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Forever Healthy The 2020 Healthcare Consumer
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Executive Summary
The future of healthcare in Europe faces many challenges. What is the best way to reverse the increase of chronic disease; how will we meet the needs of an ageing population and will we have enough healthcare professionals given that the workforce is ageing? These challenges also come at a time when there are increasing numbers of new technologies and treatments available, such as eHealth and personalised medicines, which if applied correctly, could help fill the gap and meet growing healthcare needs.
The American Chamber of Commerce including politicians, policy-makers, to the EU (AmCham EU) believes academics and representatives that if today’s healthcare model of patient associations and the continues unchanged, there will industry to ascertain their opinions be an unprecedented escalation on what needs to change in the in costs and demand. Given this healthcare delivery system and where anticipated growing demand and opportunities lie. AmCham EU also the shortages of resources, there compared these views against the has never been a greater need attitudes of 1,500 people across to re-prioritise and rebuild health Europe and what follows is a report systems that can drive healthcare that highlights the many ideas that efficiencies and improve the were generated. The findings were well-being of our citizens. Studies also used to develop a list of priorities have shown there is a direct link which AmCham EU believes should between healthcare investment guide European and national policy- and the overall economic health makers in order to provide consumers of a country as well. with affordable, sustainable and innovative healthcare systems in To contribute to the on-going debate Europe in 2020. around the future of healthcare in Europe, AmCham EU interviewed Key findings of this report are 28 leading experts in healthcare listed overleaf. 4
Key recommendations
Taking stock of where we are... professionals to meet the evolving eHealth and mHealth, needs to be and where we can expect to be needs of consumers. It will require prioritised to support this change. appropriate training, an increase in Given that the healthcare sector is ——Great strides have been made in the number of generalists and an traditionally slow to change, more treatment and care of Europeans expansion of the responsibilities of will need to be done to educate over the past two decades. existing roles to combat this. consumers, policy-makers and ——At the end of 2013 though, ——Doctors and other health practitioners about the need for healthcare is under significant professionals will need to continually change, what to expect from a new financial and capacity pressures keep abreast of technological healthcare system and how best and these are expected to increase innovations and become more IT to respond to those changes. further by 2020. literate to enhance consumer access ——The concept of healthcare ——Fundamental changes in the to information and treatment. innovation will change. way healthcare is delivered are ——Healthcare systems should not No longer will the focus be on required for Europe to meet this only try to build relationships with blockbuster medicines but rather growing demand. private providers but also adopt on improving the delivery of highly the best practices from the private personalised care. The changing role of the sector to enhance efficiencies, healthcare consumer capitalise on innovation and redesign healthcare delivery. Recommended priority areas ——Consumers will need to play a much ——Healthcare systems need to change more active part in monitoring, their focus from treatment after seeking information and making The financial challenge an illness has occurred to health decisions about their healthcare. ——The financial downturn and promotion and disease prevention. ——This will be aided by the ability Eurozone crisis has made the need This requires an emphasis on to readily access accurate, clear to curb healthcare expenditures education on the importance of and timely information available even more pressing. healthy lifestyles. electronically. ——Current healthcare funding models ——Investment in innovation is needed ——Healthcare consumers will be are not sustainable. Citizens will to drive efficiencies, improve expected to manage their own need to make a greater financial productivity and create more health to a far greater extent than contribution towards their patient-centric care. ever before and take responsibility treatment. ——Policies and resources need to be for their own well-being. ——Efficiency and systemic directed toward improving health improvements will not solve the and IT literacy of citizens and problem alone. Governments must healthcare professionals alike to Healthcare professionals – invest in healthcare and treat it as empower consumers to take more changing roles an opportunity to enhance the well- responsibility of their own health. ——Healthcare professionals will being of its citizens and its economy ——Healthcare provider roles need to increasingly need to serve as rather than simply a cost. adapt to changes in the delivery mentors to healthcare consumers, system, and healthcare insurers also helping them interpret the best need to change their remuneration available information to make A new healthcare system schemes to adapt to this change in the best decisions about their paradigm is needed focus. healthcare. ——As 2020 approaches, healthcare will ——Health has to be seen as an asset ——There is a growing shortage of become more decentralised - less rather than a cost. That requires healthcare professionals in Europe, care will be delivered in hospitals education and investment to which is expected to become and more will be delivered on an create a healthcare system that more serious by 2020. This will outpatient basis or even at home. can respond to the realities we are require new roles for healthcare ——Developing technology, including now facing. 5
Contents
Foreword John Bowis 6
Introduction Susan Danger 7
Chapter 1 Taking stock of where we are... and where we can expect to be 8
Chapter 2 The changing role of the healthcare consumer 14
Chapter 3 Healthcare professionals – changing roles 20
Chapter 4 The financial challenge 24
Chapter 5 Healthcare systems – of primary importance 32
Chapter 6 Healthy expectations – looking beyond 2020 38
The 2020 Healthcare Consumer AmCham EU recommendations 42
Appendix I Health consumer survey 2020 44
Appendix II List of participants 45
Appendix III Data sources 46
Appendix IV References 48
About the research 50 6
Foreword
John Bowis Chair of the European Alliance for Personalised Medicine
When I imagine what 2020 will be like for health policy and healthcare, the key word is responsibility. As the next decade approaches, Europe’s citizens should expect far more to rest on their shoulders when it comes to healthcare. We shall be asked to keep ourselves well for longer through healthier lifestyles and, when we do fall ill, be expected to take on more of the managing of our condition. We shall expect to be briefed on how to do this and we shall expect to be monitored to ensure we are coping; but a real partnership between patients and professionals is what we want and expect.
This report details why such a shift hope to keep more of our citizens out These however, require major is both necessary and desirable. of hospitals, which could lead to a changes. If citizens are to take on Our demographics are changing, much better patient experience and the new roles we expect of them, with a rapidly ageing population, enable them to return to a physically there is a major educational mission an explosion in chronic diseases and financially active life. That is why to undertake. If we want patients and continuing scientific research health spending by individuals and to manage their conditions, and development. That places governments is an investment and we need to teach them how. an ever-greater demand on our not just a burden. That may also require that they healthcare systems and means become digitally literate. Even with such changes, I believe we they will become increasingly also need to look at funding. Free Healthcare professionals are already unaffordable unless we encourage healthcare is a cherished principle in under pressure and are in roles that innovation and a better much of Europe but I believe we will are rapidly evolving and will continue understanding among our citizens. have to find new sources of revenue to evolve. The demands we place on I know from my own experience of for our healthcare provision. That them will be different. We will see living with diabetes and a triple by- might mean asking our citizens to them as mentors, steering us to better health and the best treatment. pass that, with initial support, contribute more to its cost. It will I now take for granted my own role in require governments and employers None of these changes will be easy. their management, from drugs and to look at how they can contribute to This report suggests many ways injections to testing and distance not only healthcare but also health we can address what is needed. If monitoring. By making citizens more promotion. Policy-makers will need we succeed, the prize will be the responsible for their own well-being, to understand that healthy people improved and sustained health and we can hope to reduce pressure on mean healthy economies and healthy well-being of our citizens and our our at-capacity systems. We can also environments. national economies. 7
Introduction
Susan Danger Managing Director of AmCham EU
At AmCham EU we believe that one What needs to be done to make of the most serious challenges we it happen? What will consumers What kind of face in Europe today is how to make expect from healthcare in the healthcare the health and social care systems future? delivery system sustainable and more responsive to Throughout this report, we use the should be in the healthcare needs we face in the term ‘healthcare consumer’ to reflect place in 2020? 21st century. There have been many a new understanding of healthcare significant scientific and technological and the fact that consumers include advances in healthcare in the last those that are healthy as well as 20 years. We have witnessed the those who are ill. BEUC, the European development of new medicines, Consumer’s Organisation stated improved diagnostics, better access that consumers are the key players to data and improved computer What needs in the economy and should be the capabilities. However, the pressures centrepiece of markets. In healthcare, to be done to of ageing populations and the consumers have expectations, can make it happen? increasing burden of chronic diseases steer demand and are active, rather still mean that there are some serious than passive in their treatment and challenges ahead. care. While in the past, healthcare In this report we have gathered systems may not have recognised the views of policy-makers, the power of the healthcare market influential thinkers, healthcare and and the consumer; this has changed What will patient associations and industry in recent years as this report consumers expect representatives through a series of 28 demonstrates. We believe that the from healthcare one-to-one interviews to collect their term ‘consumer’ better reflects the in the future? thoughts on how we can help address changing role of those who use these future challenges to deliver healthcare services. healthcare in Europe. In addition, we Finally, I would like to thank all the also polled the views of the European experts who participated in this public on the subject. This allowed project, as well as members of the us to compare the aspirations of public who took part in our polling. our experts with the expectations Healthcare delivery across Europe of the public. Further details of the has changed dramatically in the last report’s methodology can be found in two decades and while there are Appendix I. still many challenges that lie ahead, The results of this polling as well as this is an exciting time of change. findings from our experts have helped We believe the recommendations us address some of the big strategic in this report could drive questions around healthcare delivery: improvements in healthcare What kind of healthcare delivery systems across Europe to better system should be in place in 2020? meet consumer needs in 2020. 8
C hapter 1
Taking stock of where we are... and where we can expect to be
Europe is facing increasing of the disease burden in Europe pressure on its healthcare according to the World Health services. Demographic changes Organization (WHO).4 In addition, 77 average life including lower birth rates and while Europe comprises only one expectancy mortality combined with higher eighth of the total world population, for men life expectancy are leading to it has around one quarter of all a rapidly ageing population.1 cancer cases globally5, and an Increasingly sedentary lifestyles are estimated six million people with leaving citizens at higher risk of ill dementia.6 2 health. These factors are leading By 2020, we will still be living On the other hand, life expectancy to an increase in the prevalence of out the consequences of the has increased. For men it has chronic diseases such as diabetes lifestyles that we have had in 3 increased by nearly five years and hypertension. Having such the last decade, which has led between 2002 and 2011.7 conditions over prolonged periods to the increasing rise of non- On average, life expectancy for of time is known to increase a communicable diseases. person’s risk of suffering from a men in Europe today is 77 years of age, and for women it is more Mike Farrar number of cardiovascular diseases, Former Chief Executive of NHS which are now responsible for 77% than 83 years of age. Confederation 9
Healthcare success over the 20th century8
Life expectancy in EU-5 (Germany, UK, France, Italy & Spain) and US
1990’s 1955 Coronary stent 90 Polio 1948 Vaccine First RCT 75 2010 1900—1910 Robotic surgeries 60 Midwifery reform 1970s YEARS 1950 CT scanners Smoking linked 45 to cancer 1928 Penicillin 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 DATE
Health systems have contributed to an unprecedented increase in longevity and quality of life becoming a key enabler of economic growth
Job Creation Sector Growth Healthcare is a major source of skilled and local Worldwide, healthcare is now a US$ 7 trillion jobs, expected to create 3-5 million jobs in the industry, and a hotbed of research and US alone by 2020, potentially more than any innovation other sector Development Labour Productivity Over the past 30 years, the annual incidence Better health can reduce absenteeism, early of 5 major vaccine-preventable diseases* has retirement and school drop-out rates, leading to plummeted by over 90% more productive workers *Diphtheria, polio, measles, pertussis and tetanus
Today less people die of HIV/AIDS than ever before, and new treatments have made it possible for cancer patients to live longer. However, as the recent ‘Report on Health Inequalities in the European Union’ indicates, a great disparity in life expectancy remains among Member States. In 2011, there was a 19 year difference in life expectancy between the Member States with the 19 lowest and highest values! year difference in life Life expectancy at birth for females, 2001–2011, lowest and highest Member State expectancy values and EU average9
86
84
82
80
78 YEARS 76
74
72
70 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DATE
EU 27 Low High Data from Eurobase, extracted on 29 April 2013 10
Facing the Changing attitudes to drive change challenges
How can we meet the challenges Health is always seen as a Doctors and pharmacists are we face? How can Europe major cost item rather than as looking at the disease of the patient successfully care for an older, an investment. There is a shift in and how they can cure the disease more chronically ill population on perception that needs to happen. and are less looking at the issue limited resources? The 28 experts of how to maintain health. They Professor Margaret Barry interviewed for this report – drawn Head of World Health Organization think that curing disease is creating from the European Parliament, Collaborating Centre for Health Promotion health and I think that is wrong. Research, National University of Ireland, Galway European Commission, Member Dr Roberto Frontini State policy-makers, academia, President, European Association of Hospital non-governmental organisations, Pharmacists patient groups as well as industry – all agree that answering such questions will involve not only making changes to our healthcare systems but also changing attitudes toward healthcare.
None of these problems will Our interviewees shared ideas and visions, which reveal the need for go away by 2020. In fact, they fundamental changes in the way healthcare is understood. This goes to the will become more serious, more very core of how healthcare is delivered in Europe. They are changes, which complex and more pressing. will impact governments that shape the systems, the organisations and staff Furthermore, they will increasingly providing care, and – significantly – every healthcare consumer. create urgent fiscal pressures. By 2020, if the current era of financial austerity is over, Question 1 of the consumer survey: healthcare providers, professionals Q1 When thinking about healthcare services in the year 2020 and leaders can still expect to be how important do you consider each of the following?12 asked to do much more for much less. This was demonstrated in Key Healthcare services in 2020 the European Commission’s 2012 Ageing Report10 which found that ageing and non-demographic 45% drivers of healthcare expenditures, 40% 41% 40% such as wages, medical products, 35% and healthcare infrastructure will 30% 25% 29% continue to put pressure on the 26% 20% long-term sustainability of public 15% finances. In particular, 10% it found that age-related public 5% expenditures are projected to 0% Better access to healthcare Free healthcare from the point I More treatment in the community Education on how increase by 4.1% to around services than currently available start using health services than currently is in hospitals to live a healthy life 29% of GDP between 2010 % of the interviewees who replied "extremely important" and 2060.11 11
A number of our experts indicated that governments will have to view healthcare as a much higher priority, and start to view it as an investment rather than as a cost. It is not only our expert interviewees who suggested this, but the general public as well.
Question 2 of the consumer survey: Q2 In the year 2020, governments should treat healthcare as a higher priority than they do currently.13
Extent of Agreement or Disagreement with the statement in question As part of our research for this report, we spoke to citizens across Europe about their beliefs about 70.0% healthcare and 88% said that in 60.0% 2020, governments should treat 60.0% healthcare as a higher priority than 50.0% they do currently. 40.0%
30.0% No. of respondents 28.4% 20.0%
10.0% 7.4% 2.2% 1.7% 0.3% 0.0% Strongly Somewhat Neither agree Somewhat Strongly Don’t know 88% agree agree nor disagree disagree disagree believe governments should treat healthcare as a higher priority than they do currently Wherever you are in the world, the necessary processes and skills to people regard good health as one improve health and the objectives of of life’s most important assets. prosperity and solidarity; will benefit But as we move toward 2020, from higher productivity, increased it is becoming increasingly clear that labour supply and better education. good health is also essential to the All of these elements contribute to economic well-being of a country. sustainable long-term economic As José Manuel Barroso, President growth. The Council of the European of the European Commission, Union also echoed this when it stated said in his speech at the fifth World in June 2011 that: ‘Investments Health Summit: ‘Health systems are in health should be acknowledged the cornerstones of Europe’s welfare. as a contributor to economic growth. We must cherish their success While health is a value in itself, and guarantee their future’.14 it is also a pre-condition to achieve economic growth.’17 Similarly a recent Healthy individuals lead to a healthy Commission’s working document society15, which in turn leads to higher mirrored the Council’s conclusions: productivity, an increased supply of ‘Health is a value in itself. It is also a labour, and sustainable long-term precondition for economic prosperity. growth. The European Commission’s People’s health influences economic Health for Growth strategy16 outcomes in terms of productivity, recognises that countries which have labour supply, human capital and a sound healthcare infrastructure, public spending.’18 12
Debates and resistance Europe will need to find new ways to care for the health of our citizens By 2020
We already know today that our healthcare systems are unsustainable under the current trends and in their current designs.
Bruno Strigini President, Global Human Health Europe & Canada, MSD
The healthcare sector has don’t reform, we will compromise traditionally been a conservative the universality and quality of market and, as such, change can care, which form the cornerstone often be seen as controversial. of Europe’s welfare state. If a It will undoubtedly create health system is not performing questions and drive debates. well, it will not be able to provide Some individuals and the highest-quality healthcare to organisations will resist change all in the future. And we must not – whether a doctor who refuses allow that to happen.’19 to engage with an important new technology, a healthcare By 2020, Europe will need to find system which moves slowly new ways to care for the health to confront the new realities, of our citizens and our citizens will or a citizen who is unwilling have to find new ways to manage to manage his or her health. their health. In the following chapters, we will share the views What is clear, however, is that of our expert interviewees on what most of our experts consider they perceive is needed and the the current state of affairs positive steps they believe can be unsustainable. As President taken to help ensure healthcare Barroso said, ‘we must accept that consumers in 2020 receive the the time has come for structural sustainable and appropriate reforms in health systems. If we healthcare they expect. 13
CHAPTER 1 — Summary
——Great strides have been made in treatment and care of Europeans over the past two decades.
——At the end of 2013 though, healthcare is under significant pressures and these are expected to have increased further still by 2020.
——Fundamental changes are required to ensure healthcare systems in Europe can meet growing demand. 14
C hapter 2
The changing role of the healthcare consumer
I would expect by 2020 that as a consumer I will have much more of a role in shaping decisions about my healthcare. There will be more opportunities to manage my own conditions and take a more active part in the management of any condition I have and not just be a passive consumer of healthcare.
Professor Stephen Bevan Director, Centre for Workforce Effectiveness, The Work Foundation 15
[There] will be a more empowered The influence of the consumer/ patient in two senses. More empowered patient will increase; more and more in that he will insist much more on information about good health will the kind of choices that are to be be available. made, which means his opinion, his Professor Klaus-Dirk Henke participation in decision-making, will Chair of the disciplines of Public Finance be important. Secondly, in the context and Health Economics, Technical University of Berlin of autonomy, self-decision and self- management of chronic diseases.
Ri De Ridder Director-General, National Institute for Health and Disability Insurance (RIZIV-INAMI)
At this point, ‘healthcare consumer’ The move toward a more is an increasingly common phrase. consumer-based healthcare This illustrates the extent to which market is already being introduced the role of the patient has evolved in Europe. The Cross-Border in recent years. The exponential Healthcare Directive20 is looking at growth of the internet, most recently how to make healthcare available on mobile computing platforms, across borders within Europe. has put an immense quantity of The Directive acknowledges healthcare information at the openly that ‘the majority of the fingertips of citizens. This includes provisions of this Directive aim everything from academic papers to improve the functioning of to complex data on mortality rates, the internal market and the free to details of hospitals’ car parking movement of goods, persons and charges. It has also served to connect services.’21 Although what this people from all over the world through eventually means for healthcare social media and healthcare blogs, systems may only become clear such as www.patientslikeme.org and years later. www.healthunlocked.com. This has resulted in an upsurge in support and advocacy groups for those suffering similar conditions. 16
The increasing rise of consumer demand
Citizens will be less deferential to health professionals – for example we will have alternative information sources against which we can benchmark the advice we get from professionals. We will be more choosey about the way we look for healthcare.
John Chave Secretary General, Pharmaceutical Group of the European Union
While we are already beginning recipients of treatment. Instead they to see a rise in the influence of will be asked to take charge of their the healthcare consumer, our own healthcare, with professional interviewees said that they envisage support to help them. Given that a healthcare system in 2020 where responsibility, consumers will also consumers are even more involved expect to be far more involved in in their own healthcare. They believe decisions about their health and how consumers can no longer be passive it is provided.22
Question 4 of the consumer survey: Q4 In the year 2020 the public will be more actively pushing for high quality healthcare than now?23 77% public will be more Extent of Agreement or Disagreement with the statement in question actively pushing for high quality healthcare in 2020 45.0%
40.0% 40.6% 35.0% 36.0% 30.0%
25.0%
20.0% Again, these are beliefs backed by No. of respondents 15.0% 15.5% our consumer polling. 77% of those 10.0% we surveyed believe the public will 5.0% 3.7% 1.7% 2.5% be more actively pushing for high 0.0% quality healthcare in 2020 than Strongly Somewhat Neither agree Somewhat Strongly Don’t know they are today. agree agree nor disagree disagree disagree 17
Rights...... and Remote control responsibilities
I think it is important that there Consumers want and need to It is an open question will be more access to information take more responsibility for their whether patients will grow to like and knowledge on health, own health and well-being. relying on mobile apps or internet healthcare choices, the range of delivery, or non-physical face-to- Jean-Michel Marlbrancq options that are available to put the Chief Executive Officer Europe, GE Healthcare face sources of advice and care. consumer more firmly in the driving Or whether, even if they have the seat about the decisions regarding tools for more remote forms of their healthcare. healthcare delivery, they will still stick with more traditional forms. Professor Margaret Barry Head of World Health Organization John Chave Collaborating Centre for Health Promotion Secretary General, Pharmaceutical Group Research, National University of Ireland Galway of the European Union
The experts interviewed for this Given our experts’ belief that Our interviewees believed that report say that the healthcare consumers will need to be more technology will be important to consumer’s role has significantly involved in shaping their own the healthcare consumer of 2020. changed and there is no going healthcare, they suggest that the That is in large part because it back. These changes have been European citizens of 2020 will be will support the emphasis on driven not only by the move from asked to take responsibility for their self-management and keeping healthcare geared toward the own well-being to a greater extent consumers out of hospital. It may masses to a more personalised than ever before. The reason? be that consultations with doctors approach, but also by the broader There is unprecedented pressure take place over videoconference or trends toward transparency and on healthcare services without computer rather than face-to-face accountability. As a result, our the capacity to provide care in (see Chapter 5: Healthcare systems experts envisage that by 2020 the traditional way. This is why – of primary importance). consumers will demand to be more they believe the concept of But will healthcare consumers be involved in shaping decisions about self-care will be a necessity. ready to move from a 10-minute their healthcare. But consumers will Those interviewed for this report appointment at their doctor’s office want those decisions to be informed suggest the solution is primary to a consultation via computer? ones, and will expect greater access care24 which is healthcare at More importantly, will all consumers to information than ever. home or in the community where the person lives. When that is be able to? And even more There is not only information to not an option, secondary care25, importantly, are our healthcare compare the quality of health or hospitalisation should be professionals ready for this major services, or treatment detail; considered. This will not simply change? Although by 2020 a there is also information about save resources26, but our experts generation will have grown up with condition and care. There will be also believe that it should provide the internet, smartphones and an expectation that consumers for a better patient experience. tablets, the fact remains that older will have greater rights to this people may be significantly less information, and that it is accurate comfortable with newer technology and timely. – and have little or no access to it. 18
The importance of The need for education self-management
Tools for the self-management Digital literacy is imperative We need to be preventing of chronic disease will become much for health professionals and for illness and promoting good more important for patients. Self- citizens. People cannot be expected health rather than just treating management will also be important to manage their own health without illness. We essentially have for the system itself, because there the availability and assistance to a sickness system rather than will be a lack of professional staff become digitally literate if they a healthcare system. to address all aspects of care, so need it. Rebecca Taylor patients will have to do quite a lot Peteris Zilgalvis Member of the European Parliament of things themselves. The system Head of Health and Well-being Unit, will rely on patients, but I strongly DG CONNECT, European Commission believe they will be willing to take on these tasks – under the condition that they have access both to the information and to the tools that Some of our experts pointed out that healthcare consumers will need help are necessary. and education to adapt to the increasing use of technology and data. While Ri De Ridder younger consumers may be at ease – and, indeed, demand that the latest Director-General, National Institute for Health and Disability Insurance advances in communication technology are employed in healthcare – the older (RIZIV-INAMI) generation may be less comfortable with the change.
The same can be applied to healthcare information. Our experts suggested that availability of data will not be enough. That data will need to be interpreted so that consumers can use it, therefore health literacy will play a crucial role in 2020. When consumers are better informed and aware, there is a greater chance that many illnesses can be prevented.
28 Over 100 million citizens or 40% General health literacy by country of the population in Europe above the age of 15 are reported to Austria have a chronic disease, and two Bulgaria out of three people, who have Germany reached retirement age, have had Greece 27 at least two chronic conditions. Ireland Unfortunately the current European Netherlands medical models are focused on Poland acute and short-term treatments. Spain Total Helping those to manage their 0 10 20 30 40 50 60 70 80 90 100 chronic disease will significantly Inadequate health literacy Sufficient health literacy reduce the need for professional Problematic health literacy Excellent health literacy resources. 19
Interestingly, the public seem less certain that education on ‘how to live a healthy life’ will be important in CHAPTER 2 — 2020. When asked which of a list of four options would make the greatest Summary impact on healthcare in 2020, citizens classed education as the least important.
Question 5 of the Consumer Survey: Q5 Which of the four options would provide the greatest impact on healthcare in 2020?
Greatest impact on health in 202029
3.6%
11.2% 15.4%
19.1%
50.6%
——Given that consumers New Medicines Members of the public Improved technology and patients being will need to play a much better educated Improved collaboration more active part in between different Don't know healthcare users decisions about their healthcare they will have to take on greater responsibilities to prevent illness and ensure their A greater health awareness focus own well-being. has already begun. Governments are looking into more fiscal policies, ——This will require a greater which centre on health promotion investment in education and disease prevention such as and health literacy for 30 taxing alcohol and tobacco. consumers. They will Simultaneously they are looking at need to know more about providing tax incentives for certain healthy lifestyle choices healthcare products. Some of those and how to interpret we interviewed said they would like to see such initiatives go further still. information about their own health. 20
C hapter 3
Healthcare professionals – changing roles
The role of the doctor will I hear from my members that Society has changed – be to guide the patient through physicians and GPs are playing more they [doctors] are actors the different existing market and more of an advisor role. in a system. opportunities to make the best Birgit Beger Pascal Garel choice. This will be difficult, as it Secretary General, Standing Committee Chief Executive, European Health means that the doctor will not be of European Doctors (CPME) and Hospital Federation a decision maker as he is right now, but will be more of a counsellor with the highest possible level of expertise.
Antonyia Parvanova Member of the European Parliament 21
A changing relationship
The role of the doctor will change dramatically, because on one hand we have a different understanding of what a doctor should do and what a patient should know. The doctor will be more of a guide, than a decision-maker.
Professor Helmut Brand Jean Monnet Professor of European Public Health, Head of Department of International Health at Maastricht University
As the role of the healthcare consumer changes, so does the role of the healthcare professional. Today’s consumers are more willing to question their doctors and ask about different treatments based on the information gathered from their own research through social media, healthcare blogs and online patient groups. The opinions of doctors are no longer automatically accepted by the patients for whom they are caring.
Combined with the increasing focus on prevention, our interviewees expect that by 2020 healthcare workers will be seen as mentors and guides. Rather than being expected to offer a definitive answer, doctors will be asked to offer advice. They will help healthcare consumers navigate the system, and make sense of the wealth of information available. 22
Ageing population affects the workforce too The emergence of new roles
It has been estimated that by 2020 we will be missing around 700,000 We should see the emergence medical professionals. Which means that right now, today, we have to put in of new health professionals, such the medical universities 700,000 doctors and nurses so they will be ready for as case managers, health coaches, 2020 to jump into the system. This will not happen of course. There is no such etc. who will take on additional capacity for the universities. For nurses it will be even worse, because there is services that require less medical even less capacity in the nurses’ schools. expertise and training. These additional services will improve the Antonyia Parvanova Member of the European Parliament quality and efficiency of the whole system. In particular, these new health professionals should free up time for doctors to focus on more difficult and expensive care.
Bruno Strigini President, Global Human Health Europe & Canada, MSD
13,400 nurses were due to retire in 2010
While Europe’s ageing population million healthcare workers by Some of those interviewed is creating more demand than ever 2020, rising to two million if long argued that the creation of new before for the services of healthcare term care and ancillary professions roles will be required to deal with professionals, many healthcare are taken into account. This means the shortfall and that existing professionals are approaching around 15% of total care will not healthcare professionals – nurses, retirement age. This is compounded be covered compared to 2010. pharmacists, allied health by the fact that not enough young It also revealed that in 2009, about professionals – will also have to people are coming into the system 30% of all doctors in the European take on more responsibilities. Our to replace them. Union were over 55 years of age and interviewees also felt that this move that, by 2020, more than 60,000 – would be motivated by the fact The sheer scale of the problem 3.2% of all European doctors – that physicians will be expected to was detailed in the 2012 European are expected to retire annually. take on new tasks beyond patient Commission action plan for the In Italy alone, 13,400 nurses were care. As the use of technology in European Union health workforce.31 It due to retire in 2010 but only 8,500 healthcare increases, they will have stated that if the ‘retirement bulge’ nurses graduated in 2008/09. to become far more IT literate. In an was not addressed, there will be a age of limited resources, they can potential shortfall of around one also expect to have to take on new budgetary responsibilities. 23
Working with the private sector CHAPTER 3 — Summary The EC does not aim to move the healthcare system solely into the private sector or consumerist delivery, but the work of the private sector will remain important. Private sector investment will continue to be welcomed.
Peteris Zilgalvis Head of Health and Well-being Unit, DG CONNECT, European Commission ——Healthcare professionals will increasingly serve as mentors to healthcare consumers, helping them make the best decisions and interpret the available information.
——There is a growing shortage of healthcare professionals in Europe, which is expected to become more serious by 2020. Creating new healthcare roles, training more generalists and expanding the responsibilities of existing roles, will be necessary to address Many of our experts felt that private supported in Europe (even though this problem. sector involvement in European private clinics already provide healthcare had traditionally been a large share of hospital care in ——Doctors will be expected frowned upon, despite the belief that some European countries) and the to embrace change and industry had a valuable role to play. involvement of for-profit enterprise. become more IT-literate For example, private companies will Some of our experts felt that there as the use of technology supply the IT systems and technology were valuable lessons, which the to deliver healthcare for eHealth, including innovations public sector could learn from the grows. related to mobile health (mHealth) private sector, particularly around and cloud IT solutions. So it will be delivering efficiencies and streamlined ——Healthcare systems important for healthcare professionals service. Already we are seeing should not only try to to be prepared to forge relationships business management methods, build relationships with 32 with private partners. such as ‘Lean Six Sigma’ that have private providers but been used now for decades in the also take best practice To overcome these negative attitudes manufacturing industry, increasingly from the private sector toward the private sector, our finding their way in healthcare and incorporate it into experts feel it will be important to settings to improve quality and distinguish between the privatisation efficiency.33 the public sector. of healthcare which is not generally 24
C hapter 4
The financial challenge
If we do not prioritise health All the stakeholders, both promotion and prevention, private and public, need to work we will face an unpayable or collectively to make the sector more unfinanceable demand for efficient, to deliver good quality, healthcare services in 2020. for everybody, at lower cost.
Antonyia Parvanova Jean-Michel Marlbrancq Member of the European Parliament Chief Executive Officer Europe, GE Healthcare 25
A substantial expenditure
Healthcare represents one of the most In the past few decades, the amount expensive areas of public spending being spent has grown. In 1980, in the EU. A significant proportion 5.7% of the European Union’s of gross domestic product (GDP) is GDP was devoted to healthcare. dedicated to healthcare in Member By 2010, the 27 EU Member States States and it is the second largest social were spending about 8% of GDP expenditure item after pensions. 34 on healthcare.35
Key drivers and dynamics of health expenditure growth36
Improved survival rate Ageing imply more years of New populations treatment therapies will comprise 30% enlarge options of global pop. by of care but raise 2040 costs Lack of performance transparency prevents matching demand to the Growing most productive supply Rising unit burden of cost of care disease
Unhealthy Innovation lifestyles are strategy driving chronic focuses on preventable outcomes not disease Demand Supply value for of health health services services
Maslow’s Vested hierarchy interests slow extends demand the pace of once basic needs change are met
Higher Increasing capacity Suboptimal patient induces demand allocation of expectations resources
Value Incentive consciousness systems do not limited by lack of Payment systems offer always reward price signals and little financial incentive value creation incentives for patient to minimize cost 26
Increasing Longer-term solution needed pressures
I regard care as a form of I see health as wealth and economic activity. I don’t see it as a without a healthy population, there burden; I see it as wealth creation of would be economic drawbacks the purest type. As societies get richer because a healthy population is they can afford more of it; it is not important for a healthy workforce, a burden. which in consequence is important The rising costs of healthcare in for the economy. Stephen Dorrell MP Europe and the consequent need Chair, House of Commons Health Select Birgit Beger of finding ways to drive efficiencies Committee Secretary General, Standing Committee in healthcare and increase of European Doctors (CPME) productivity has been on European government agendas for some time. It is a mission that has been made more urgent, however, by the recent Increasing demand for healthcare This is why our experts speak worldwide financial downturn and services means that the need for about the need to fundamentally more specifically by the Eurozone increased funding will remain. refocus the sector. Many of those crisis. One third of governments As such, many of the experts interviewed argued that healthcare in Europe – including those of interviewed emphasised the must no longer be looked at as a Austria, Czech Republic, Greece, importance of greater efficiency. cost, but as an investment, just like Slovenia and Spain – have adopted However, while focus on efficiency education. This seems to echo the explicit cuts to health budgets as gains may reduce waste and recent Commission paper ‘Investing part of wider austerity measures.37 improving quality, it will not in Health’ which states that health Meanwhile, some European nations address the immediate financial expenditure is recognised as growth- are trying to lower public spending crisis. Likewise it is unlikely to be a friendly expenditure. Cost-effective on healthcare by shifting costs to comprehensive, long-term solution and efficient health expenditure individual citizens or by changing to increasing healthcare demand. can increase the quantity and the Finally, there is a certain risk of ‘false the scope of public health systems.38 productivity of labour by increasing savings’ as the impact of policy 43 We have already seen that while healthy life expectancy.’ changes is not always immediately health spending as a percentage apparent due to the time lag.41 In This will have to be borne in mind of the European Union’s GDP fact, the way forward is not that when looking at some of the tools to grew on average by close to 5% obvious, as the OECD notes, ‘it is transform services. Pharmaceutical year-on-year from 2000 to 2009, not clear yet whether the recent innovation has been and will this has since been followed by a slowdown reflects mainly cyclical continue to be a major contributor sluggish growth of around 0.5% factors and may therefore not have to efficiency gains in healthcare, in in 2010 and 201139 since the lasting effect when economy growth particular as they push back and help Eurozone crisis hit. In addition, in picks up, or whether it reflects more reduce expensive hospitalisation and its annual growth survey for 2013, structural changes such as a slower rehabilitation costs.44 Technology the European Commission stated diffusion of new technologies and and innovation – particularly that ‘reforms of healthcare systems pharmaceuticals, and changes eHealth – were also cited as having should be undertaken to ensure in provider payments resulting in significant potential to deliver 42 cost-effectiveness and sustainability, greater efficiency.’ Indeed, slower greater efficiencies and better health assessing the performance of diffusion of innovation might be outcomes. But neither is cheap and these systems against the twin aim counterproductive in the long run their funding can be challenging for of a more efficient use of public and fiscal tightening fails to address policy-makers. resources and access to high quality the design flaws of our healthcare healthcare.’40 systems in addressing societal needs. 27
New funding methods
The growing demand for European Union countries, some healthcare funding – coupled nations are reducing coverage with the austerity measures and and increasing co-payments. population changes leads some In Spain, for instance, legislation of our experts to believe that the was passed in April 2012 ,45 current healthcare funding model which restricts free healthcare used by many Member States to those with residence permits, will need to change by 2020. unless emergency care is They point to a trend that has required.46,47 In addition, for the already started. While universal, first time, Spain’s pensioners are government-funded, healthcare expected to contribute to the is widely regarded as a right in cost of their medicine.48 28
Advanced societies are defined Generally speaking, if you are There will be a dilemma in the by their welfare systems and the a European government with sense that there will be more and access to the services provided by a socialised healthcare system, more sophisticated treatments it. Our societies need to advance it is very challenging to focus on available also for smaller patient in the access to those services. new funding methods. On the populations at a higher and higher Healthcare is a right and we cannot other hand, from a long-term cost. Governments will increasingly trade with it. We need to improve sustainability point of view, have to prioritize whether they will the efficiency of the system but this I don’t think that they will be able make these treatments available cannot be an excuse to deny the to ignore it. and deprioritise other things. access to healthcare services based Dr Timothy Garnett Dr Flemming Ornskov on the arguments of austerity Chief Medical Officer and Senior Vice Chief Executive Officer, Shire measures. President, Eli Lilly
Andrés Perelló Rodríguez Member of the European Parliament 29
A sensitive issue
Changes to national health Those interviewed for this report systems have often been hugely suggested that the commitment controversial, with protests from to provide healthcare to everyone healthcare professionals and citizens will be very difficult to reverse; nor alike.49 Changes to healthcare would many want to. But at the Just 53% of those we surveyed coverage and payments have same time most acknowledge the agreed that people will have already started in the United public will have to contribute more; to contribute more financially Kingdom, Cyprus, Ireland, Italy and whether financially, or in taking to ensure the sustainability of Greece and have proven contentious. better care of their own health. healthcare systems in 2020. Such sensitivities reveal the extent Our consumer polling suggests that, Furthermore, 73% of those to which universal healthcare, when it comes to the financial side, surveyed said they considered largely free at the point of care, healthcare consumers may not yet free healthcare services to be is still seen as desirable in Europe. be ready for such a change. ‘very important’.
Question 3 of the consumer survey: Q3 In the year 2020 people will have to contribute more financially, 50 53% in order to ensure the sustainability of healthcare systems? Extent of Agreement or Disagreement with the statement agreed that people will have to contribute more financially 40.0%
35.0% 36.8% 30.0% 25.0%
No. of respondents 20.0% 21.3% 15.0% 16.3% 10.0% 14.3% 9.7% 5.0% 1.6% 0.0% Strongly Somewhat Neither agree Somewhat Strongly Don’t know agree agree nor disagree disagree disagree
Another particularly sensitive area governments often do not have the some of our experts identified flexibility to fully capture potential was investment decisions in new savings in parts of the healthcare technologies and innovations. sector that new technologies Many acknowledged that it is more can deliver. Our experts said that difficult to introduce innovation into governments will increasingly the healthcare sector because of need to develop plans for funding its conservative nature. Some also healthcare innovation as they will noted that this fact is not helped increasingly face consumer demand by the initial upfront cost of new for the latest medicines, diagnostics innovation, which creates specific and technologies which can all help budgeting challenges. Because deliver better results and greater of the complexity of healthcare, patient convenience. 30
Social care relevant too Prevention is better than cure
There is sense in merging health and social care budgets but I think One of the shocking statistics it will require a good deal of thought to get it right. is that the European Union only spends 3% of the healthcare Mike Farrar Former Chief Executive of UK National Health Service Confederation budget on prevention.
Professor Stephen Bevan Director, Centre for Workforce Effectiveness, The Work Foundation
Just as there are significant pressures Regardless of their views on whether Our interviewees agree that the on health funding, so too is social the money should be divided into funding priority should be long-term care funding under strain. Social care separate pots, many of those prevention to help reduce pressures covers a wide range of services to interviewed hoped that policies in on health systems. Healthcare support the elderly, those recovering health and social care would be much spending will move from being a from illnesses and other vulnerable more closely coordinated. cost to an investment in the future populations. Could budgets for these well-being of populations across two areas be merged by 2020? There Breaking down the boundaries Europe. are clear arguments for doing so: between health and social care may How countries approach changing greater efficiencies and better patient also assist with the shift from cure their healthcare model from one care, with the individual having a to prevention. The idea that health that focuses on treating late-stage seamless journey from doctor to services will have to move from disease to prevention and earlier hospital to home. treating ill health to maintaining good health was frequently raised detection and intervention may Our experts had diverging views by our interviewees. By promoting vary. In fact, OECD data unveiled on whether these are winning healthy lifestyles – and helping that the potential benefits of arguments, however. Some felt it people with conditions to manage investment in prevention is not that was helpful that health and social them better at home – the burden well recognised: ‘In many countries, care continued to be viewed as of caring for the ageing population governments have also decided to quite separate sectors and funded will be significantly reduced. cut their spending on prevention accordingly. Others saw benefits to a and public health, although combining of budgets but most were these typically represent only a sceptical that this could take place in small share of their overall health the next six years. budgets.’51 In fact, with a growth rate of minus 3.2%, prevention and public health was impacted by the financial crisis the most, followed by pharmaceuticals (-2.4%).52 Our experts felt that investment in public health and preventative measures needs to be better prioritised by governments. 31
CHAPTER 4 — Summary
——The financial downturn and Eurozone crisis has exacerbated the need to curb healthcare expenditures.
——New models of funding healthcare coverage must be assessed. Consumers can expect to make a greater financial contribution toward their treatment.
——The need for healthcare services to operate more efficiently has been emphasized, but efficiency improvement will not solve the challenge on its own. Governments must see investment in healthcare as an opportunity rather than simply a cost – an asset in the governmental balance sheet. 32
C hapter 5
Healthcare systems – of primary importance
Healthcare systems will have to Health isn’t created in hospitals Primary care will be the most adapt and whether we like it or not and clinics. You have to look at important level in the context healthcare is going to become more where health is created and where of chronic disease and ageing of a market place where only the it’s damaged: it’s where people live Ri De Ridder efficient will survive. their everyday lives. Director-General, National Institute for Health and Disability Insurance Dr Flemming Ornskov Professor Margaret Barry (RIZIV-INAMI) Chief Executive Officer, Shire Head of World Health Organization Collaborating Centre for Health Promotion Research, National University of Ireland Galway 33
Across Europe, healthcare systems are In all the public health being restructured. Some countries ‘big books’ it is written that are changing the groups eligible the biggest amount of money for state-funded health coverage; should go to primary care, then others are asking citizens to pay more to secondary, then to tertiary. toward their treatments. There is Since developing public health however one common theme across science, this has not happened. the board, and that is the importance There is no single Member of primary care. State which has this kind of Time and again the people interviewed pyramid, and we constantly for this report said that, by 2020, conclude that the pyramid is the focus on primary healthcare will upside down. increase. The reasons are multiple, Antonyia Parvanova complex and interrelated. There is Member of the European Parliament of course a clear financial impetus for supporting more extensive use of primary care: treating someone in hospital is far more expensive than treating that someone in a general practitioner’s office or in their own home. A literature review by the World Health Organization (WHO) demonstrated that increased availability of primary healthcare is associated with reduced aggregate healthcare spending.53
Yet the same review also revealed clear quality of care implications. It reported: ‘International studies show that the strength of a country’s primary care system is associated with improved population health outcomes for all-cause mortality, all-cause premature mortality, and cause- specific premature mortality from major respiratory and cardiovascular diseases. This relationship is significant after controlling for determinants of population health at the macro-level and micro-level.’54 34
Fewer hospitals The growth of technology
With the ageing population, I think technology will help The economic and social diseases will become much more patients to be more in control. They benefits of implemented eHealth chronic. If you take people into will have more knowledge but also solutions will grow. hospital, they will be obliged to stay there will be better technology that Professor Klaus-Dirk Henke there for months in a row, or maybe supports them to manage their own Chair of the disciplines of Public Finance years in a row. This is very expensive healthcare. and Health Economics, Technical University of Berlin of course. It’s also not the best Professor Stephen Bevan solution from the consumer point Director, Centre for Workforce Effectiveness, of view. I think the time that you The Work Foundation can put people together in hospitals for months in a row is over.
Philippe De Backer Member of the European Parliament
As well as reduced mortality and Our experts felt that there are Those interviewed for this report reduced costs, countries with well- opportunities for healthcare IT to expect technology to be one developed primary care systems assist in improving the quality of important way that care in have higher levels of patient medical care. In particular, as the non-traditional health settings satisfaction.55 Most healthcare delivery of appropriate healthcare will be supported. When a visit to consumers want to stay at home to those with non-communicable a healthcare professional is required, and not spend time in a hospital. diseases becomes more complex it may not always be in the form requiring greater collaboration of a traditional, in-person, Given that our expert interviewees between a variety of institutions, consultation. In fact healthcare agree, many argued that healthcare professionals and healthcare consumers will be able to be professionals will need to focus on consumers, the issue of whether monitored, tested and prescribed how to support care closer to home. healthcare systems can operate treatment remotely. Many of those Many leading hospitals are sustainably without more investment interviewed see enormous potential already recognising this in healthcare IT has become a in eHealth in the widest sense of changing landscape and critical focus. that term, including the most recent are adapting. Our experts developments in mHealth. discussed how some are using IT to virtually break out of their structural confines, to forge better connections with healthcare consumers, 61% physicians and clinics and to said more treatment in invest in medical technologies Revealingly, 61% of the consumers we polled as part of the community was very our research for this report said that more treatment in that enable earlier diagnosis important and better-targeted treatment. the community was ‘very important’ when thinking about In short they are transforming, healthcare services in 2020. and connectivity is the key. 35
Rising Popularity of Mobile Health Apps
Infographic quoted by: European Commission, Rising Popularity of Mobile Health Apps, 23 January 2013 http://ec.europa.eu/digital-agenda/en/news/rising-popularity-mobile-health-apps 36
Caring and sharing The potential of eHealth...
Interoperability of the new ways of communication or eHealth will be an issue. Because there will be some countries and some regions which will have them, some others not as much, and there will be a problem with the development of the eHealth network or the IT network more in general.
Antonyia Parvanova Member of the European Parliament
1/2 More than half of the citizens said they expected ‘improved medical technology’ to have the biggest impact by 2020
Some resistance can be expected The European Commission defines The European Commission has from consumers as well (see eHealth as tools and services using recognised the importance and Chapter 2: The Citizens). Even so, information and communication challenges of so-called eHealth it is to be expected that 2020’s technologies (ICTs) that can improve through a directive on the application healthcare consumers will demand prevention, diagnosis, treatment, of patient rights in cross-border their providers use data and monitoring and management.56 healthcare. Directive 2011/24/ technology more efficiently. EU, passed in March 2011, calls Good information sharing and use on Member States to increase the Our experts also believe technology of technology does not just improve interoperability of their healthcare will be important in sharing healthcare consumers’ experience, ICT systems.57 To this end, it created information. Again, that is in the also leads to a significantly more a voluntary eHealth network to widest sense. On the one hand, efficient health service, with less which almost all Member States healthcare consumers will expect duplication of effort. However, our now belong.58 The network has drawn information about their health to interviewees fear that developing up guidelines which will enhance follow them whether they change these systems will be far from interoperability, ensuring continued location or doctors. On the other, straightforward. A wealth of access to high quality healthcare.59 they will expect information to keep healthcare IT systems are used them informed about their health across Europe, not all of them are and the choices available to them. interoperable. In fact, in the UK – where many healthcare organisations There is likely to be resistance are merging; single providers may use from the sector itself, as addressed multiple systems. earlier in this report. As such, some interviewees suggested that it may be valuable for the sector to look to the private sector for examples of change. 37
Redefining innovation CHAPTER 5 —
When it comes to pharmaceutical I believe that it will be perfectly Summary innovation, most of the low hanging possible and reasonable to be able fruit has already been picked. to give people more personalised We are now moving toward an era care in 2020. of developing more personalised Mike Farrar treatments, which do not target Former Chief Executive of NHS Confederation large groups of patients as the big blockbusters have done.
Rebecca Taylor Member of the European Parliament ——As 2020 approaches, the emphasis on healthcare will increasingly move from secondary to primary care. Less care will be delivered in hospitals: the aim will be for healthcare consumers to receive care closer to home or even at home. Interviewees suggested that what is that the EU Commissioner for viewed as innovation in healthcare Health and Consumers Tonio Borg ——Developing technology, today will not be the same in 2020. has praised in the past. He has including eHealth and There will be less focus on blockbuster described personalised medicine as mHealth, will support medications and more on developing ‘an innovative, efficient and patient- effective treatment delivery systems centred alternative to a one size fits this move, though for consumers and tailoring their all medicine.’ Notably, he continued: it will present some treatment. ‘It also yields a maximum return on challenges, as the healthcare investment – a valuable healthcare sector is The personalisation of healthcare argument for decision makers in times traditionally slow to and treatments through greater use of austerity.’60 change. More will need of genetic profiling is something to be done to break down conservative attitudes within healthcare systems. more focus on developing effective ——What is meant by treatment innovation will change. No longer will the focus delivery be on blockbuster medicines but rather systems on improving the delivery of highly personalised care. 38
C hapter 6
Healthy expectations – looking beyond 2020
We really do need to evolve a much more long term view of healthcare and recognise the interventions that we may take now may not pay off in the next 30 years.
Dr Timothy Garnett Chief Medical Officer and Senior Vice President, Eli Lilly 39 40
What we can expect Question 5 of the consumer survey: Q5 To the best of your knowledge, which of the following will provide the greatest impact on healthcare in the year 2020?61
I really believe that there are Greatest impact on health in 2020 new paradigms coming up which might completely change the view on healthcare. I really believe that healthy life will be a much more 60.0% important issue in the near future, 50.0% much more than just healthcare. 40.0%
Ri De Ridder 30.0% Director-General, National Institute for Health 20.0% and Disability Insurance (RIZIV-INAMI) No. of respondents 10.0% 3.6% 1.0% 0.0% 3.6% 15.4% 33.4% 50.6% 28.5% 19.1% 20.2% 11.2% 13.3% 0.0% New Improved Improved Members of the Don't know Not stated medicines technology collaboration public and patients between different being better healthcare users educated
Most important option Second most important option
Given that change can be slow in My wish is that we invest the Something we need urgently, the healthcare sector, many of our funds for the genetic testing of and it is really a hard task, is to experts felt that the fundamental individuals. We can then better have good tools to assess treatment changes that they believe are diagnose and prescribe more outcome. I don’t think the tools needed will not be completed by appropriate drugs and treatments we have currently are very 2020. Moving from a focus on for individuals or clusters of people. good. They are not creating the treatment to prevention, ensuring At the moment we live by a knowledge we need to improve. citizens are fully empowered, scattergun approach that says; Dr Roberto Frontini developing proper information if you have got a disease, then you President, European Association of Hospital sharing – all of these are significant should take drug A, even if it does Pharmacists and lengthy tasks. It is therefore you no good at all or has adverse unsurprising that, when asked to side effects. It is necessary to invest, focus on the picture beyond 2020, but ultimately you will improve most of our interviewees stated that health outcomes and save money the biggest priority is to implement by avoiding waste. these changes. It is clear that a long John Bowis term view is needed when looking Chair, European Alliance for Personalised at Europe’s healthcare systems; but Medicine that is easier said than done. 41
The importance of research and measurement CHAPTER 6 —
A long-term view needs to apply to research as well. While personalised Summary medicines and treatments are frequent headline grabbers, our interviewees emphasised that much work is still needed before they are to become day-to-day reality.
Just as new scientific discoveries will be important, so too will be assessing their impact. The true value of apparent breakthroughs in healthcare can only be judged if powerful assessments tools are in place. Some of our experts saw this as an important area in which healthcare can develop post-2020.
——With 2020 now just a few years away, Everyone has a responsibility some of our experts suggest that only and contribution to make limited changes will be implemented by then. Resolving the growing burden of the disease and earlier detection health-related issues is as much and treatment. Cost-effective ——Changes to attitudes about promoting policies that healthcare is about reducing risk will be slow to encourage behavioural change, factors, maintaining a healthy lifestyle implement, but it will and the detection and treatment of and leveraging technology and data be vital to shift the diseases earlier, as it is about treating early, not once the disease is well conversation around late-stage disease. These are major established healthcare to one challenges. However with today’s around creating health advances, we already have many tools The work needs to start now. not just treating illness. at our disposal including technology It cannot be done by any one entity to support such efforts. Clearly this but requires the collaboration of ——A longer-term is a much broader topic than can be healthcare providers, governments, perspective will need adequately summarised here, but at industry, and consumers to work its core is the belief that there should together to ensure that Europe is to be adopted on be more attention diverted from the ready to make the necessary changes healthcare – by all intervention in disease at the late required to deliver cost-effective, parties. stage, to the conditions leading to quality healthcare to its citizens. 42
AmCham EU recommendations
AmCham EU believes the following recommendations are required to bring about affordable, sustainable, innovative healthcare in Europe in 2020:
Health systems need a stronger focus on Policies and resources need to be directed keeping people healthy (health promotion, toward improving health and IT literacy prevention), while investing in innovation that of citizens to empower them to take more can drive efficiencies, improve productivity responsibility for their own health. and facilitate patient-centric care.
—— While the current era of financial austerity may be —— Our interviewees believe a healthcare system in 2020 over by 2020, healthcare providers, professionals and should help consumers help themselves and practice leaders can still expect to be asked to do much more self-care. They believe that consumers can no longer with less. be passive recipients of treatment. —— Challenges such as ageing and chronic diseases will —— EU policies need to facilitate citizens taking charge increase the financial pressure on health systems. of their own healthcare. This is even more relevant as Interviewees believe health services will have to evolve chronically ill patients are on their own for the most from treating illness to maintaining good health. part of their daily life and interacting only infrequently —— Promoting healthy lifestyles and helping people with with the healthcare system. chronic conditions to manage them better at home, —— This will require the European Commission to will significantly reduce the burden of caring for an develop a strategy with a strong focus on citizen ageing population. Maintaining health becomes empowerment, health literacy/education and self-care. therefore an imperative and a primary objective for This will also help achieve the European Innovation health systems. Partnership on Active and Healthy Ageing’s goal to —— Research and innovation will continue to be vital to increase the average number of healthy life years the future of healthcare; the focus needs to be on for EU citizens by two years by 2020. Health and IT targeted innovation such as personalised medicine. literacy should be promoted in the framework of this This includes diagnostics and treatment, process Partnership. innovation such as better integrated care pathways, —— The EU Chronic Conditions Strategy must include self- improving health literacy and empowering patients management as a standard of care across the EU. to drive efficiencies in healthcare. More efficient Many suffering chronic illnesses are frequently left on healthcare has a positive impact on productivity and their own without assistance, so self-management is healthcare resource use. really needed. —— The EU must safeguard innovation by implementing —— Healthcare systems should also focus on providing policies that provide incentives to drive creative more and better information for patients and solutions by 2020 and beyond. healthcare professionals, in particular safety information for medical products and devices. This requires strong health education programmes, eHealth solutions, and healthcare systems that are more consumer friendly. 43
Healthcare providers need to re-think their Health has to be seen as an asset rather roles, and insurance companies need to than a cost. re-think their remuneration schemes.
—— With the help of technology there needs to be a shift —— A change in how healthcare is perceived is needed. in the roles of healthcare professionals. In particular Health is important for the well-being of individuals primary care needs to focus further on prevention with and society, but a healthy population is also a the general practitioner becoming more of a mentor prerequisite for economic productivity and prosperity. to the healthcare consumer. Good health is essential to the well-being of a —— Similarly the roles of other healthcare providers such country’s economy. as pharmacists or nurses will shift to help support —— Investing in areas like health literacy, eHealth, patients in self-management. innovative technologies, and medicines can lead to —— The European Commission should revise its 2012 savings in many other areas of society. In particular Action Plan for the EU Health Workforce to respond EU financing schemes need to ensure that we raise to current challenges. It should strongly encourage health standards and bridge the gap across the region. Member States to implement its main provisions. —— Investing in healthcare innovation creates jobs and This includes improving health workforce planning growth. The European Commission’s Health for and forecasting, anticipating future skills needs and Growth Strategy62 recognises that countries with improving training, recruitment and retention of sound healthcare infrastructure, processes and skills health professionals. benefit from higher productivity, increased labour —— These changes will also have implications for the supply and better education. This in turn contributes remuneration of healthcare professionals and their to sustainable long-term economic growth. services. The role of mentoring patients to self- —— AmCham EU calls for a much greater level of manage their healthcare needs should be recognised investment in healthcare, in particular through EU as a key healthcare service and be reimbursed just financing schemes to ensure that we raise health like surgery. Insurance providers need to re-think their standards across the region. incentive schemes to facilitate better coordination and collaboration. 44
Health consumer survey 2020 appendix 1
Introduction Main questionnaire BRYTER is a market research For this section of the survey we’d like you to think about what healthcare agency specialising in healthcare will be like in the year 2020. and pharmaceutical research. We are conducting research on behalf of a public relations company. Q1 When thinking about healthcare Q3 To what extent do you agree services in the year 2020 how or disagree with the following The survey will take approximately important do you consider each of statement? (Please select one 5 minutes to complete and the following? (Please use the 1-10 answer) In the year 2020 people will include topics such as your scale to rate how important each will have to contribute more attitudes toward the future option is, where 1 is not important financially, in order to ensure of healthcare, as well as some at all and 10 is extremely the sustainability of healthcare profiling information about you important) systems. and your lifestyle. Better access to healthcare Strongly agree Before you begin, let us assure services than currently available Somewhat agree you that BRYTER complies with Free healthcare from the point Neither agree nor disagree the MRS Code of Conduct and is I start using health services Somewhat disagree registered in accordance with the More treatment in the community Strongly disagree than currently is in hospitals Don’t know Data Protection Act. Your name education on how to live remains confidential to BRYTER, a healthy life Q4 To what extent do you agree and will not be passed on to or disagree with the following any third parties without your Q2 To what extent do you agree statement? (Please select one permission. All information that or disagree with the following answer) In the year 2020 the you provide will be aggregated statement? (Please select public will be more actively with that from other respondents one answer) In the year 2020 pushing for high quality before being passed on to our governments should treat healthcare than now. client, and thus no individual healthcare as a higher priority Strongly agree response can be identified. than they do currently. Somewhat agree Strongly agree Neither agree nor disagree Conducted by Bryter Research63 Somewhat agree Somewhat disagree between Monday 23 and Neither agree nor disagree Strongly disagree Wednesday 25 September 2013. Somewhat disagree Don’t know For the detailed results of the Strongly disagree consumer survey, please contact Don’t know Q5 To the best of your knowledge, the AmCham EU secretariat. which of the following will provide the greatest impact on healthcare Mode: Quantitative online survey in the year 2020? ( Please select Target timing: 5 minutes the next most important option. Sample size: 1500 (200 each in Please select one answer.) UK, France, Germany, Italy, Spain; New medicines 100 each in Belgium, Hungary, Improved medical technology Bulgaria, Czech Republic, Poland) Improved collaboration between Quotas: Mixed by age (18 and different healthcare providers over), gender, region Members of the public and patients being better educated 45
List of participants appendix 2 AmCham EU would like to thank the following experts (listed alphabetically by organisation name) who participated in the project:
Professor Margaret Barry Mr Mike Farrar Ms Antonyia Parvanova Head of World Health Organization Former Chief Executive of NHS ENVI Committee Member, Member Collaborating Centre for Health Confederation of the European Parliament, Bulgaria Promotion Research, National Dr Roberto Frontini Mr Andrés Perelló Rodríguez University of Ireland Galway President, European Association ENVI Committee Member, Member of Ms Birgit Beger of Hospital Pharmacists (EAHP) the European Parliament, Spain Secretary General, Standing Mr Pascal Garel Mr Ri de Ridder Committee of European Doctors Chief Executive, European Health Director-General, National Institute (CPME) and Hospital Federation (HOPE) for Health and Disability Insurance Professor Stephen Bevan (RIZIV-INAMI) Dr Timothy Garnett Director, Centre for Workforce Chief Medical Officer and Senior Dr Andrzej Rys Effectiveness, The Work Foundation Vice President, Eli Lilly Director for Health Systems and Mr John Bowis Products, DG SANCO, European Professor Klaus-Dirk Henke Chair, European Alliance for Commission Chair of the disciplines of Public Personalised Medicine (EAPM) Finance and Health Economics, Dr Christoph Schwierz Professor Helmut Brand Technical University of Berlin Policy Analyst, DG ECFIN, Jean Monnet Professor of European European Commission Mr Pierdavide Lecchini Public Health, Head of Department Ministry of Health, Permanent Dr Allison Streetly of International Health at Maastricht Representation of Italy, Deputy Director of Healthcare Public University Council of the European Union Health, Public Health England (PHE) Mr John Chave Mr Jean-Michel Malbrancq Mr Bruno Strigini Secretary General, Pharmaceutical Chief Executive Officer Europe, President, Global Human Health Group of the European Union (PGEU) GE Healthcare Europe & Canada, MSD Dr Philippe De Backer Dr François Meyer Ms Rebecca Taylor Member of the European Parliament, Advisor to the President, National Substitute ENVI Committee Belgium Authority for Health, (Haute Autorité Member, Member of the European Dr Isabel de la Mata de Santé, HAS) Parliament, UK Principal Adviser for Public Health, Mr Anders Olauson Mr Peteris Zilgalvis DG SANCO, European Commission President, European Patients’ Forum Head of Health and Well-being Unit, Rt Hon Mr Stephen Dorrell MP DG CONNECT, European Commission Dr Flemming Ornskov Chair, House of Commons Health Chief Executive Officer, Shire Select Committee, UK 46
Data sources appendix 3
Agencia Estatal Boletín Oficial del Estado, European Alliance for Personalised European Commission, MEX/13/1119, 19 ‘Royal Decree Law 16/2012, urgent Medicine, ‘EAPM Report – Statement by November 2013, measures to ensure the sustainability of Tonio Borg, EU Commissioner for Health http://europa.eu/rapid/press-release_MEX- the national health system and improve and Consumers’, 13-1119_en.htm the quality and safety of its services,’ April http://euapm.eu/4886-2/ 2012, European Commission, ‘Population http://www.boe.es/diario_boe/txt. European Chronic Disease Alliance, The structure and ageing,’ Eurostat, October php?id=BOE-A-2012-5403 case for urgent political action to reduce 2012, the social and economic burden of chronic http://epp.eurostat.ec.europa.eu/ Alzheimer’s Society, Demography, July disease through prevention, July 2010, statistics_explained/index.php/ 2013, http://www.escardio.org/about/what/ Population_structure_and_ageing http://www.alzheimers.org.uk/site/scripts/ advocacy/Documents/Chronic-disease- documents_info.php?documentID=412 alliance-final.pdf European Commission, Report on Health Inequalities in the European Union, José Manuel Barroso, President of the European Commission, ‘Action Plan for Commission Staff Working Document, European Commission, speech to the 5th the EU Health Workforce,’ Public Health, September 2013, World Health Summit, 20 October 2013, 2012, http://ec.europa.eu/health/ http://europa.eu/rapid/press-release_ http://ec.europa.eu/health/workforce/ social_determinants/docs/report_ SPEECH-13-838_en.htm policy/index_en.htm healthinequalities_swd_2013_328_ en.pdf BBC News, ‘Spain’s migrant healthcare European Commission, ‘Annual Growth dilemma,’ September 2012, Survey 2013,’ November 2012, European Commission, Report on Public http://www.bbc.co.uk/news/world- http://ec.europa.eu/europe2020/pdf/ Finances in EMU 2013,DG ECFIN, 2013, europe-19487321 ags2013_en.pdf http://ec.europa.eu/economy_finance/ publications/european_economy/2013/ BMJ, Protest against the privatization of European Commission, ‘eHealth Network’ pdf/ee-2013-4.pdf healthcare in Spain, (Blogs), March 2013, Public Health, http://blogs.bmj.com/bmj/2013/03/28/ http://ec.europa.eu/health/ehealth/policy/ European Commission, Rising Popularity aser-garcia-rada-protests-against-the- network/index_en.htm of Mobile Health Apps, 23 January 2013, privatisation-of-healthcare-in-spain/ http://ec.europa.eu/digital-agenda/en/ European Commission, ‘eHealth Policy’ news/rising-popularity-mobile-health-apps Council conclusions: toward modern, Public Health, responsive and sustainable health http://ec.europa.eu/health/ehealth/policy/ European Commission, ‘Social Investment systems, Official Journal C 202, index_en.htm Package. Investing in Health, Commission 08/07/2011 P. 0010 – 0012, Staff Working Document’ SWD(2013) 43 http://eurlex.europa.eu/LexUriServ/ European Commission, ‘Health care’ final, LexUriServ.do?uri=OJ:C:2011:202:0010:0 Employment, Social Affairs & Inclusion, http://ec.europa.eu/health/strategy/docs/ 1:EN:HTML http://ec.europa.eu/social/main. swd_investing_in_health.pdf jsp?catId=754&langId=en BEUC, The Consumer Book 2009-2014, European Commission, The 2012 2009, European Commission, ‘Investing in Ageing Report: Economic and budgetary http://www.beuc.org/custom/2010- Health, Commission Staff Working projections for the 27 EU Member States 00120-01-E.pdf Document’ SWD (2013) 43 final, February (2010 -2060), 2012, 2013, http://ec.europa.eu/economy_finance/ http://ec.europa.eu/health/strategy/docs/ publications/european_economy/2012/ swd_investing_in_health.pdf pdf/ee-2012-2_en.pdf 47
European Hospital and Healthcare OECD, ‘Health spending continues to World Health Organization, ‘Health, health Federation (HOPE), Chronic diseases: a stagnate,’ June 2013, systems and economic crisis in Europe: clinical and managerial challenge, October http://www.oecd.org/els/health-systems/ Impact and policy implications, European 2010, health-spending-continues-to-stagnate- Observatory on Health Systems and http://www.hope. says-oecd.htm Policies, 2013, be/05eventsandpublications/ http://www.euro.who.int/__data/assets/ docpublications/84_chronic-diseases/84_ Official Journal of the European Union, pdf_file/0011/186932/Health-and- HOPE_Publication-Chronic_diseases- ‘Directive on the application of patients’ economic-crisis-in-Europe4.pdf October_2010.pdf rights in cross-border healthcare’ (2011/24/EU), World Health Organization, ‘Health policy Global Health Policy Forum, Transforming http://eur-lex.europa.eu/LexUriServ/ responses to the financial crisis in Europe, Healthcare through Human Capital, 2012, LexUriServ.do?uri=OJ:L:2011:088:0045:0 European Observatory on Health Systems https://docs.google.com/ 065:en:PDF and Policies, 2012, http://www.euro.who. viewer?url=https://workspace.imperial. int/__data/assets/pdf_file/0009/170865/ ac.uk/global-health-innovation/Public/ The Economist, ‘A hospital case’, 18 May e96643.pdf GHPS_Innovative_Delivery_Models_ 2013, Report.pdf http://www.economist.com/news/ World Health Organization, Health business/21578020-sweden- systems, health and wealth: Assessing the Golean Six Sigma, The basics of Lean Six leading-world-allowing-private- case for investing in health systems, edited Sigma, accessed in December 2013, companies-run-public-institutions- by Josep Figueras, Martin McKee, Suszy http://www.goleansixsigma.com/what-is- hospital?fsrc=scn%2Ftw_ec%2Fa_ Lessof, Antonio Duran, Nata Menabde, lean-six-sigma/ hospital_case 2008, http://www.euro.who.int/__data/assets/ International Journal of Obesity, Physical West Middlesex University Hospital, How pdf_file/0017/91430/E93699.pdf inactivity, sedentary lifestyle and obesity we fit into the NHS, accessed in December in the European Union. M A Martínez- 2013, World Health Organization, Tackling González et al. 1999, 23 (11):1192-201. http://www.west-middlesex-hospital.nhs. chronic disease in Europe: strategies, International Social Security Association, uk/about-us/freedom-of-information/ interventions and challenges, European ‘Reform of the Spanish National Health publication-scheme/who-we-are-and- Observatory on Health Systems and System’ June 2013, what-we-do/how-we-fit-into-the-nhs/ Policies, 2010, http://www.issa.int/News-Events/News2/ http://www.euro.who.int/__data/assets/ Reform-of-the-Spanish-National-Health- World Economic Forum and McKinsey & pdf_file/0008/96632/E93736.pdf System Company, ‘The financial sustainability of health systems - a case for change’, 2012 World Health Organization, ‘What are Frank R. Lichtenberg, 2008. Have World Health Organization Europe, ‘Data the advantages and disadvantages Newer Cardiovascular Drugs Reduced and statistics: cancer’, of restructuring a healthcare system Hospitalization? Evidence From http://www.euro.who.int/en/health-topics/ to be more focused on primary care Longitudinal Country-Level Data on noncommunicable-diseases/cancer/data- services?’2004, 20 OECD Countries, 1995-2003, NBER and-statistics http://www.euro.who.int/__data/assets/ Working Papers 14008, National Bureau pdf_file/0004/74704/E82997.pdf of Economic Research, Inc. World Health Organization Europe, Health OECD, ‘Health Data 2013’, 2013, Fig. 3, Literacy. The Solid Facts: Adapted from: World Health Organization, World Health http://www.oecd.org/els/health-systems/ Comparative report on health literacy in Report: Health Systems Financing – health-spending-continues-to-stagnate- eight EU s. The European Health Literacy Executive Summary, 2010, says-oecd.htm Project 2009–2012. Maastricht, HLS-EU http://www.who.int/whr/2010/10_ Consortium, 2012, summary_en.pdf http://www.health-literacy.eu 48
References appendix 4
1 European Commission, ‘Population 11 Ibid.10 24 Primary care is the local healthcare that is structure and ageing,’ Eurostat, October received from general practitioners (GPs), 2012, http://epp.eurostat.ec.europa.eu/ 12 Please see Appendix I: Health consumer dentists, pharmacists and optometrists, statistics_explained/index.php/Population_ survey 2020 for more information about West Middlesex University Hospital, How structure_and_ageing the survey. we fit into the NHS, accessed in December 2013, http://www.west-middlesex-hospital. 2 International Journal of Obesity, Physical 13 Ibid.12 nhs.uk/about-us/freedom-of-information/ inactivity, sedentary lifestyle and obesity in publication-scheme/who-we-are-and-what- the European Union. M A Martínez-González 14 José Manuel Barroso, President of the we-do/how-we-fit-into-the-nhs/ et al. 1999, 23 (11):1192-201. European Commission, speech to the 5th World Health Summit, 20 October 2013, 25 Secondary (or ‘acute’) care is the healthcare 3 European Hospital and Healthcare http://europa.eu/rapid/press-release_ that people receive in hospital. It may be Federation (HOPE), Chronic diseases: SPEECH-13-838_en.htm unplanned emergency care or surgery, or a clinical and managerial challenge, planned specialist medical care or surgery. October 2010, http://www.hope. 15 World Health Organization, Health systems, The individual is referred to a specialist by be/05eventsandpublications/ health and wealth: Assessing the case the GP, http://www.west-middlesex-hospital. docpublications/84_chronic-diseases/84_ for investing in health systems, edited by nhs.uk/about-us/freedom-of-information/ HOPE_Publication-Chronic_diseases- Josep Figueras, Martin McKee, Suszy Lessof, publication-scheme/who-we-are-and-what- October_2010.pdf Antonio Duran, Nata Menabde, 2008, we-do/how-we-fit-into-the-nhs/ http://www.euro.who.int/__data/assets/ 4 World Health Organization, Tackling chronic pdf_file/0017/91430/E93699.pdf 26 See Global Health Policy Forum, disease in Europe: strategies, interventions Transforming Healthcare through Human and challenges, European Observatory 16 European Commission, ‘Investing in Health, Capital, 2012, https://docs.google.com/ on Health Systems and Policies, 2010, Commission Staff Working Document’ viewer?url=https://workspace.imperial.ac.uk/ http://www.euro.who.int/__data/assets/ SWD (2013) 43 final, February 2013, http:// global-health-innovation/Public/GHPS_ pdf_file/0008/96632/E93736.pdf ec.europa.eu/health/strategy/docs/swd_ Innovative_Delivery_Models_Report.pdf investing_in_health.pdf 5 ‘World Health Organization Europe, ‘Data 27 European Chronic Disease Alliance, The and statistics: cancer’ http://www.euro.who. 17 Council conclusions: toward modern, case for urgent political action to reduce int/en/health-topics/noncommunicable- responsive and sustainable health systems, the social and economic burden of chronic diseases/cancer/data-and-statistics Official Journal C 202, 08/07/2011 P. 0010 disease through prevention, July 2010, – 0012, http://eurlex.europa.eu/LexUriServ/ http://www.escardio.org/about/what/ 6 Alzheimer’s Society, Demography, LexUriServ.do?uri=OJ:C:2011:202:0010:01 advocacy/Documents/Chronic-disease- July 2013, http://www.alzheimers. :EN:HTML alliance-final.pdf org.uk/site/scripts/documents_info. php?documentID=412 18 Ibid.14 p. 1 28 World Health Organization Europe, Health Literacy. The Solid Facts: Adapted from: 19 Ibid.12 7 European Commission, Report on Health Comparative report on health literacy in Inequalities in the European Union, eight EU s. The European Health Literacy 20 Official Journal of the European Union, Commission Staff Working Document, Project 2009–2012. Maastricht, HLS-EU ‘Directive on the application of patients’ September 2013, http://ec.europa.eu/ Consortium, 2012, http://www.health- rights in cross-border healthcare’ (2011/24/ health/social_determinants/docs/report_ literacy.eu healthinequalities_swd_2013_328_en.pdf EU), http://eur-lex.europa.eu/LexUriServ/ LexUriServ.do?uri=OJ:L:2011:088:0045:00 29 Ibid.12 8 World Economic Forum and McKinsey & 65:en:PDF Company, ‘The financial sustainability of 30 World Health Organization, World Health 21 Ibid.18 health systems - a case for change’, 2012, Report: Health Systems Financing – p.5 Executive Summary, 2010, http://www.who. 22 And these rights may also lead to more int/whr/2010/10_summary_en.pdf 9 Life expectancy at birth for females, 2001- responsibilities, such as co-pays, as shown in Chapter 4 ‘Financial challenges’. 2011, see below (Source: Ibid.7) 31 European Commission, ‘Action Plan for the EU Health Workforce,’ Public Health, 2012, 23 Ibid.12 10 European Commission, The 2012 http://ec.europa.eu/health/workforce/policy/ Ageing Report: Economic and budgetary index_en.htm projections for the 27 EU Member States (2010 -2060), 2012, http://ec.europa.eu/ economy_finance/publications/european_ economy/2012/pdf/ee-2012-2_en.pdf 49
32 Lean Six Sigma is a managerial concept 41 ‘The third is the time lags between policy 53 World Health Organization, ‘What are combining Lean and Six Sigma that results changes and their impact on health the advantages and disadvantages in the elimination of the eight kinds of outcomes, a problem that may involve of restructuring a healthcare system wastes: Defects, Overproduction, Waiting, ‘false savings’ because they may lead to be more focused on primary care Non-Utilized Talent, Transportation, to increased costs or other unintended services?’2004 http://www.euro.who. Inventory, Motion, Extra-Processing. consequences in the long term.’ See Ibid.14, int/__data/assets/pdf_file/0004/74704/ More information here: Golean Six p. 10. E82997.pdf Sigma, The basics of Lean Six Sigma, accessed in December 2013, http://www. 42 Ibid.34 54 Ibid. 47 goleansixsigma.com/what-is-lean-six-sigma/ 43 Ibid.14 55 Ibid.47 33 ‘The Economist, ‘A hospital case’, 18 May 2013,http://www.economist.com/news/ 44 Highlighted several times during the 56 European Commission, ‘eHealth Policy’ business/21578020-sweden-leading-world- interviews. For more information, Public Health, http://ec.europa.eu/health/ allowing-private-companies-run-public- Frank R. Lichtenberg, 2008. Have ehealth/policy/index_en.htm institutions-hospital?fsrc=scn%2Ftw_ Newer Cardiovascular Drugs Reduced ec%2Fa_hospital_case Hospitalization? Evidence From Longitudinal 57 Ibid.18 Country-Level Data on 20 OECD Countries, 34 European Commission, ‘Health care’ 1995-2003, NBER Working Papers 14008, 58 European Commission, ‘eHealth Network’ Employment, Social Affairs & Inclusion, National Bureau of Economic Research, Inc. Public Health, http://ec.europa.eu/health/ http://ec.europa.eu/social/main. ehealth/policy/network/index_en.htm jsp?catId=754&langId=en 45 Agencia Estatal Boletín Oficial del Estado, ‘Royal Decree Law 16/2012, urgent 59 European Commission, MEX/13/1119, 19 35 European Commission, Report on Public measures to ensure the sustainability of November 2013, http://europa.eu/rapid/ Finances in EMU 2013,DG ECFIN, 2013, the national health system and improve press-release_MEX-13-1119_en.htm http://ec.europa.eu/economy_finance/ the quality and safety of its services,’ April 60 European Alliance for Personalised publications/european_economy/2013/ 2012, http://www.boe.es/diario_boe/txt. Medicine, ‘EAPM Report – Statement by pdf/ee-2013-4.pdf php?id=BOE-A-2012-5403 Tonio Borg, EU Commissioner for Health 36 Ibid.8 p. 10 46 Reform of the Spanish National Health and Consumers’ http://euapm.eu/4886-2/ System, International Social Security 37 World Health Organization, ‘Health policy Association, June 2013, http://www.issa.int/ 61 Ibid.12 responses to the financial crisis in Europe, News-Events/News2/Reform-of-the-Spanish- 62 Ibid.14 European Observatory on Health Systems National-Health-System and Policies, 2012, http://www.euro.who. 63 http://www.bryter-research.co.uk/ int/__data/assets/pdf_file/0009/170865/ 47 BBC News, ‘Spain’s migrant healthcare e96643.pdf dilemma,’ September 2012, http://www. bbc.co.uk/news/world-europe-19487321 38 World Health Organization, ‘Health, health systems and economic crisis in Europe: 48 Ibid.42 Impact and policy implications, European Observatory on Health Systems and Policies, 49 BMJ, Protest against the privatization of 2013, http://www.euro.who.int/__data/ healthcare in Spain, (Blogs), March 2013, assets/pdf_file/0011/186932/Health-and- http://blogs.bmj.com/bmj/2013/03/28/ economic-crisis-in-Europe4.pdf aser-garcia-rada-protests-against-the- privatisation-of-healthcare-in-spain/ 39 OECD, ‘Health spending continues to stagnate,’ June 2013, http://www.oecd. 50 Ibid.12 org/els/health-systems/health-spending- continues-to-stagnate-says-oecd.htm 51 Ibid.34
40 European Commission, ‘Annual Growth 52 OECD, ‘Health Data 2013’, 2013, Fig. 3, Survey 2013,’ November 2012, http:// http://www.oecd.org/els/health-systems/ ec.europa.eu/europe2020/pdf/ags2013_ health-spending-continues-to-stagnate- en.pdf says-oecd.htm 50
About the research
To research this report, the project team conducted 28 in-depth interviews between May and October 2013 with leading experts in the healthcare sector, including policy-makers, academics, as well as healthcare, patient association and industry representatives. A list of participants who took part in the interview programme is detailed in Appendix II.
Our experts were questioned on the To gather the views of the following topics: general public, the project team ——Their main expectations regarding commissioned a pan-European health and healthcare. sampling of public opinion by polling company Bryter. The total sample ——The impact of a more active, size was 1,500 with 100 participants empowered and educated patient each in Belgium, Hungary, Bulgaria, cohort. Czech Republic and Poland, and 200 ——The future relationship between each in Germany, France, Italy, United healthcare consumers and doctors. Kingdom and Spain. ——The potential of new healthcare innovations, including ehealth, and The project team was led by the resulting changes it could bring. Emanuele Degortes, Pierre Bouygues and the AmCham EU Healthcare ——The management and integrated Committee. Hanover Communications of healthcare. was commissioned to carry out the ——The future payment models and interviews and write the report. financial pressures for healthcare systems. The findings and views of the report do not necessarily reflect the opinions The project team also reviewed of individual member companies the literature and data available of AmCham EU. on Europe’s healthcare systems. A list of the data sources consulted for this research is in Appendix II. 51
AmCham EU would like to thank the member companies that made this report possible:
AmCham EU speaks for American companies committed to Europe on trade, investment and competitiveness issues. It aims to ensure a growth- orientated business and investment AmChamEU climate in Europe. AmCham Avenue des Arts, 53 EU facilitates the resolution of 1000 Brussels, Belgium transatlantic issues that impact business and plays a role in creating +32 (0)2 513 68 92 better understanding of EU and [email protected] US positions on business matters. www.amchameu.eu Aggregate US investment in Europe totalled €1.9 trillion in 2012 and Follow us on: directly supports more than 4.2 million jobs in Europe.