Prior to jumping into the topic, it should be noted that Dr. Quentin has a unique position to comment on this topic. He is a medical physician, but also has a strong history of involvement in healthcare systems management. Specifically, he has an MSc in this topic and works with the European Observatory on Health Systems and Policies (EOHSP).
He started off by spending some time talking about this last organization. EOHSP “is a partnership, hosted by WHO/Europe, which includes other international organizations (the European Commission, the World Bank); national governments (Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, Switzerland and the United Kingdom); decentralized authorities (the Veneto Region of Italy, the French National Union of Health Insurance Funds (UNCAM)); and academia (the London School of Economics and Political Science (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM)).” Based out of Brussels, Belgium, it has primarily an advisory role – it has no direct power over any EU member country’s health care system, as these are under the jurisdiction of the nation itself.
But, what is a health system? Around the early 2000’s, there was an increased focus on health systems rather than just individual healthcare delivery. The WHO report entitled “The World Health Report (2000)” was a pivotal report and a must-read for anyone interested in this space. Rather than delineating individual components that all healthcare systems must have, it identified key functions and outcomes of a complete health system. Below:
These may take different forms in different countries, but these are common functions and goals in all countries. Ultimately, the health of the patient is the most important objective – but this should take into account the non-medical expectations of patients (responsiveness) and fair financial contributions.
Based on this the WHO came up with a scoring system, emphasizing health (50%) heavily, but also responsiveness and fair financial contributions (25% each). All countries were graded on this system – and many countries were not happy with the result. France was ranked #1, Germany #25. Others much lower. There was a lot of backlash and they discontinued reporting as such. There have been other scoring systems (including the Euro Health Consumer Index 2017), but all have their own flaws and are rarely accepted easily as true metrics.
However, the basic function of the above diagram is correct. And it is important to understand these features for whatever country you happen to be living in. To that effect, the EOHSP actually has a component called the “Health Systems and Policy Monitor,” which publishes detailed reports about each member country (and some non-member countries, like Canada and Israel), which are freely available and regularly updated. You can even compare specific features across countries.
The EU has also begun to work with the EOHSP to generate a new initiative evaluating each of the member states’ healthcare systems and to provide recommendations. Part of that report includes a healthcare system performance report, with 3 sections: Effectiveness, accessibility, and resilience. This is highlighted below:
Based on all of this, Dr. Quentin had the following components he feels makes a well-functioning health care system:
1) Health promotion and disease prevention
- You cannot understate the importance of health promotion (exercise, etc) and disease prevention programs
- These are often underutilized – 80% of healthcare costs are due to non-communicable disease, but only 3% of health budgets are spent on prevention
2) A strong primary care network – primary care physicians should be gatekeepers to other health care resources.
- 27% of patients in the EU visit an emergency room due to inadequate primary care
- 14 countries in the EU actually require primary care physicians to refer to consulting specialists – which help reduce costs
- Unfortunately, 9 other countries have incentives for referrals
3) Integrated care
- The time has come to ensure all the pieces of the healthcare puzzle work around and follow the patient – healthcare should not be piecemeal, with the patient try and take data from place to place
- Specialists and all healthcare professionals should coordinate care
- In today’s world, multidisciplinary care is essential as patients are older; there is a rising burden of chronic disease and multiple morbidity diseases
4) Assuring timely access to care
- This should not depend on access to resources – though it does in some EU countries
5) Improving resilience through stable funding
- Between 2008-2014 (recession), there was a significant dip in healthcare funding across the EU
- Yet, reducing funding mainly hits primary care and prevention measures
- This is something that should be maintained despite the overall economy – maintaining a healthy population is important for future economic success as a country
6) Workforce planning – maintaining an appropriate workforce for the needs of the population
- External pressures (aging population, migration, technical innovation) and internal pressures (recruitment and retention of healthcare workers, skills distribution) have an important effect
- These need to be modulated and managed proactively!
His final slide was:
Presented by: Wilm Quentin, MD, Technische Universität Berlin | TUB · Department of Health Care Managemen, Berlin, Germany
Written by: Thenappan Chandrasekar, MD, Clinical Instructor, Thomas Jefferson University, twitter: @tchandra_uromd, @TjuUrology at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23, 2018, Munich Germany
Further Related Content:Pillars of an Effective Healthcare System in Europe, Special Focus on Healthcare in Central and Eastern Europe