This week, many of the leading lights in European healthcare policy will converge on Gastein in the Austrian Alps for the European Health Forum. Centre stage at this year’s Forum is demographics and their impact on the European Healthcare.
For centuries, studying demographic change has been like watching a glacier move, but rapidly advancing medical science, prevention and public health is creating dynamic change.
By 2025, the global population is expected to increase by 1 billion people, with half a billion more people over 50 years of age. These significant demographic changes are reflected in Europe, where life expectancy has risen by nearly a decade over the last 50 years. According to the Organisation for Economic Co-operation and Development (OECD), the percentage of the European population over 80 years of age has risen from 2% in 1980 to 5% today and is projected to rise to 7% by 2030.
As the population continues to age and grow, so does the prevalence of chronic diseases such as diabetes, cardio-vascular disease and cancer. Between the ages of 45 and 65, the incidence of heart disease more than doubles, and over a quarter of people aged 85 years and over lives with dementia.
The result of these significant demographic changes is that Healthcare systems across Europe are facing unprecedented challenges. Food for thought for the Alpine bound healthcare community.
Despite the challenges, there are many reasons to be optimistic about a healthier future for Europe. With over 7000 medicines in development, an exciting, new wave of innovation will play a key role in addressing the challenges faced by patients, healthcare systems, and society. This pharmaceutical innovation is mirrored by developments in medical devices, diagnostics, imaging and data science.
But patients can only benefit from this innovation if it is affordable now and sustainable in the future. In the context of ageing populations and chronic disease, the adoption of innovation places additional pressure on resources. How we manage the rising healthcare demand, capitalise on the new medical innovation in a sustainable way is likely to be the foremost question for many delegates at the European Health Forum.
Europe provides some of the best healthcare in the world. It has long been a centre of excellence for medical research, education and clinical practice. But despite the progress of public health across countries in Europe, significant health inequalities persist. This is not simply a question of economics; the evidence suggests significant variation in outcomes for patients between countries but also within countries, which cannot be explained by different levels of investment in health and healthcare.
Like much of healthcare the reasons are complex and multi-faceted. The cumulative effect of variations in clinical practice, complex care pathways, data fragmentation and transaction-based incentives is variation in outcomes for patients, waste and inefficiency in the system. In the context of ageing populations, increasing prevalence of chronic disease, and constrained resources, this puts the long-term sustainability of healthcare in Europe at risk. It also provides a clue to how we can re-orientate the management of healthcare to improve outcomes for patients and make them more sustainable.
Working towards a healthier future
By re-orienting healthcare systems on outcomes, many stakeholders, including EFPIA, believe that we can put healthcare systems in Europe on a more sustainable path.
The principle behind outcomes-based healthcare is that healthcare systems should focus on delivering health-outcomes, rather than on delivering interventions. Focussing on outcomes addresses the central problem that healthcare systems today do not incentivise what actually matters: better health for patients.
Instead of paying for hospital beds, visits to the doctor, pills, screenings and surgical interventions, our focus should be paying for better health and longer lives. By determining exactly what type of intervention brings the best health outcome for each patient, and directing our resources to those specific measures facilitates better health outcomes and quality of life for patients. A focus on delivering outcomes also results in more value for money and can contribute significantly to healthcare system sustainability by identifying and discontinuing interventions that do not deliver superior or no patient outcomes. By eliminating spending on ineffective interventions, a focus on outcomes can free up the resources required to address the healthcare needs of an ageing population and fund those innovations that deliver positive results for patients and value for systems. The potential for waste reduction is significant. It is estimated that 20% of healthcare spending is currently wasted on ineffective interventions.
True value-based healthcare, in which systems guide their decision based on the ratio of outcomes to cost, is still in its infancy. Healthcare systems across Europe are still grappling with how to make the concept a reality and what kinds of tools are needed to make it work. Like other potentially paradigm-shifting concepts such as big data or mobile health, the initial excitement is followed by the realisation that system-wide change is immensely challenging. But at EFPIA we believe that the goal, a healthier, more sustainable future, can be realised step-by-step, in partnership with stakeholders across the system.
This transition will take both time and investment, and most of all political will. Member States need to invest in integrated health information systems for tracking health outcomes – with disease registries and Electronic Health Records as key components – and standardise outcomes metrics that will make it possible to compare health outcomes across providers, regions and even countries. Patient involvement is key when agreeing on these outcomes metrics, but equally so is the involvement of healthcare professionals, since a continuous evolution of evidence based clinical practice is at the core of an outcomes-based approach to healthcare.
The good news is that we don’t have to wait for the perfect system to be in place, change can be implemented step-by-step. Even though reduced waste and better value for money will be one of the rewards, the main driver for change must be better health outcomes and putting the patient at the centre of healthcare management. The key is to learn from each other and spread the use of models that have been proven to work.
No two healthcare systems in Europe are at the same point on the journey to a more outcomes-based approach. Some have advanced examples of good practice, others are beginning to look at outcomes-based reimbursement models, others simply do not have the infrastructure in place to base clinical decision-making and service design on outcome measures. However, at whatever point a healthcare system is on the journey towards an outcomes-based approach there are a number of actions that can be undertaken to support change.
- Understand the healthcare challenges
Understanding the epidemiological, structural, technical, financial and political challenges can help inform strategies to move to outcomes-based model of healthcare
- System Readiness Assessment
Using structured analysis of stakeholder awareness, data infrastructure, proof of concepts, and enablers in a local system to obtain insight in to areas to develop and invest.
- Define health outcomes measures
Defining standardised sets of health outcomes measures for all diseases and conditions, together with patients, that will allow for systematic measurement and comparisons across providers and countries
- Develop integrated health information systems
Tools such as electronic health records, disease registries and user-friendly data capture systems all contribute to developing an outcomes based system
- Build a health data eco-system
To spark, develop and deliver change, data needs to be of high quality and shared across the healthcare system for quality improvement and research
- Analyse variation
Data analytics provides the key to identifying variances in care and their impact on outcome, to detect sources of waste and inefficiencies in the system
- Identify best practice
Standardised outcomes measures, quality and transparent outcomes data, coupled with the use of data analytics will facilitate the identification of best practice for replication across health systems
- Promote proof of concepts
Successful pilots of improving outcomes in a specific patient population build trust in the merits of an outcomes-based approach and provide important clues into the practicalities of implementing outcomes-based healthcare
- Feedback and learn
As clinical practice and service delivery changes, real world evidence and data analytics provide a mechanism for real-time learning and continuous development
- Remove budget siloes and reward quality of care
Establishing flexible and holistic finance systems that promote care integration, and payment models that reward good health outcomes for patients can help facilitate change
Standardising definitions of outcomes, agreeing measures and putting in place the infrastructure to capture, measure and analyse healthcare data to support outcomes-based decision making is a long and complex process. To facilitate change requires dialogue, partnership and collaboration from across the healthcare spectrum. Often it will require attitudinal change at an individual and institutional level. System-wide transformation of healthcare is a bold and ambitious goal but central to a more sustainable and Healthier Future.
Over the coming months EFPIA will be exploring many of the issues around outcomes-focused healthcare through a programme of activities under the banner of #healthierfuture. We look forward to engaging in this important debate and are keen to hear your views.0