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

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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

4 . 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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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)

7 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

14 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

15 Decision criteria of doctors for practice locations:

Quelle: Survey among doctors according to relevant criteria of the practice location from 10th 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

17 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)

18 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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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

23 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?

24 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)?

25 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)

27 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)

28 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.

Seite 33 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

35 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

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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

38 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

40 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)

Seite 41 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

Seite 42 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

Seite 43 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

44 Prospects for the way forward

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Thank you very much for your attention!

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