expenses related to these three patient categories are found in other systems that do not seem to change much.
The three patient categories are:
Older medical patients
These patients become expensive because the follow-up treatment is expensive. Many older patients are hospitalised with limited mobility and are discharged some 8-10 days later without proper mobility. Most of these patients are rather expensive for the municipalities, not only short-term after hospitalisation but very often for the rest of their lives.
No numbers are available on the total expenses related to this patient category which turns out to be so expensive e.g. because of frequent, often unfounded hospitalisation periods.
Patients with paralysis following a stroke
In a Dutch investigation from 2006, Recovery of gait after stroke – Utrecht University Repository, this patient category is estimated to be the most expensive one within the Dutch healthcare system at 3%.
The Dutch healthcare system is estimated to be slightly more expensive per inhabitant than the Danish system; however, the total of 3% probably also applies in Denmark.
The number of new patients in this category is approximately 2 per 1,000 inhabitants in the entire western world, and also in Denmark we see approximately 11,000 new patients with paralysis following a stroke per year. If the conditions in Denmark can be compared to those in Holland, this patient category costs a total of approximately DKK 4.56 billion (€ 608 million) per year in Denmark.
According to a large Dutch overview investigation from 2006, there is good evidence that persistent rehabilitation quickly after the event – within a few days – can allow the patient to more or less return to his or her former level of functionality.
Nowadays, patients are often trained in ways how to deal with their new impairments instead, and that is because the work required is extremely strenuous for the physiotherapists and other rehabilitation team members who simply lack the right tools that would ease their work.
Apart from the costs directly related to the treatment of these patients, add the loss of the value of many of them at the labour market which they could contribute to had they been able to return faster and in good shape.
Patients with broken hips
This patient category sees approximately 12,000 new patients each year and is considered the most expensive single diagnosis category within the Danish healthcare system. It probably costs more or less the same as the paralysed patients, i.e. around DKK 4.5 billion (€ 600 million) per year.
The problem for these patients is that rehabilitation is contrasting.
The patient needs maintaining strength training for legs and lower body but it has to take place without straining the damaged hip too much.
The solution is probably an individually based training that can be achieved through the training robot to a certain degree.
Chief physician Jens Lauritsen from the orthopaedic surgical ward at Odense University Hospital states that it is unknown what resources could be released through individual rehabilitation.
What these three patient categories have in common is
that they hold the possibility of achieving significant improvements for both patients and healthcare budgets if more effort were put into efficient training. This effort is possible if physiotherapists and other rehabilitation team members are assisted by suitable tools such as the interactive and patented Atlin® training robot.
Older medical patients need maintaining exercise during hospitalisation.
The geriatric ward at Odense University Hospital has been monitoring the development of the interactive Atlin® training robot for several years, and the staff members at this department have participated in robot tests throughout the development of the robot which is now ready for demonstration.
Patients with paralysis following a stroke must be offered intensive training with the training robot. This training must be offered as soon as possible after patient stabilisation, e.g. within one or two days.
Then the training must continue at a pace that suits the patient.
Patients in this category will obviously have diverging opinions as to what they are able to and want; however, they must be encouraged to train in order to return to their former level of functionality much quicker.
This requires the help of physiotherapists but they do not have to be next to the patient all the time, meaning that one physiotherapist can train with several patients at the same time.
The goal of this training is that the patients are able to walk out of hospital on their own after just a few weeks of intensive efforts.
Patients with broken hips must be offered the type of light training that the training robot offers.
Each patient will have his or her own way of training with the robot but even the weakest patients will be able to train. At the beginning, they will use it very carefully and with small pedal movements but as they become acquainted with the robot the training will become more efficient.
What is the result in terms of socio-economics?
Based on the knowledge of the cost for two of these three large patient categories it is estimated that the total expenses related to these three categories amount to approximately DKK 10 billion (€ 1.3 billion) per year.
Improved exercise efforts for these patients will reduce the costs by more than 2% per year, equally yearly savings of more than DKK 200 million
(€ 27 million).
The total yearly cost of such efforts is estimated at approximately DKK 75 million (€ 10 million).