The report was sponsored by Eucomed, the European medical technology association. It is based on in-depth interviews with more than 25 medical professionals and experts in five European countries.
European healthcare systems have helped to create some of the longest living populations in history, which enjoy enviable levels of general health. In recent decades, these systems have seen almost continuous reform efforts, but these efforts have not been able to alleviate the concerns of politicians, healthcare professionals and citizens that healthcare systems are not prepared for a variety of challenges looming in the near future. New thinking is needed to prevent the recycling of old arrangements. Based on in-depth interviews with 28 experts and practitioners in five West European countries— the Netherlands, Germany, the United Kingdom, Denmark and France—this study looks at the major issues facing health systems, as well as specific initiatives to improve them, in order to provide ideas for the type of changes that will be needed. Its findings are highlighted below.
Financial constraints threaten the status quo: Various factors are forcing payers to spend more:healthcare inflation has for many years almost invariably run ahead of headline inflation; new goods and services, including drugs and technology, are a boon to many patients but this expanded range of offerings need to be paid for; and increasingly demanding patients are not willing to settle for cut-price provision. At the same time, amid low economic growth and government budget cuts, healthcare systems that rely on state funding are unlikely to see significant cash infusions to meet growing cost pressure. Finding efficiencies will be central to the preservation of high-quality care.
Longevity per se does not raise health-cost issues: According to the most recentdata, more than one in five residents of the countries in this study are smokers, the populations are among the world's biggest consumers of alcohol, and a substantial proportion is overweight or obese Despite warnings of healthcare budgetsbeing swamped by a "silver tsunami", ageing populations account for only a small increase in health spending each year: one extensive study puts the cost at 0.5% annually. A failure to adjust retirement ages might lead to a revenue pinch, but this affects all aspects of government. The most significant healthcare impact of ageing will be the increasing number of people with multiple chronic conditions: 40% of Europeans over 50 have more than one such disease and a pioneering British study of the over-85s found that on average people of this age have five chronic diseases.
Lifestyle choices will lead to higher rates of chronic disease as well: According to the most recent data, more than one in five residents of the countries in this study are smokers, the populations are among the world’s biggest consumers of alcohol, and a substantial proportion is overweight or obese (61% in the UK). These behaviours, if left unchanged, will lead to high rates of chronic disease such as diabetes and cancer.
To meet the challenges of the future, healthcare systems must be efficient, effective, integrated and informed and changes come in steps:
Healthcare reform in the Netherlands: The Dutch government has shifted the financing of healthcaretowards a system that is based entirely on private insurance and regulated to insure universal coverage. The new system has brought some benefits for patients but has not yet led to a substantial change in how delivery is organised. Debate about the latter, however, is beginning as all stakeholders adjust to the new system.
Integrated care in Germany: The German government's efforts to subsidise more integrated care hasled to 6,000 integrated care contracts in the country. Four million patients have been treated under such arrangements. They have proven their worth by improving patient outcomes substantially even while cutting costs, but remain a small part of overall provision in Germany.
Outcomes measurement in the United Kingdom: The publication of outcomes data by the Society ofCardiothoracic Surgery has helped surgeons to reduce dramatically the rate of heart surgery mortality in the UK, even though more high-risk operations have taken place. Now, for four types of operations, the National Health Service has begun the countrywide gathering of Patient Recorded Outcomes Measures (PROMs)—assessments by the patient of how a procedure affects the specific problem being treated, and of the patient's more general state of health. This is helping doctors to understand better the impact of their interventions, and is redefining health away from clinical measures towards feelings of well-being.
Electronic patient records in Denmark: Denmark is one of the few countries that has been able to makeelectronic patient records work, through a judicious use of incentives, regulation, and a focus on the interoperability of various systems rather than the creation of a single one. The results have included lower cost, reduced paperwork and, especially through outcomes data and analysis, improved quality of care.
New regional health agencies in France: France has just created new regional healthcare arrangements that will, if successful, create a highly co-ordinated health system. At the regional level, the new regional health agencies will be responsible for almost everything related to health: environmental issues, prevention, monitoring of public health and warnings in case of emergency, monitoring of education, all aspects of medical care provision, and long-term care for the elderly and disabled. To ensure integration, the agencies need to create strategic plans that encompass all the areas under their purview. These local plans are now all in place. Time will show with what results.
