Health Systems Innovation and Transformation: Accelerating Cross Border Learning
TO – REACH: organizing health service and system research in Europe
Stefano Vella MDIstituto Superiore di Sanità
(the Italian National Institute of Health) – Rome -Italy
1. A snapshot at our (European) Health System(s)
THE BISMARCK MODEL
• Germany, Japan, France, Belgium, Switzerland, Japan, and Latin America
• Named for Prussian chancellor Otto von Bismarck, inventor of the welfare state
• Characteristics: – Providers and payers are private – Private insurance plans – financed jointly by
employers and employees through payroll deduction – The plans cover everyone and do not make a profit – Tight regulation of medical services and fees (cost
control)
THE BEVERIDGE MODEL
• Named after William Beveridge – inspired Britain’s NHS
• Great Britain, Italy, Spain, • Characteristics:
– Healthcare is provided and financed by the government, through tax payments
– There are no medical bills – Medical treatment is a public service – Providers can be government employees – Lows costs b/c the government controls costs as the
sole payer
A VALUES FRAMEWORK FOR HEALTH SYSTEM REFORM(Reinhard Priester. Health Affairs 11, no.1 (1992):84-107)
From Individual values to community values
Three Decades of Dynamic Change in Health Systems 1980s 2010s
• Changes in information technologies (electronic medical record, e-health capacities, tablet-based patient management, centralized Big Data)
• Changes in citizen expectations (choice of provider, equal and rapid access, privacy)
• Changes in patient expectations (participation in decision-making, second opinions, international quality standards, patient rights)
• Changes in payment systems (public and private): case-based payment, penalties for poor outcomes (re-admission, re-treatment), volume based contracting
• Changes in provider configuration (consolidating hospitals and services, integrating health and social care)
7Richard B. Saltman Emory University
The changing health systems landscape: preparing for the “perfect storm”
Scarcity of resources
Chronic diseases, multimorbidity
Growing expectations of patients/citizens
Expensive
breakthrough medicines
and biomedical devices
Demographic change and population ageing
HealthSystems
The commonest chronic conditions are costing the EU countries more than 1 trillion Euros per year, which is expected to increase to 6 trillion Euros by the
middle of the century.
Health systems differences and common challenges
oDifferences in finance, organisation, outcomes
oPart of (and subject to) wider political, cultural, economic environment
oChallenges relate too Rising costs / need for cost containment
o Demographic changes
o Technological advances
o Increasing public expectations
oCommon challengeo Ensuring accessible health care of high quality that is responsive,
equitable, affordable and financially sustainable
2. A look into the future
DEMOGRAPHY: By 2050 over 1/3 of EU population will be over 60 years old (UN)
% of EU population aged +60
Million
1950 2050
Demand
Source: Projections of global health outcomes from 2005 to 2060 using the International Futures integrated forecasting model. WHO bullettin 2011.
Chronic diseases
Coping with Innovation
Personalized / Precision Medicine: is it affordable ?
Foresight for the exogenous health drivers
21 18.08.2017
Grand Challengesfor Healthand Health
policy
Demographic shift
Climate change
Rising costs of health care
Changing patternsin infectious & chronic diseasesChanging status of
women
Diseaseprevention andlifestyle changes
Healthcareinnovation andregulation
Shortage of medical andhealthcareworkers
Cognitiveenhancement
Short- , medium- and long - term developments
Demographic change
Increase of
healthy life years
and
UrbanisationIncreased
exposure to air pollution
Decreased
exposure to air
pollution
vDecrease of
healthy life years
Agriculture & global food
chains Unhealthy diet Healthy diet
Economic pattern and tech change
Stagnation Decrease of life
standards
Growth and
higher life
standards
High impact on
population health
Citizens empowerment
Low access to information for prevention and
healthy life styles
Spread access to
info for
prevention and
healthy life styles
Increase in extreme events and heat waves
Climate change and low carbon
transition
Decrease in
extreme events
and heat waves
Equity Decrease of GINI
index
Innovation in medicine
Increase of GINI
index
Limited impact on
population health
BUILDING SCENARIOS, COMBINING TRENDS
DesolationHealth
We will Health
you
The rich get
healthier
Healthy Together
3. The european action
Our goal is to identify the European Health Care common challenges and organizational needs, and to propose
possible solutions to improve health system performance and to identify the most effective ways to organize, manage, finance, and deliver high quality care to our
citizens
The challenge of health service and health system research in Europe (and abroad)
• The domain of health services and systems research is an area in which voluntary European collaboration and information sharing are of added value. Health systems are becoming increasingly inter-dependent as they are shaped by global trends.
• Many countries are individually exploring solutions to ensure sustainability of service delivery, e.g. by strengthening preventive and community care, redesigning hospital care and de-institutionalizing long term care with care provided closer to home, and placing more emphasis on patient involvement and self-management.
• There is a need to further expand the area of Health Services and Systems Research in a full European perspective, addressing aspects such as service delivery; information and evidence; access to innovative health technologies; health workforce; health financing; leadership and governance.
• As the current research funding landscape for health system research is fragmented, there is a need to create better synergies across Europe and globally and to work towards the development of a common research agenda.
TO-REACH
Coordinated by the Istituto Superiore di Sanità – Walter Ricciardi
29 partners / 21 countries
Our Transatlantic Partners
✓ Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, USA
Arlène Bierman
✓ McGill University, Montrteal, Canada
Robyn Tamblyn
TO-REACH: stakeholders
Project partners
PAC
Scientific AdvisoryCommittee
PolicyAdvisory Committee
Fellow interna-tionalinitiatives
Alliances of regional or local authorities
Sector or provider associations
International bodies
Fellow funding bodies including charities
Citizen and patient plus caregiver organisations
Media & General public
Politiciansand policy makers
Scientific community
Payer and insurerorganisations
Our Scientific Advisory Committee
Kieran Walshe - UKDiana Delnoii - NLRafael Bengoa - SpainPedro Barros - PortugalJacqueline Müller-Nordhorn - GermanyTuula Tamminen - FinlandKarine Chevreul - France
1. Identify Strategic Priorities
Identify future challenges and priorities (roadmapping)
Main objectives
2. Building Research Infrastructure
TO REACH: objectives, tasks, outcomes
Provide knowledge synthesis and analytical framework
(meta-questions)
Main tasks
Prepare a common and sustainable platform by research funding bodies
(strengthening the network)
Enhance cooperation and linkage with other funders
networks (embedding the network)
Strategic Research Agenda
Outcomes
• Effects of health care reforms on major health outcomes, such as changing the
funding of health insurance or privatisation of care.
• Understanding the optimal relationship between hospital care and primary care and
community care
• Ensuring service provision that is safer, of higher quality, and more patient- centred
• New approaches to health technology assessment and to the economic and
organisational consequences of introducing health technologies.
• Effectiveness and efficiency of performance indicators and their linkage to other
governance policies.
• Exploring the reasons (and suggest the solutions) for the existing disparities and
inequalities in health care provision.
• Implementing biomedical innovation in health services and systems
Towards the ERA-NET Research Agenda: identifying metaquestions, themes and policy areas
Our Strategic Research Agenda will pave the way to future European Joint Research Initiatives to tackle the
challenges ahead of us and design through evidence the policies of the future.
Thank [email protected]