#EAPM – Teamwork needed for shot on target in health care sustainability goal

| December 27, 2018
The European Commission has regularly said that it aims to support member states in moving towards effective, accessible and resilient health systems, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

It has also stated that, given the different aspects involved, many of which are dependent on stakeholder interests, it is important to define the different approaches to value and develop a more holistic view of it in a wider health system context, all while taking account of society as a whole.

Well, this throws up certain questions in and of itself.

Not least, how can the search for what we call value-based health care inform decision making, contribute to health system transformation, and help health systems across the European Union become, as the Commission puts it, more effective, accessible and resilient?  These are tough asks given the creaking health-care systems in Europe, which are almost collapsing under the weight of an ageing population with more co-morbidities and chronic conditions while scrabbling around for cash and other resources in efforts to do their best for their citizens.

Meanwhile, given member state competence for health, there is a distinct lack of cooperation in certain parts of what is clearly not a level playing field for the EU’s patients.

Perhaps a New Year’s Resolution across the broad width of stakeholders at EU, member state and regional level, to include all disciplines and sectors, could be to agree that a far-greater level of cooperation is needed more than ever as the whole arena becomes more complex?

One can only dream…

But one thing that is certain is that various studies have shown that ‘health equals wealth’. Among the reasons for this are a more productive society which spends a greater amount of time adding to GDP rather than clogging up resources such as hard-to-come by hospital beds.

We have had relatively new additions in healthcare, such as smart eHealth devices, electronic health records (although only time will tell when they eventually become used in an optimal fashion, alongside cross-border healthcare) and the explosion of Big Data.

The latter, when put to good use can help immensely with diagnosis and lead to the best treatment for each individual patient.

Preventative information, better doctor-patient dialogue and an increase in screening programmes, meanwhile, can also cut the use of health professionals’ time while leading to better results and, thus, saving money and valuable resources across the health-care landscape.

New gene-sequencing techniques can aid those with a predisposition to a particular disease or diseases, and can even help their close families (although there are ethical issues here and, obviously, not everyone ‘wants to know’ that they will most likely suffer from a certain disease down the line).

Of course, all of this innovation has already cost – and will continue to cost – money. But the tools are now there and, used properly, could certainly bring about these much-vaunted ‘effective, accessible and resilient health systems’. From its point of view, and it is difficult to argue, the Commission talks about effectiveness referring to a health system’s ability to produce positive outcomes (which means improving the health of the population).

Access it describes as the result of interactions between different factors, including health system coverage, depth of coverage, affordability and availability of health-care services. And resilience in this context is the ability of the health system to adapt effectively to changing environments and apply innovative solutions to tackle significant challenges with limited resources. The EU executive has noted that it is becoming “increasingly important for health systems to spend the resources they do have wisely and efficiently”. Indeed it is.

The above could be based on taking a longer-term view to the correlation between health and wealth, along the lines of those who advocate more targeted treatments, such as the EAPM, which has sought through many meetings, conferences and congresses to define value in the burgeoning arena of personalised medicine, taking into account the many sides and domains that try to nail a definition.

Like all forms of modern-day health care, personalised medicine approaches have themselves experienced dramatic changes in the way they address conditions and pathologies. Mostly, it has been due to the launch and application of the afore-mentioned new technologies and solutions, such as genetics, improvement in the recording of clinical, environmental and life-style data and capacity of the systems to integrate all these data and provide targeted diagnostic and prognostic profiles for individual patients.

This promising landscape is generating a change in the way health professionals diagnose, treat and follow-up patients and it is clearly having an impact on the management of individual patients.   It has also had an impact on health-care systems’ organization, budgets and outcomes. One issue at this stage is to determine to what extent existing frameworks designed to capture value of technologies can be directly applied to innovative solutions.

For its part, the Commission has noted also that, by and large – even today in the face of all the sustainability issues – health systems are still paying for medical goods and services in terms of inputs. This in plain language means procedures carried out or the volume of medical goods purchased.   However, it concedes that “there are some examples of providers taking a more holistic approach and considering the outcomes of the treatments, rather than purely input costs, to inform their spending decisions”. Hallelujah.

There are various ways in which this is being helped along: less silo-based thinking, more generic drugs as long-standing patents expire, incentives for research, new proposals on joint health technology assessments, the (carefully monitored) sharing of medical data across institutions and borders…the list goes on.

But the above represent big, big changes to the status quo that has been in existence until very recently and virtually none of it is running optimally at the current time. This is isn’t helping today’s or tomorrow’s patients anywhere near as well as it should be.

Many have said, including the Commission, that value-based health systems are seen by some as a system change which could improve the quality of health care for patients, while simultaneously making health care more cost-effective.

But we always come back to perhaps the biggest question of all. Who defines ‘value’ in a health-care context? EAPM says it should be the patient but, as we see time-and-time again, competition to define value comes from many different angles, not least from payers, health-care providers, pharmaceutical companies and manufacturers of medical devices. Getting everyone to agree, or even compromise, has always proven difficult and there is very little sign of consensus suddenly emerging in this context. We demonstrably need more teamwork at all levels.

As noted above, the Commission maintains that it is a key pre-requisite to define the different approaches to value while bearing down on its (and pretty much everyone’s) goal of building those effective, accessible and resilient health systems. No-one is arguing with this. We must all, however, figure out how to put the value ‘ball’ in the back of the net and quickly, before time blows the final whistle on our health-care systems.

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Category: A Frontpage, EU, European Alliance for Personalised Medicine, Health, Personalised medicine