A year on and the mood music in Washington is very different. My return to this beautiful city, where fall colours are emerging in their full majesty, has seen a very different atmosphere from a year ago when the Obama health reforms were on their way and universal coverage seemed a very real probability. The full effect of the economic aftermath of the last decade and a half of unsustainable growth has bitten the Democrats hard and the mid-term elections look like changing the balance of power and, with it, the level of certainty around the healthcare reforms.
To us Europeans the goal of universal coverage seems a long overdue reform that is a blight on the reputation of an otherwise admired nation. To right wing forces here it is a symbol of government interference in the freedom of the individual.
In an early address on Tuesday 19 October at the Advamed 2010 conference Don Berwick, the recently appointed head of the Centers for Medicare and Medicaid Services (CMS) and a long time, passionate advocate of health reform, made a speech that would be inspirational to us Europeans. He played to the audience by describing the medical technology industry as ‘a vanguard of innovation in an industry that needs a lot of innovation’. But what he was saying is to many of us the embodiment of why innovation is the key to creating sustainable high-quality health systems. In setting out his goals, he described the ‘gap between what we have and what we need’ and stated that he intended to reinvigorate ‘safety, effectiveness and patient centeredness’.
To do this the CMS would focus on patient safety initiatives and investment in prevention of disease but, most importantly in promoting integrated care. This is something that we in Europe refer to a great deal but in the USA is viewed by many as the key block to sensible deployment of resources. At its heart is the ‘fee for service’ model, and this creates many of the inefficiencies of the system and prevents innovative new ways of caring for patients from being introduced. To create the right incentives to innovate you have to change the way people are reimbursed and pay for care continuums rather than individual events.
In many parts of Europe we do not face the same challenge because the barriers to implementing integrated care are much lower in publicly funded systems. But we do face greater challenges in introducing innovation into the care pathways because publicly-funded health systems tend to be very conservative. What is clear is that on both sides of the Atlantic the realisation that innovation is the ‘only way’ to develop a sustainable high-quality system is beginning to be understood. As an industry we rightly trumpet our ability to innovate and improve patients lives but now health systems need to learn from us and there is a huge opportunity for our sector if we align around shared goals. Those goals are higher quality at lower total cost.
– John Wilkinson, Eucomed Chief Executive