Debating Europe has already asked you what “European education” should look like, and we’ve also asked whether we can afford the “European social model” in an “Age of Austerity”. Last week, one of the members of the European Central Bank’s Executive Board told us that we urgently need to reform our economies in order to prepare for Europe’s ageing population. The future of public services in Europe, then, seems bleak.
Education, healthcare and welfare budgets are increasingly coming under pressure. One of our commenters, Leonardo, argued that:
Politics has taught people an unsustainable idea of what is reasonable (both in magnitude of requests and time of realisation); politics is able to ride this discontent but unwilling to tell the truth.
Others (such as Christos and Patrick) argued that cutting healthcare budgets would increase both inefficiency and inequality, leading to serious social problems in the future. Is there anything we can do, then, to preserve our standard of living whilst also cutting costs? We spoke to David Byrne, former EU Commissioner for Health, and asked him what he thought:
I think that the science behind health has developed in recent years, particularly in relation to mapping the human genome. We will be heading in the direction of personalised medicines. The care that’s given to the patient will be specific to that patient.
If we are careful in the next phase with research at the level of medicines, we should be able to make medicines cheaper. You know that a given drug will only work for a small percentage of people who have a specific DNA shape, for example. At the moment, the drugs work on only 30% of the people who take them, so there’s an unnecessary cost in there caused by trial-and-error that a more targeted approach could reduce.
There are other savings that could be made through ICT: the doctor at his desk, for example, could maybe have access to cloud computing that enables good decisions to be taken in a more efficient manner. That’s a little utopian right now, but it’s the sort of thing we could see to drive down costs and make healthcare more affordable. That’s something I think the European Union can give leadership on; the up-scaling of ICT in the healthcare sector.
It sounds like science fiction, but could technology provide the “magic bullet” that helps save the European social model? We asked Professor Finn Borlum Kristensen, a health technology expert, what the future might hold:
There have been a lot of expectations placed on ICT in healthcare, and they have been somewhat frustrated; but there are doubtless efficiency gains to be made. For example, through sharing lab results, imaging results, electronic patient records, etc. There are always privacy concerns, but politicians must acknowledge that, at a very, very high level, you can exchange information on individuals as part of healthcare without that information being misused with negative consequences.
Then there are issues around using ICT for monitoring people at home remotely. Perhaps we could see patients being sent home from hospital earlier with a monitoring device, saving money on hospital care. We could see ICT employed in different devices to replace the need for constant monitoring by caregivers.
What do YOU think? Could a “revolution” in healthcare technology save the European social model? Or does it raise just as many issues as it solves? Issues of privacy and safety of personal information? Let us know your thoughts in the form below, and we’ll take them to policy-makers and experts for their reaction.
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Certainly a ‘revolution’ is required but not just in the healthcare theatre. This entire neo-financial system does not and will not work for a modern society. This must be blatantly obvious to anyone that is capable of thought. A complete new approach to values and how those values are measured is what is needed and for any viable future, those values need to exclude the monetary system as we know it. Bits of paper and shiny stuff (gold&silver) are mere artificial things that has kept us (some of us that is) natives happy for thousands of years, this system has run its course. So certainly a revolutionary approach is required otherwise the human race will be doomed to the ‘groundhog day’ scenario, if it survives at all.
I agree with both speakers above…But please keep health care public or partly public and free..Once you have worked for so many years and contributed by paying your taxes of course..Other wise what is the point of trying to extend the human life, or better the living conditions, if that is a privilege of the few who can afford such things…
As the operator of a website dedicated to global health technology, one might expect me eagerly to agree with both speakers above. I have also worked as an academic researcher in Canada and the US on some of the technologies the panelists mention. There certainly is a lot of promise in those advances. But my interest in European (or American, or Canadian) health care reform is focused on equity. Europe has a good track record here. Particularly in northern Europe, policies have focused on solidarity (social inclusiveness) over advances that do not benefit everyone. I think given that our economies are still capitalism-based, there will be a natural tendency for companies to focus on those technologies that can be marketed to those who can best pay for them. Do we think that personalised medicine will really benefit everyone? I don’t think so, because we need to provide uniform access to basic health care services to everyone first.
Here, technologies like rapid diagnostics and integrated electronic medical records could play a major role. If you only see a patient once, as is often the case with immigrants, the poor, and transient populations, medical records need to follow the person, not the other way around.
Short answer: spend the money and technology on reinforcing access to primary health care (as promised in the Millennium Development Goals anyway) and in the long run, the health care dollars will go a lot further.
True, healthcare budgets throughout Europe are under pressure. And also true, we should do everything to preserve and further increase high healthcare standards we’ve achieved today.
To do that we need to do two things: to rationalize healthcare services and to ration healthcare services.
Rationalizing will get us a long way and ICT will play an important role here. It’s not just the personalized healthcare, where Mr. Byrne estimates that currently ~70% of patients genetically don’t benefit from the drugs they are taking. Generally we know since more than 30 years, that ~50% of patients are non compliant with their treatment. They forget to take their drugs, take the wrong drugs or decide not to take their drugs at all, because they read something on the internet which scared them off. Innovative ICT solutions can play an important role in increasing patient compliance and thus save some of the billions we spend on drugs each year.
But it doesn’t have to get complicated at all. The Bundesrechnungshof, which examines federal financial management in Germany, published a report earlier this week, finding that public healthcare payers in Germany annually spend ~800 million EUR too much on hospitals, because every third hospital bill is inaccurate/upcoded. Clearly sophisticated auditing technologies using all the data that payers have collected on patients could automatically identify a large share of those inaccurate bills.
These are just a few of many examples where money in the system is wasted and where rationalizing with the help of ICT could take a lot of pressure from the system.
However, these additional resources that can be freed through rationalizing, will not last forever, due to progress in health technology and demographic change in Europe. Therefore, we also have to start thinking about rationing healthcare services. Today there are still many useless, or at least not evidence-based healthcare services, that we spend tax money on. Or take services that do not have a balanced cost-benefit relation. I’m not suggesting that we directly eliminate all these services, but rather that we start a public debate on which services we want the healthcare system to cover and which services should be privately paid for. Fostering and moderating this discussion throughout Europe should be a top priority for European policy makers.
It’s really hard subject. In my opinion taxes destinated for health care should income direct to regional health care organizations (hospitals, emergency units,…) in order to skip costs of administration. Taxes should be obligatory. I think every citizen should be able to use h. care as good as it is possible. More money could be spent for early diag. and preventive h.care what decrease costs of med. treatment.
Good evidence and good science is of course essential to good health policy. There are important issues as how science on how is made, promulgated and used that are not given the attention I feel they deserve in public discourse on health policy at EU level.
These issues include the research agenda (what questions are asked, or not asked), transparency (access to data), publication (authorship, publication bias, peer-review etc), promotion (relationships with professionals and patients) and many others.
On medicines, we will probably always need large trans-national, complex and profit driven organisations but we need to look critically at how they work, and the context in which they work – and of course we should not exclude other models in proper cases.
I try to canvass some of these issues in my blog on science and medicine, OpenMedicineEU, at http://openmedicineeu.blogactiv.eu
In previous blogs I describe of some of the worst problems in this area. I try to keep the focus on science and how to promote good science in medicine – not to be “anti-pharma” but to be pro-science.
If it is a question of cost, then preventative medicine should be stressed in an age of austerity. We all are aware how our system is focussed on the more expensive curative approach. Still there are less costly curative approaches. With the advances in medical technologies, early diagnosis can help identify illnesses before they take their toll on the patients’ quality of life and the healthcare systems. What is stopping it?
A personal example: I am presently suffering from an illness that had caused severe secondary hypertension. Initial visits to the hospital and my GP had resulted in several prescriptions of new BP medications, and as the effects continued to intensify over the months, the dosage was merely increased (on a cocktail of four anti-hypertensives) with further prescriptions for painkillers as needed. It was up to me to push for a specialist to try to find the cause before a stroke would debilitate me or worse.
So I am pessimistic to the future of EU healthcare – doctors offices will overflow as populations age, with less time for proper diagnoses, while writing prescriptions to pharmaceuticals would be the easiest solution to ease the backlogs. So we would have more pharmaceuticals covering up early diagnoses until crises turn individuals into patients in the medical system. A small part of the population, like myself, will benefit from the open access to information and take the initiative to use the technologies to identify illnesses before they become debilitating. The majority will avail of the unlimited (?) palliative care budgets, which, with access to even more pharmaceuticals, can extend a poor quality of life for years.
Concentrating on that small part of the population with access to medical technology overlooks the real risk in the system that starts in the doctor’s office.
I can’t believe the french system I am told is true: you have to take out an insurance policy, a mutuelle, to top up state cover. Nobody in their right mind would create a system like that, can’t be true?!
Every mutuelle has its buildings, staff/wages, plant and so on plus they (apparently) spend on publicity and brochures (recycling costs never added in, why?). How on earth can this competition and waste be cheaper than the state doing all of it? Unless the state wastes even more/is very inefficient, which it might/be.
The crazy (if true?) costs of reimbursements, the mad lists of what % you get reimbursed for different prescription drugs = bonkers. Can’t be true, can it?
The NHS in the UK used to cover (free at the point of delivery) ALL prescriptions. If a doctor prescribes something it must be necessary right? Are doctors careful, how many unnecessary prescriptions do they write – because blinded by their wonders/magic, eg antidepressants? But now you must pay: too bad if you’re on a very low wage or unemployed, you can’t have them. The wealthy don’t know how this feels: the choices we must make, e.g. to eat or keep warm or pay the rent or use the bus or get our medicine.
Universal healthcover for ALL free at the point of delivery. Yes governments (and NHS) can be very inefficient but private companies must pay shareholders and make profits and will cherry-pick the services which make easy money = they never provide emergency/A&E = they rely on the NHS but they never pay into it, they must.
IF the NHS was well-managed and waste/internal fraud cut out/down THAT is the best way. Nowhere else (?) are you covered for all and every eventuality? Which is what we all need of course but ACCESS then PREVENTION and EARLY treatments (including dentists, opticians etc.) save LOADS, of course. Common sense.