The turn of the year brings all manner of analysis of the events of one year and predictions for the year ahead. 2010 will not be fondly remembered by many as it heralded the impact of the 2008 banking crisis on the real world of citizens and business. For those in the public sector and healthcare in particular, the year was one of considerable uncertainty and that uncertainty looks likely to extend into 2011 and beyond. Much will depend on the ability of European economies to pick up and return to some reasonable level of confidence. One sage once said that ‘economic forecasts were introduced to give credibility to astrology’ so I am not going to venture an opinion on the European economy but I am interested in the challenges and opportunities that these difficult times present.
At the heart of the challenge in healthcare is the enormous pressure on public funding created by the need to address spiralling debt. This is not just an issue for the PIGS (Portugal, Ireland, Greece and Spain) but for all European countries. All have been forced to address exploding public debt and even, not frequently mentioned, Belgium will see public sector debt exceed 100% of GDP this year. The question is not should we address the problem but how. The UK, Greece and Ireland have taken extremely tough stances while some other countries muddle along hoping for the best or assuming that the economic cycle will come to their rescue.
That demand for healthcare is rising inexorably is not in doubt as this is driven by the demographics of an ageing and increasingly demanding population. The nature of the response to the increase in demand when set against public sector spending cuts is very much in doubt. Across Europe we have seen artificially imposed caps in supply of healthcare. Under most European reimbursement systems this should not really be possible as the systems respond to demand. Raising thresholds for care or increasing waiting times are the only real ways to influence supply. One of these, waiting lists, is postponing the problem till tomorrow and the other is diluting the quality of care. Ultimately, neither is desirable, politically acceptable or sustainable.
With rising demand for its products the medical technology industry is in good shape. To play a full part in squaring the circle of rapidly rising demand versus limited funding, there is only one way forward. That is in innovation of the models of care and harnessing the full potential of the industry to help health systems redesign the way that care is delivered. The financial crisis is, at last, creating the conditions where some leaders are realising that innovation really is the only solution. Those that try to push back the frontiers of progress by trying to buy yesterday’s technology at knock-down prices are merely helping to preserve clinical and management practices of a bygone age. This suits some economic players whose best interests are served by inertia but it does not serve the citizen, the nation or Europe as a whole. Now is the time for accelerated innovation in the ways that we treat and interact with patients (e.g. through eHealth) and appreciate the full value that enabling technologies such as minimally invasive surgery, highly targeted diagnostics, super-efficient wound management products and a host of other treatments deliver.
The future is bright for the industry but we must continue to do better at explaining how we generate value and deliver the potential for change. Governments are beginning to get the message but health systems are still buried in inertia. Partnership amongst stakeholders supported by strong evidence is critical to driving change. That is just one reason why Eucomed has supported the European Health Technology Institute for Socio-economic Research (EHTI) to act as a catalyst for high quality health economic evidence generation. Evidence-based decision making is required in both clinical and economic domains but there remains a shortage of high quality work in the latter. The next decade needs to change all of that with radical restructuring of care pathways. We can see quality and access to care rising at the same time as costs remain at politically and economically acceptable levels. Political will to embrace change is key.
– John Wilkinson, Chief Executive Eucomed