Zoe Tabary: What are the greatest challenges facing European health systems?
Mark Pearson, OECD: We haven’t managed to reduce resources for healthcare areas of lower efficiency – that is a problem if you’re not expecting many more resources, as is the case in Europe. Health systems are also riddled with inefficiencies and there are hardly any incentives or information available to increase efficiency at the provider level.
The failings are particularly severe in some areas, such as mental illness. For example, over 30% of people who are unemployed in the OECD have a mild mental health disorder, but only 30% of those people get treatment.
What should healthcare systems prioritise over the next five years to meet future primary and secondary care needs?
We always wish for more money to improve health systems but that’s not available, so we need to find a way to re-allocate resources and ask ‘what is the least valuable activity in our health system’? Hospitals, for example, provide very expensive care. Yet health systems choose to cut prevention and primary care spending rather than hospital spending, because the latter is so politically sensitive. But prevention is where you can extract most value.
Furthermore, health systems are often left to a messy compromise between physicians, politicians and managers. They don’t have the independent institutions to choose where to re-allocate resources or staff, and increase efficiency of care.
How can governments and the private sector play a role in promoting prevention?
Prevention is cheaper and easier whenever government works with private stakeholders. But not all cases of prevention are successful and we should be able to identify and react when it isn’t working. Cost-benefit analysis, in particular, is extremely helpful.
For example, school-based programmes on obesity are often the least effective prevention measures. Their pay-off is so far in future that rates of return may be lower than expected. However, that kind of reality is hard to accept for politicians, and they are entitled to take factors other than pure cost-benefit analysis into account. I understand that health systems must take into account the political costs of decisions, but cost-benefit analysis can be used to better inform those decisions.
What are some of the most innovative efforts you’ve seen to improve quality of care while controlling costs? Could these be replicated elsewhere?
Healthcare providers need to deliver care in a cost-effective way and the most promising experiments I have seen are to do with the bundling of payments. This implies paying healthcare providers a fixed amount of money to deal with say dementia, and leave it to them to decide how they want to split it on services – essentially, giving them more flexibility. The UK, the Netherlands and the US are particularly good at doing this.
Health systems also need to be more joined up, by using electronic health records for example, which can be accessed instantly from any location. This will make patient data more fluid and improve their quality of care, while reducing costs.
What is your greatest hope for healthcare in Europe?
I’ll know we’re getting somewhere when I see patients protesting outside hospitals asking that they shut down because of poor quality of care. Currently, the opposite is happening – people are protesting to keep hospitals open at all costs, even though they may face obstacles such as treatment delays, complex processes or a lack of knowledge among frontline staff.
This interview is part of a series managed by the Economist Intelligence Unit for HSBC Commercial Banking. Visit HSBC Global Connections for more insight on international business.
