On January 17, Health Ministers from OECD countries will gather in Paris to discuss how healthcare systems can reform to better deal with the challenges and to realize the opportunities of tomorrow. Important milestones are on the agenda including how to tackle ineffective spending in healthcare and how health care systems should adapt to new technologies.
The challenges: an ageing population and the growing burden of chronic conditions such as cancer, diabetes, Alzheimer’s, and cardiovascular disease. Thanks to improvements in living conditions, socio-economic development and medical progress, we live longer than ever before. This is fundamentally a great achievement. However, as people get older, they often live with several chronic diseases at once. Healthcare systems face a dilemma of growing demand and the need to invest for the future, while budgets have been flat or declining following the global financial crisis.
The opportunities: a rapid development of science and technology, including in biomedicine, biotechnology, genomics, and nanotechnology. We are breaking new ground in ways never seen before. For example, new gene editing techniques and stem cell therapies allow us for the first time to target the root-cause of many diseases. At the same time, we are in the midst of a rapid digitalization in healthcare, including the advent of big data analytics. We are creating the tools that can truly transform how we combat disease, how we deliver healthcare, and how patients manage their own health.
However, sometimes these opportunities are also perceived as threats. Indeed, new technology can be disruptive. It can change the treatment paradigm for major diseases. It can make old technologies and skills obsolete. It can change the relationship between patients and their physicians. It requires funding decisions that often include tough trade-offs. And it may require new ways of paying for healthcare that don’t fit with the current system.
A case in point are the new cell- and gene-therapies that are examples of the cutting edge of current innovation in medicine. By repairing defective genes, or by replacing malfunctioning cells, we might be able to treat diseases such as diabetes, blood cancers, and rare genetic disorders in a much more effective way than today. Perhaps, we will be able to provide cures. But there are challenges. Today, healthcare systems incur the cost for these patients over time – sometimes over the entire lifetime of the patient. Moving to financing a single high-cost intervention upfront can be a problem for healthcare budget holders, even if the intervention creates a long-lasting benefit and savings down the line.
The challenges that arise when new technology causes disruption in established systems are significant and must be addressed. However, when innovation is perceived more as a threat than an opportunity, we have a problem. The answer should never be to reject scientific progress. Instead, we must work together to develop new approaches for realizing the full potential of new technologies.
In this context, three points are particularly important:
– The impact of new technologies should be assessed long before they reach the market through better horizon scanning across technologies – be it medicines, cell- and gene therapies, devices, or digital healthcare tools. With good forecasting, healthcare systems should be able to project how scientific developments will impact patient outcomes, healthcare delivery, and society. The adoption of breakthrough technologies becomes much less disruptive for a system if their impact is understood and their introduction is planned in good time.
– Rather than focusing on the price of individual technologies, we should systematically scrutinize the overall cost of healthcare and ask ourselves how we can deliver the most value to patients for the money we spend. Today, too many resources are wasted on low value care – healthcare interventions that deliver suboptimal results compared to alternatives. This needs to be stopped. The OECD project on reducing waste across the whole spectrum of healthcare is therefore very important, and should be supported by all actors.
– To be able to assess the true value of medicines and other healthcare interventions, we must become better at measuring the actual health outcomes that our healthcare systems deliver. We still focus too much on the various inputs into healthcare – number of doctors, number of pills, or number of screenings. Instead, we should focus on the value these inputs create in terms of better health for patients, savings for the healthcare budgets, and benefits to society as a whole. Patient Reported Outcomes (PROMs) are important to fill in some of the blanks in our understanding of health outcomes, and the proposal to task the OECD to develop cross-country comparisons of PROMs is therefore very welcome. Outcomes measures should be used for improving quality in healthcare, for better resource allocation, and to set incentives. If payment can be tied to the result of a treatment rather than to the production of a healthcare input, it would send a powerful signal to healthcare providers, including private sector players. Our industry is ready to move to a model where we are rewarded not for the number of pills that we sell, but for the actual results achieved in patients. Applying such a model across the whole spectrum of healthcare services would allow us to reduce waste, save lives, and better address the needs of our ageing populations.
Open and transparent stakeholder dialogue is an important enabler to achieve these objectives. The innovative pharmaceutical industry is ready to play its part. The OECD Ministerial is a great opportunity to provide an important stepping-stone for that dialogue and for more effective public-private collaboration going forward.