Health Systems

facts about sustainability

The health landscape worldwide especially in Europe is of high noncommunicable disease rates, staff shortage, large hospitals, a growing trend of home care, but overall of financial hardship and debt. In one picture, a fragmented system where large hospitals and solo offices fail at reaching economies of scale. 

non communicable avoidable disease

As the WHO (2014) reports, a relatively small group of noncommunicable
diseases (NCDs) are responsible for approximately 86% of
the deaths and 77% of the disease burden; to which 80% of its risk factors
are life-style related and avoidable (WHO, 2017).

ageing population

A large proportion of the population faces retirement whilst the workingage
population consistently decreases. As consequence, home care and institutional
care will increase (Schulz, 2010) with lesser security benefits to its
recipients (Federal Statistical Office, 2015).

cost reduction policy

In spite of high rates of lifestyle and age-related NCDs health cost reduction
policies focus on reducing hospital inpatient care (OECD, 2014) without
clear policy on improving outpatient care.

pathogenic over salutogenic approach

Health policy has a clear pathogenic approach over a salutogenic one.
The amount of avoidable disease in Germany accounts for 80% of all
healthcare costs (EU Commission 2014). Anyhow, only 3,3% of the total
health expenditure is from disease prevention and health promotion strategies
(OECD, 2014).

care staff shortage

Care staff capacity is overloaded and year by year suffers shortage. The
number of patients per week is of 243 when in other OECD countries ranges
between 102-154 and contact times between general practitioners (GPs)
and patients are less than 8 min when in other OECD countries is between
11-19 min. The total workload of GPs is of 50,6 hours a week, again above
the EU average.

fragmented systems

Healthcare services are highly fragmented; 70% of primary care physicians
and 75% of secondary care physicians practice in solo offices (Hirsch
et al., 2012). As a result, multi-morbid patients are mostly attended by single
diseases with serial care instead of their health being managed employing
parallel care (Schlette, Lisac, & Blum, 2009).

difficulties in evaluation

In the system, health and economic outcomes are punishing to evaluate,
for a similar health service or condition the system allows two processes
(The Economist, 2015): a DRG (disease-related group) system for inpatient
care, and out-of-pocket for service for outpatient care.


Original article:

Medical Neighbourhoods: Urban Planning and
Design Considerations for Charité Virchow
Klinikum in Berlin, Germany

Alvaro Valera Sosa
Technische Universität Berlin