Why do we need to create more resilient healthcare systems?
"Build Back Better", the mantra of planning for the post-pandemic recovery, can sound facile at times. But, if we are to give it meaning and substance, where better to start than with healthcare systems?
There can be no return to the status quo ante in a sector whose vulnerability has often been exposed during the coronavirus crisis despite huge successes. It's time for a rethink: we should treat this crisis as an opportunity to reform healthcare into a more efficient, cost-effective and resilient system, one that is value-based and patient-centred.
Countries in the CEE region with historically underperforming, underfinanced HC systems have suffered disproportionally higher than the EU average with per-capita mortality since pandemic's start almost double the EU average; in the case of Czech Republic and Hungary and Slovakia 40 percent and Poland 20 percent above the EU average. The dramatic increase in demand for healthcare from COVID-19 patients has severely disrupted other health services in the CEE countries, with almost certainly an even greater detrimental impact on what are already relatively poor health outcomes compared to Western European countries.
There is a real risk we could undo many of the advances Europe has made in fighting diseases and prolonging people's lives in recent years. We know, for instance, that, thanks to R&D investments, innovative and more varied diagnostics and treatments the number of people dying from cancer is growing at a slower pace than the number of new cases. But now, in less than 18 months of the pandemic, we have seen in Europe a drop of 40% in diagnoses of cancer. Even in France around 30,000 cases of cancer are said to have been undetected as the result of the disruptions related to COVID-19 in just a few months.
Response and solution for post-COVID healthcare systems
Learning from the COVID-19 crisis, a consensus is emerging among health authorities that the priority is to strengthen healthcare systems. That means examining critically all elements of current health and social care systems, identifying key issues and the reforms – and action – required to address them. The focus now should be on leveraging efforts to boost resilience, re-imagine how health systems are organised and operate and to ensure they deliver on the priorities. The key is to allocate resources to high-value care and prevention, with outcomes and investment assessed as a whole.
This renewed focus on stronger health systems is now supported by significant funding, with, for instance, €1.9bn earmarked this year within Horizon Europe for health research initiatives to aid post-pandemic recovery. This changes the dynamic; effective reforms stand a better chance of being implemented. A value-based system creates incentives and investment capacity for high-value interventions and innovations that improve patient and population health outcomes in the long run, including through primary and secondary prevention.
A priority field must be oncology, which is set to be the leading cause of death in the EU, with the Commission forecasting a rise in mortality of 25% by 2035 at an annual economic cost of €100bn-plus. That is a primary reason for prioritising cancer but improving cancer patient pathways can also bring better patient outcomes overall.
In Slovakia, host country for our recent GLOBSEC Bratislava Forum, the cancer mortality ratio is shockingly high at 351 per 100,000 cases. And, I'm sorry to say, one reason for this is unacceptably long delays in making life-saving treatments available for patients in CEE – 634 days for Slovakia, 682 days for Czech and well over two years (823 days) in Poland compared with 18 weeks (127 days) in Germany.
Innovation and reform
Governments across Europe, east and west, north, and south, agree that greater health system resilience is an urgent priority – and not just to prepare for future waves of pandemics. Take antimicrobial resistance (AMR) that threatens millions of lives amidst a shortage of new, effective antibiotics, with only 43 new antimicrobials in clinical development according to the WHO.
This will entail innovative reforms in how healthcare is organised and delivered at a European (shared) level as well as nationally and sub-nationally. A partnership model, involving a consortium of private and public bodies working together as in the search for COVID-19 vaccines, may be a better catalyst for unlocking the required funds and the know-how. Here too the European Union's new EU4Health programme, worth €5.3bn, is a good start – providing €1.25bn towards Europe’s Beating Cancer Plan.
Key drivers must be creation of value for the patients individually and for the society in total. Preventive medicine must stop being a slogan and become a reality as the current vaccine roll-out underlines by making the daily case for immunisation. At the same time, personalised medicine built around VBHC (value-based healthcare) redirects the focus onto outcomes that truly matter for patients, including giving them greater life expectancy and/or survival times, enabling not only better quality of life but also better and longer contribution to the economy and the society.
One vital innovation in this area must be in reforming and modernising policies for reimbursement: The spirit of VBHC should be reflected in holistically looking into efforts required to cure patients rather than paying for the treatment itself. It means rewarding innovative diagnoses and treatments that address unmet health needs. These principles apply in or out of pandemics.
For CEE countries in particular preventive medicine, including immunisation, must enjoy a bigger slice of increased health budgets rather than the paltry amounts now devoted to it. We already know, for instance, that HPV vaccination is an efficient and effective measure to prevent cancer. Yet immunisation as a whole accounts for nominally less than 0.5% of health budgets. Every cancer prevented by a simple vaccination is avoiding a lot of suffering for the individual patient and much larger investment for the public system later on! It's often forgotten that smallpox, now eradicated by vaccines, killed half a billion in the last century.
"Leaving nobody behind" is another of those often facile phrases one hears during this pandemic. So, let's make the European health union a joint endeavour that will deliver on better access on modern treatments for patients in need, delivering greater value and best outcomes for patients and societies. We can make a start by making health inequalities between east and west Europe a thing of the past. European society as a whole will benefit.
Gabriele Grom, Public Policy Lead, Mid-Europe Region, MSD