Health Systems Innovation and Transformation: Accelerating Cross Border Learning TO REACH: organizing health service and system research in Europe Stefano Vella MD Istituto 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): casebased payment, penalties for poor outcomes (readmission, re-treatment), volume based contracting Changes in provider configuration (consolidating hospitals and services, integrating health and social care) Richard B. Saltman Emory University 7
The changing health systems landscape: preparing for the perfect storm Scarcity of resources Demographic change and population ageing Health Systems Chronic diseases, multimorbidity Expensive breakthrough medicines and biomedical devices Growing expectations of patients/citizens 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 o Differences in finance, organisation, outcomes o Part of (and subject to) wider political, cultural, economic environment o Challenges relate to o Rising costs / need for cost containment o Demographic changes o Technological advances o Increasing public expectations o Common challenge o Ensuring accessible health care of high quality that is responsive, equitable, affordable and financially sustainable
2. A look into the future
Demand DEMOGRAPHY: By 2050 over 1/3 of EU population will be over 60 years old (UN) % of EU population aged +60 1950 2050 Million
Chronic diseases Source: Projections of global health outcomes from 2005 to 2060 using the International Futures integrated forecasting model. WHO bullettin 2011.
Coping with Innovation
Personalized / Precision Medicine: is it affordable?
Foresight for the exogenous health drivers Cognitive enhancement Demographic shift Shortage of medical and healthcare workers Healthcare innovation and regulation Grand Challenges for Health and Health policy Climate change Rising costs of health care Short-, medium- and long - term developments Disease prevention and lifestyle changes Changing status of women 21 18.08.2017 Changing patterns in infectious & chronic diseases
BUILDING SCENARIOS, COMBINING TRENDS Desolation Health We will Health you The rich get healthier Healthy Together Decrease of healthy life years v Demographic change Increase of healthy life years and Increased exposure to air pollution Urbanisation Decreased exposure to air pollution Increase in extreme events and heat waves Climate change and low carbon transition Decrease in extreme events and heat waves Unhealthy diet Agriculture & global food chains Healthy diet Low access to information for prevention and healthy life styles Citizens empowerment Spread access to info for prevention and healthy life styles Limited impact on population health Innovation in medicine High impact on population health Stagnation Decrease of life standards Economic pattern and tech change Growth and higher life standards Increase of GINI index Equity Decrease of GINI index
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 29 partners / 21 countries Coordinated by the Istituto Superiore di Sanità Walter Ricciardi
Our Transatlantic Partners Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, USA Arlène Bierman McGill University, Montrteal, Canada Robyn Tamblyn
TO-REACH: stakeholders Sector or provider associations International bodies Payer and insurer organisations Scientific community Alliances of regional or local authorities PAC Policy Advisory Committee Project partners Scientific Advisory Committee Fellow international initiatives Politicians and policy makers Fellow funding bodies including charities Media & General public Citizen and patient plus caregiver organisations
Our Scientific Advisory Committee Kieran Walshe - UK Diana Delnoii - NL Rafael Bengoa - Spain Pedro Barros - Portugal Jacqueline Müller-Nordhorn - Germany Tuula Tamminen - Finland Karine Chevreul - France
TO REACH: objectives, tasks, outcomes Main objectives Main tasks Outcomes 1. Identify Strategic Priorities 2. Building Research Infrastructure Identify future challenges and priorities (roadmapping) Provide knowledge synthesis and analytical framework (meta-questions) 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
Towards the ERA-NET Research Agenda: identifying metaquestions, themes and policy areas 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
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 you to.reach@iss.it