Healthcare systems should move away from their traditional focus on facilities such as hospitals and strengthen capabilities in areas such as prevention and data use. This was one of the messages from a Friends of Europe health working group which aims to generate insights and recommendations for the next EU mandate. This first meeting addressed ways of making smart investments and the next meeting on 15 May 2018 will examine the related issue of disinvesting from redundant, obsolete or ineffective health interventions.
The group met as European economies are growing healthily once again after a decade of decline. Health spending was growing faster than GDPs before the crisis, but governments cut back amid pressure on public finances. There is now a chance to reinvest in health systems in a way that addresses new concerns, such as aging populations, and takes advantage of new opportunities.
Instead of just plugging existing spending gaps, governments, private investors or philanthropic foundations could make smarter choices about how and where to inject increased funds. This will involve careful analysis of the financial incentives within healthcare systems, stopping outdated or ineffective practices and embracing modernisation and innovation.
“The health sector is a huge consumer of technologies, and is also being offered digital innovations by various industry sectors,” said one of the participants meeting under Chatham House rules. “The question is: How will these innovations act in the health sector?”
Waste is an important area of focus. Up to a fifth of health spending in the OECD is ineffective or even wasteful, 1 in 10 hospitalisations and half of anti-microbial prescriptions. There is also too much recourse to hospitals’ emergency departments. “We need to rethink what kind of assets we need for patients,” said a participant. “They may not be the assets of primary care as we know them nowadays. Huge hospitals that do everything are prestigious but are not fit for all patient groups. If we are busy with these institutions, we are not busy with other things.” The need to create a new healthcare landscape, with more facilities locally available offered by a greater range of providers and connected by technology.
More should be invested in prevention. And doctors should be given more training in the use of data, a lot of which is sitting in hospital records, unusable and unused. “We have to solve the ownership issues,” said one participant. “The data is the patients’ data and they should be able to access it. We also need to invest in security of data.”
Friends of Europe is launching a reflection process on health (dis-)investment in Europe. A diverse group of stakeholders will be convened for roundtables to discuss the complementary issues of smarter investment for better health and disinvestment in health interventions that are ineffective, inefficient and outdated. These discussions will culminate in a publication summarising the highlights of each roundtable and commentary through opinion pieces from leading players in innovation for health.
This work is a follow-up on the results of a previous Friends of Europe Working Group on Health that generated recommendations for the 2014-2019 European Commission and European Parliament mandate. 21 recommendations on what the EU should start or stop doing, or do differently, were agreed on among the key health stakeholders that composed the group. A key focus of this work was to identify and highlight the need to stop doing things that are inefficient or ineffective. The proposed new series on health (dis-)investment follows directly from this recommendation.
This event is part of Friends of Europe’s Health and Wellbeing programme, which focuses on how the obstacles of vested interests and short-term political thinking can be overcome in the difficult transition to new healthcare models and systems – and how these new systems can be financed.
- Friends of Europe discussion paper: Disruptive Models of Healthcare for Europe
- Friends of Europe report with 21 recommendations on what the EU should start or stop doing, or do differently: Adapting EU Health Policy to an Evolving Europe
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The 2008 Tallinn Charter on Health Systems for Health and Wealth confirmed that investments in health are investments in human development and growth. But since then, governments have struggled to maintain levels of spending for health in the light of growing demand and a prolonged economic crisis. Updating the infrastructure and integrating new technology will be expensive initially, but should generate efficiencies and long-term savings. Another big change that is needed is to move away from reimbursing transactions such as medical consultations and interventions and towards rewarding maintenance of good health through incentives within the system.
- Where should scarce health resources be invested in order to get the best value?
- How can all players in healthcare be rewarded for better health outcomes?
- Given the complexity and fragmentation of healthcare, do investments in digital technology make financial sense for public authorities?
The event will bring together a select group of some 40 high-level stakeholders from across Europe, including EU and national policymakers, senior officials from international organisations, business representatives, NGO leaders, experts from the academic world.
It is the first of a series of two working group meetings. The second session will focus on “A strategy for health disinvestment” and the series will culminate with a presentation of the outcomes at the Global Health Forum in Gastein.
Director, Basque Office for Health Technology Assessment (OSTEBA) at the Basque Ministry of Health, Spain
Head of the Organisation for Economic Co-operation and Development (OECD) Health Division
Chief Scientist Advisor of the Dutch Ministry of Health, Welfare and Sports
Deputy Director-General for Health and Food Safety, European Commission
Senior Fellow at Friends of Europe
With nearly 30 years of experience within the Basque Ministry of Health, José Asua has a deep understanding of regional public health systems. He works to provide information and advice to the Ministry on the efficacy, effectiveness and accessibility of different existing and future health technologies based on systematic reviews and cost analyses. A specialist in preventive medicine and public health, Asua’s previous roles include working as a general practitioner; chairing the International Network of Agencies for Health Technology Assessment (INAHTA); as well as participating in several international projects on health across the EU.
Francesca Colombo is responsible for OECD’s work on health, which aims at providing internationally comparable data on health systems and applying economic analysis to health policies, advising citizens, stakeholders and policymakers on how to respond to demands for more and better healthcare. Colombo supports the strategic orientations of the Secretary-General and their implementation in the area of health. She had led numerous projects on the performance of health systems in OECD countries, covering a wide range of topics, including quality of health care policies and health financing.
A professor in fiscal sustainable health care systems and Director of the Celsus Academy at Radboud University Medical School, Patrick Jeurissen is an expert on the design and implementation of policies addressing finance, sustainability and affordability in healthcare. He advises the Dutch Ministry of Health on reforms in order to receive more affordable care for citizens, focusing on the relationship between cost and quality of healthcare. Jeurissen is also a member of the Health Steering Committee of the Organisation for Economic Co-operation and Development (OECD) and has (co-)authored some 75 international publications on health related issues.
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