European healthcare systems have helped to create some of the longest living populations in history, which enjoy enviable levels of general health. In recent decades, these systems have seen almost continuous reform efforts, but these efforts have not been able to alleviate the concerns of politicians, healthcare professionals and citizens that healthcare systems are not prepared for a variety of challenges looming in the near future. New thinking is needed to prevent the recycling of old arrangements. Based on in-depth interviews with 28 experts and practitioners in five West European countries— the Netherlands, Germany, the United Kingdom, Denmark and France—this study looks at the major issues facing health systems, as well as specific initiatives to improve them, in order to provide ideas for the type of changes that will be needed. Its findings are highlighted below.
Financial constraints threaten the status quo: Various factors are forcing payers to spend more: healthcare inflation has for many years almost invariably run ahead of headline inflation; new goods and services, including drugs and technology, are a boon to many patients but this expanded range of offerings need to be paid for; and increasingly demanding patients are not willing to settle for cut-price provision. At the same time, amid low growth and government budget cuts, healthcare systems that rely on state funding are unlikely to see significant cash infusions to meet growing cost pressure. Finding efficiencies will be central to the preservation of high quality care.
Longevity per se does not raise health-cost issues: Despite warnings of healthcare budgets being swamped by a “silver tsunami”, ageing populations account for only a small increase in health spending each year: one extensive study puts the cost at 0.5% annually. A failure to adjust retirement ages might lead to a revenue pinch, but this affects all aspects of government. The most significant healthcare impact of ageing will be the increasing number of people with multiple chronic conditions: 40% of Europeans over 50 have more than one such disease and a pioneering British study of the over-85s found that on average people of this age have five chronic diseases.
Lifestyle choices will lead to higher rates of chronic disease as well: According to the most recent data, more than one in five residents of the countries in this study smoke, the populations are among the world’s biggest consumers of alcohol, and a substantial proportion is overweight or obese (61% in the United Kingdom). This behaviour, if left unchanged, will lead to high rates of chronic disease such as diabetes and cancer.
To meet the challenges of the future, healthcare systems must be efficient, effective, integrated, and informed: Rising levels of chronic disease and multi-morbidity reveal existing weaknesses that healthcare systems will no longer have the money to paper over. First, as one interviewee put it, “it is blindingly obvious how the [healthcare] service is incredibly confusing [and] disjointed.” The treatment of people with numerous, ongoing conditions will require a shift from systems built on acute care to ones where different providers can provide co-ordinated, ongoing care. Second, medical professionals too often lack full information on the range of treatments a patient is receiving, or even accurate data on what will work in a given situation. Patient records and outcomes measurement will need to inform health systems if they are to provide improved care and operate more efficiently.
Change comes in steps: Because of the difficulties of system-wide reform in healthcare, this study considers five developments that are individually interesting and, together, point toward the future:
Five healthcare initiatives that show what is possible
Size and complexity make the reform of healthcare systems famously difficult. As the case studies in this paper show, however, positive changes that prepare for the future are possible.
For detailed information on how 5 EU countries are future-proofing their healthcare, visit www.reforminghealthcare.eu