Health systems in Europe are diverse, the result of history, culture and the economic and political environment in which they operate. They range from predominantly single-payer systems, such as the UK and Spain, which tend to spend a lower amount of their resources (Gross Domestic Product (GDP)) on healthcare; to systems of competing insurers and providers such as Germany and the Netherlands, which are two of Europe’s highest spenders on healthcare. Understanding what makes an effective healthcare system is therefore quite challenging. This week’s blog summarises the findings in our new report, Vital Signs- How to deliver better healthcare across Europe.
Our report explores the performance of six European countries- Denmark, France, Germany, Netherlands, Spain and the UK, to try and understand how they are tackling the health and care challenges they face. These challenges are remarkably similar:
- unrelenting demand pressures, due to increases in the size and ageing of the population
- growing public expectations for more personalised and convenient services
- a miss-match between demand and supply of numbers and types of healthcare staff
- increasing costs of providing healthcare, driven by the availability of new technology, innovative medical equipment and pharmaceutical interventions
- a desire to provide high-quality care, equitable access and optimal outcomes within an affordable, and sustainable, cost envelope.
What differs is how each country approaches these challenges, what they are prepared to pay and what they are prepared to trade off or prioritise. Our report draws on an extensive body of published literature, data from international benchmarking reports and our experience in working across the health and social care and life sciences sectors. We examine health system performance through the lens of seven ‘Vital Signs’. The report identifies what good care might look like, highlights key performance metrics, a patient portrait and examples of good practice for each vital sign. It also suggests a number of key enablers to help transform healthcare services, grouped under three headings, systems and processes, workforce and technology.
The vital signs explored in the report are:
- Prevention and health promotion
Prevention is an investment in people’s health, reducing the burden of disease and contributing to the sustainability of health systems. As our scientific knowledge and technology capable of tracking and monitoring health status improves, the impact of failing to invest in prevention will become increasingly evident and difficult to justify to citizens. A fully funded prevention strategy should therefore be at the core of every health system and requires a new social contract between planners, payers, providers and the public, based on new models of co-creation and self-management. It also requires investment in improving health literacy, especially in the over 75s and socially disadvantaged groups.
- Primary care today and tomorrow
A strong, well-resourced primary care system can provide patients with consistency and continuity of care and help control demand for more expensive, unwarranted, hospital-based interventions. There is a need to develop new business models in partnerships with patients and carers that incentivise the accelerated use of technologies and encourage staff to work differently. Key to improving performance is an ability to work across organisational boundaries and develop lasting partnerships and alliances.
- Productivity in hospitals
While hospitals will always be a much needed resource for acute and emergency care, there is enormous scope to improve staff productivity, standardise clinical pathways, develop and adhere to explicit guidelines and develop IT systems that cement these practices into the everyday work of staff, including providing information and support to patients from admission through to discharge and rehabilitation.
- Palliative and end-of-life care
A ‘good death’ requires support from multi-disciplinary teams focussed on the physical, social, psychological and spiritual concerns of those who are dying. The holistic management of pain and symptoms not only improves patient experience but has also been shown to reduce costs. Improving care requires effective community engagement, adoption of digital technologies and provision of staff education and training. Importantly it requires staff to have the confidence to identify when someone is dying and to communicate with, advise and guide, those who are dying and their families. “If end of life discussions were an experimental drug, the FDA would approve it” Atul Gawande.
- Patient engagement and empowerment
Empowering people to be involved in decisions about their own and their family’s health requires citizens to have the knowledge and information sufficient to imbue confidence and a willingness to engage in decisions about their treatment. Patient engagement is an essential strategy for achieving the triple aim of: improving patient experience; improving the health of the population; and reducing per capita costs of healthcare. “If patient engagement were a drug, it would be the blockbuster of the century and malpractice not to use it” Leonard Kish.
- Population health management (PHM)
Progress with PHM in Europe is fragmented and at a relatively early stage of implementation. PHM means assuming responsibility for the quality of care and outcomes (physical and mental health and social care) of a defined population; and being accountable for those outcomes within an agreed cost envelope. It is a fundamentally different economic model based on actuarial analyses and aligning incentives to drive clinical integration and create value. Adoption of PHM is a ‘must do’ if the challenges in matching healthcare demand to supply, tackling health inequalities and reducing the gaps in care delivery and funding, are to be addressed.
- Partnerships between industry, providers and academia
Partnerships between industry, academia and healthcare providers, implemented effectively, can help deliver economic benefit alongside improvements to health and wellbeing for people across Europe. This includes speeding up the innovation process to help medicines and technology move more quickly from conception to adoption at scale. A well-integrated medical research community with trusted partnerships between healthcare providers, academia and industry, leads to better health outcomes and a stronger economy.
While no country has yet developed the perfect healthcare system, we believe that addressing the seven ‘Vital Signs’ will, over time, help all countries to reduce health inequalities and address variation in performance between and within countries’ health systems. While a few countries feature consistently as top performers, all countries have room for improvement but also have examples of good performance which provide lessons for all health systems.
By sharing the insights in our report we hope to stimulate discussion and debate and help countries, and healthcare stakeholders, deliver better health for the population, better experience and outcomes for patients and better value for money from healthcare expenditure.