‘Community care’ has no hard and fast definition. However, what it means in practical terms is the decentralisation of care, taking it away from acute care settings such as hospitals, and bringing it closer to primary care. Patients are therefore treated in settings such as the local GP surgery or at home, by encouraging out-patient ambulatory care and using facilities like day-care units or local clinics. For the elderly and disabled, such local care is much more acceptable than travelling and experiencing in-patient care. Europe’s ageing population means that there will be increasing numbers of care-dependent older people who will be in need of community care.
This shift towards community care has a number of advantages; it better addresses the needs of patients, but at the same time offers considerable savings to healthcare systems. Indeed, studies have shown that between 20 - 30% of patients over the age of 75 who enter a hospital for acute care are admitted inappropriately. Furthermore, once admitted, they remain in the hospital for far longer than necessary, occupying much-needed and expensive hospital beds – institutional care can be around 10 times more expensive than home care.
Investment in community care offers clear benefits. Innovative medical technology already supports patients in a variety of areas, including for example helping them to live with and manage their incontinence, and using telemedicine to improve cardiac care. In the case of incontinence, the pursuit of ever better solutions is enabling patients to self-manage their condition with minimum recourse to hospital care. For patients with an Implantable Cardioverter Defibrillator (ICD), the industry’s investment in remote monitoring technology is helping to deliver better, more comprehensive and more cost-effective care.
Although the definition may differ from country to country, community care will become an increasing part of healthcare budgets. Used appropriately, it will deliver better care more effectively to a growing segment of the population. The medical technology industry is continuing to innovate methods to make it possible for people to better manage their disease or health condition themselves and minimise their use of hospital care. However, for citizens to derive the full benefit of these advances, policymakers need to invest in the infrastructure that will deliver effective community care, including public awareness. This will provide a further step towards sustainable, cost-effective healthcare systems.
“Together, we need to be courageous and smarter about how we use the resources we have and to direct them towards models of care that can deliver a demonstrable positive return on investment in healthy life years for citizens.” (1)
As demonstrated by the quote above, the medical technology industry is committed to playing its part in the collective effort required to restructure our health services. Eucomed believes the Community Care Sector can play a constructive role in delivering services more efficiently.
In a world of finite budgets, it is our contention that directing funds towards capital-intensive building projects traps resources in bricks and mortar which would otherwise be spent on direct patient care. Breaking down silo budgeting structures for the treatment of people with chronic conditions can help ensure patients receive consistent, high-quality care across all care settings. Payers need to move towards paying for an “episode of care” rather than paying based on the site of care.
However, it must be acknowledged that more data is needed in order for policymakers to make informed choices. Because the definition of community care varies across Europe, a mapping exercise should be undertaken to get a fuller picture of how community-based services are delivered and funded. This will support the identification and sharing of best practices,
Developing smooth-running community care services requires a deeper appreciation of the needs of all stakeholders. Patients being treated in the community need medical devices and care products that are affordable, easy to manage and effective. For health professionals, products should be suitable for use in the community without the support of an institutional setting. Products should support patient compliance, be easy to use and teach, and provide the desired outcome. Payers need products which are affordable and, increasingly, supported by additional services such as patient and caregiver education or transition support programmes. Here, the manufacturer can participate directly by liaising with community care services once the patient has been discharged from an inpatient setting.
Finally, industry investment in R&D and clinical research, as well as distribution and administration costs, must be acknowledged. Adequate reimbursement is needed to support these costs and to provide companies with incentives to innovate. Companies require a clearer pathway for bringing new products to the community care market. Without a clear incentive for innovation, new technologies which can deliver better, more cost-effective outcomes will not materialise.
(1) Eucomed, 2011. Contract for a Healthy Future