Futureproofing Western Europe's healthcare
Executive summary
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 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: Despite warnings of healthcare budgets being 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 smoke, the populations are among the world’s biggest consumers of alcohol, and a substantial proportion is overweight or obese (61% in the United Kingdom). This behaviour, 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: Rising levels of chronic disease and multi-morbidity reveal existing weaknesses that healthcare systems will no longer have the money to paper over. First, as one interviewee put it, “it is blindingly obvious how the [healthcare] service is incredibly confusing [and] disjointed.” The treatment of people with numerous, ongoing conditions will require a shift from systems built on acute care to ones where different providers can provide co-ordinated, ongoing care. Second, medical professionals too often lack full information on the range of treatments a patient is receiving, or even accurate data on what will work in a given situation. Patient records and outcomes measurement will need to inform health systems if they are to provide improved care and operate more efficiently.
Change comes in steps: Because of the difficulties of system-wide reform in healthcare, this study considers five developments that are individually interesting and, together, point toward the future:
- Dutch healthcare reform: The Dutch government has shifted the financing of healthcare toward a system based entirely on private insurance which is 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 has lead 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 of Cardiothoracic Surgery has helped surgeons reduce dramatically the rate of heart surgery mortality in Britain even while more high-risk operations have taken place. Now, for four types of operations, the NHS has begun the countrywide gathering of Patient Recorded Outcomes Measurements – assessments by the patient of how a procedure affects the specific problem being treated, and of his or her more general state of health. This is helping doctors understand the impact of their interventions better, and is redefining health away from clinical measures toward feelings of well-being.
- Electronic patient records in Denmark: Denmark is one of the few countries that has been able to make electronic 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.
- France’s new Agences Régionales de Santé: France has just created new regional healthcare arrangements which 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 which encompass all the areas under their purview. These local plans are now all in place. Time will show with what results.
Five healthcare initiatives that show what is possible
Size and complexity make the reform of healthcare systems famously difficult. As the case studies in this paper show, however, positive changes that prepare for the future are possible.
- Using the market to improve delivery: The Dutch healthcare reforms which began in 2006 have had a positive, if limited, impact. Moreover, they are now slowly creating debate on more thoroughgoing changes to delivery.
- Integrating healthcare provision: Germany’s efforts to promote the use of integrated care have led to its greatly expanded use, and with it better patient outcomes at a lower cost.
- Measuring and analysing outcomes: The publication of outcomes data on heart surgery in the United Kingdom has already helped cut mortality in half. Now an initiative to gather Patient Recorded Outcomes Measurements could change how doctors think about the success of procedures.
- Creating electronic patient records: In contrast to failures elsewhere, Denmark has a functioning Electronic Patient Records system covering almost the entire population, which is helping medical professionals provide better, faster care.
- Integrating healthcare with other health-related areas: France’s new Agences Régionales de Santé are an attempt to create healthcare that is integrated with everything from prevention and environmental health to social care.
More information
For detailed information on how 5 EU countries are future-proofing their healthcare, visit www.reforminghealthcare.eu
