Cochlear implants are just one example of how life-changing innovation can change people’s lives. Their impact is profound. Deaf children who receive one of these devices at a young age can develop normal language skills, allowing them to hit the same development milestones as their peers.
But imagine your child’s hearing was saved by a cochlear implant only for the device to fail, perhaps at the age of six or seven years. They are at risk of abruptly losing their hearing, falling behind in school and suffering socially.
What would you do? Perhaps you would expect your health insurance (public or private) to replace or fix the failed device. If that did not work, you might consider paying out of pocket. If it cost thousands of euro you may have to cancel a holiday or buy a cheaper car. You’d do whatever it takes.
Now, think how you would solve this problem if you lived in Bulgaria, a European Union Member State where a typical salary is €400 per month.
This was the reality faced by some parents in my country. Several years ago, after a long but successful campaign by patient advocates and parents of deaf children, the national health insurance fund agreed to reimburse cochlear implants.
But there was a catch: while the surgery to implant the device is covered, maintenance was not. Devices need their batteries changed and sometimes they need to be fixed or replaced.
Families went to all kinds of extraordinary lengths to save their children’s hearing in cases where the device needed to be maintained. Many got a second job, others sold family property, some launched fundraising campaigns and a few left the country in search of work in countries where cochlear implants were fully covered – countries where their children would be able to hear.
In recent weeks, it was decided that coverage would be extended to include maintenance of cochlear implants. This was a small victory that took years.
Of course, it’s not just cochlear implants, and there are other battles for patient to fight. As chair of the Bulgarian National Patients’ Organisation (NPO) and a patient representative on the board of the insurance fund, I see countless examples where economic and policy issues stand in the way of optimal patient care. Insulin pumps for diabetes patients are another case in point: the maintenance of pumps is reimbursed but the devices and their installation are not.
Bulgaria has the dubious honour of being the poorest member of a rich club. For parents who know the value of medical technologies but cannot access them due to price, the downsides of EU Membership are plain to see. They believe they are faced with rich-country prices but have poor-country incomes.
This is a European problem and we need to find solutions at European level. What Europe needs to do – and this means the medtech industry and Member States – is come up with a system that would be fairer; a system that is based on value while acknowledging the purchasing power of countries, the needs of patients, and other local factors.
It is a shared problem. Europe must explore ways to make the highest standards of care available to all European citizens. Failure to do so will exacerbate health inequalities in the EU which in turn makes weak economies weaker.
Stanimir Hasardzhiev was a speaker at the European MedTech Forum 2015. He was a panel member during the session “Creating Value through Cooperation: Toward a European Strategy on Medtech”, discussing the creation of a sustainable framework of cooperation between researchers, industry and hospitals.
