Healthcare reform: A European perspective on how to succeed

Prophets of doom have been forecasting the imminent collapse of the healthcare system in countries like Switzerland for years.

But while costs continue to grow steadily healthcare is still functioning. So just how urgent is reform and what chance does it have of succeeding?

From a global perspective, the depressing news is that most healthcare reforms actually fail. According to Mark Robert, Harvard School of Public Health, reforms can succeed if the following three processes are mastered in parallel:

  • Use of the RIGHT technology
  • Master political processes to get reform done
  • Understanding society's values (eg healthcare rationing)

European health ministers have tended to focus on sinking pharmaceutical prices to keep the electorate happy, but pharmaceuticals only account for 4% of total healthcare spending. There are bigger issues to address like what can be done to alleviate the 80/20 problem (80% of healthcare costs comes from 20% of the populace, the chronically ill). German reformers are suggesting a combined approach addressing fours systems in parallel:

  • Acute patient care (most European healthcare systems currently do this well)
  • Integrated care systems for chronically ill (reducing unnecessary hospitalisation costs)
  • Simple case care (to avoid clogging up doctor's offices and emergency rooms)
  • Social care (social versus medical care: channelling people in the right direction)

Digital health and patient safety

Advances in digital health require huge investment before savings can be made. Most European countries are investing in e-health, but progress is hindered by debates over who is actually paying for it. According to Michael Porter debate needs to shift away from cost towards value proposition, ie what quality do we really get out of the system.

On a similar note, medical error is possibly one of the biggest killers, but many hospitals are still reluctant to open discussions about patient safety. Nevertheless, zero preventable deaths in hospitals should be an achievable aim.

Medical error – the third leading cause of death in the US
Source: BMJ 2016;353:i2139

Holistic approaches and the challenge of migration

Most European countries have opted for a holistic approach to healthcare. Take the Swiss plan, which boils down to focussing on health security, healthy living and healthcare reforms. But current socio-political and economic challenges are stirring the pot, eg how are all the new migrants to be integrated into existing healthcare systems?

Finally, as more and more people fail to pay their premiums and illegal immigration continues to be a problem, increasing numbers of people are slipping through the healthcare net in Europe. As in the case of the 10% non-insured in the US, it is these groups of people who could end up costing healthcare systems a lot more irrespective of the healthcare system reforms.

Summary of the Centre for Global Dialogue's Transforming Healthcare event in February 2017. Summary by David M. Taylor.