EFPIA opinion on Health at a Glance: Europe 2016
EFPIA welcomes the publication of the “Health at a Glance: Europe 2016”, by the OECD, in cooperation with the European Commission, and the start of the “state of health in the EU cycle”. EFPIA agrees with the objective to integrate a more comprehensive analysis of health and health systems into EU policies, including the European Semester, and that this must be based on solid evidence and data. The state of health in the EU cycle will hopefully create a comprehensive platform for discussing how to reform European healthcare systems to meet the challenges of demographic change and the burden of chronic diseases, and EFPIA seeks to be an active and constructive partner in that dialogue.
The report shows clearly the burden of chronic disease, not only for patients but for societies as a whole. According to the report, premature mortality rates from major Non Communicable Diseases corresponds to an estimated loss for the economy of around 3,4 million productive life years across the EU28 countries in 2013, which amounts to EUR 115 billion in potential economic loss each year (based on the average earnings of workers in EU countries). These figures clearly show how important it is to tackle chronic disease to achieve not only sustainable healthcare systems but also sustainable public budgets.
What is striking, however, is the variations between EU Member States in terms of dealing with the impact of chronic diseases on employment. The reduction in employment for people with 2 or more chronic diseases varies significantly between the best and the worst performing countries (Figure 1.1). This indicates that the way you manage chronic diseases, and in particular for multi-morbid patients, can have a huge impact on societies, the economy and the fiscal sustainability of public budgets.
The report also shows strong variations in health outcomes for patients after treatment. For example, the death rate after 30 days following hospital admission for Acute Myocardial Infarction ranges from 4,5% in Sweden to 15,4% in Latvia, and the corresponding death rate after stroke ranges from 5,1% in Finland to 18,4% in Latvia (and 13,2% in Slovakia). Clear differences are also shown in the survival and mortality for different types of cancer. While some of these differences can be attributed to factors outside the healthcare system, such as lifestyle and other risk factors, or the way data is collected and reported, a large part of these variations are due to differences is care pathways, the deployment of evidence-based technology and other factors relating to the healthcare system. For example, the report notes that the difference in mortality following AMI and stroke could be due to variations in pre-hospital emergency care, treatment or transfer patterns, and that improvement during the last decade could be due to better access to high-quality acute care, timely transportation of patients and evidence-based medical interventions.
These differences constitute a huge waste, primarily of course in terms of loss of human life, but also for societies as a whole. There is therefore a huge potential to reduce waste and low-value care through analysing these differences to establish the care pathways and organization of healthcare that bring the best outcomes for patients. This requires in turn better data that is both collected and reported in a standardized way across providers and countries, and risk-adjusted to remove variations based on various external factors. As the report shows, cross-country comparable data on health outcomes and quality of care is only available for a narrow set of diseases and conditions (and also in those cases only for some countries), whereas there is much more available data on epidemiology (e.g. cancer incidence), risk factors (e.g. fruit consumption), healthcare system inputs (e.g. number of doctors, number of CT scanners) and procedures (e.g. hospital discharges, number of consultations). These types of indicators are for obvious reasons easier to measure, whereas collection of disease- and treatment-specific outcomes data is more challenging. EFPIA believes that more should be done to advance the collection of standardized data on health outcomes in European health systems, and that the European Commission and the OECD has an important role to play in driving this important development.
Better data on health outcomes would also enable a more evidence-based discussion around healthcare budgets and resource allocation in healthcare, making sure that resources are allocated to actions and interventions that bring the most value for patients for the money spent. As noted in chapter 5 “Health expenditure”, expenditure on both pharmaceuticals and prevention had a negative growth during the period 2009-2014, to a large extent due to budget cuts in the wake of the financial crisis. Often these cuts were made without a thorough assessment of their impact on health outcomes or long-term sustainability, but rather made due to budgetary structure and administrative expediency. In order to achieve a truly sustainable healthcare system, all expenditure items must be assessed in terms of their long-term efficiency in improving health and reducing the burden of ill health for patients, healthcare systems and societies. The last chapter of the report deals with “Resilience, efficiency and sustainability of health systems”, and contains among other things statistics on average length of stay in hospital. Reducing costly hospitalization is an important goal for health systems that want to stay on a sustainable path, and EFPIA would like to highlight the important role of medicines in reducing the need for emergency care and hospitalization, for example in areas such as diabetes, HIV/AIDS, Hepatitis C and cardiovascular diseases. Future advances in innovative medicine in areas such as combination therapies in oncology and immuno-oncology, Alzheimer’s disease, gene therapies for hemophilia and cell therapies for diabetes, could bring further benefits both to patients but also to healthcare systems and societies in terms of reduced costs and a healthier workforce. EFPIA would like to see a more dynamic analysis of the factors and characteristics that makes a health system sustainable in the long-term, including how to encourage and introduce innovation in health.
EFPIA welcomes that the report examines how primary care can be strengthened, and in that context looks closer at payment models used in healthcare. As noted, traditional forms of payments such as fee-for-service can bring various unwanted side-effects, such as promoting over-consumption of low-value care. In order to fully transform a healthcare system towards delivering the best possible health outcomes for patients, all aspects of the system, including financial incentives, need to be aligned with this objective. Pay-for-performance-type schemes and bundled payments to promote quality and good outcomes in integrated care settings are examples of innovative ways to align financial incentives with the ultimate objectives of healthcare, and more and more payers are looking into outcomes-based solutions to reimburse medicines as a way to resolve the need to introduce innovative medicines with uncertainties on clinical effectiveness and the need for additional real world data. EFPIA believes that this development needs to continue and should be gradually scaled up across the healthcare system. This is a long-term goal that will only be achieved using a step-wise approach and learning from best practice, and EFPIA therefore suggests using the country profiles to explicitly assess experiences with outcomes-based payment schemes, so as to allow best practice exchange when overcoming logistical and organizational hurdles.
An important enabler to allow for outcomes-based payment models is a health information infrastructure that can collect reliable and high-quality data on health outcomes. A comprehensive system for Electronic Health Records that works across providers and services is key in this regard, and the possibility to link data to other data sources such as disease-based registries, claims databases and bio-banks. EFPIA would welcome a more extended chapter on eHealth adoption looking at how health information systems are deployed and used in different Member States.
The need to combat chronic diseases with an ageing population requires a lifelong approach to health and wellbeing, with disease prevention and health promotion playing an important role as one of the most cost-effective ways of avoiding ill-health and disease if done right. That includes lifelong immunization, as explicitly mentioned by the December 2014 Council Conclusions on vaccination. While the only measured vaccine coverage for the elderly in the report is the flu vaccine, lifelong immunisation goes further and includes different antigens for different age groups, e.g. influenza, Herpes zoster and pneumococcal for the elderly, pertussis and influenza for pregnant women, HPV for adolescents, etc. As such, EFPIA would welcome a broader approach, in line with the Council recommendations, for the future reports and country-specific profiles. EFPIA would also like to see more focus in the report on anti-microbial resistance, as a key health-threat facing European populations.
EFPIA would also like to highlight the potential of health data and the digitization of healthcare to revolutionize disease prevention and health promotion. Bringing together genetic information with data on lifestyles, consumption patterns, real-time monitoring of health status through wearables and other applications and big data analytics, will create the potential for personalized prevention interventions, tailored to every persons risk-profile and genetic make-up. Digital technologies could also bridge the gap between prevention and treatment through an increased focus on disease interception – the early detection of disease in the asymptomatic phase through specific markers, enabling early and more effective treatment. These developments has the potential to transform the way we manage our health, making it more effective, personalized and life-cycle-oriented, but requires that regulatory systems, the organization of healthcare services, payment models and healthcare professionals are ready to adopt these new solutions.
EFPIA recommendations on healthcare reform
To make European health systems more sustainable and provide better health outcomes for patients and populations, EFPIA has issued six recommendations for the European Semester 2017:
- Evaluate Member States health policies based on a thorough and evidence-based assessment of health system performance.
- Reform healthcare systems through focusing on health outcomes.
- Promote integrated solutions for health service delivery, and integrated budgets.
- Use Health System Performance Assessment to compare and analyse healthcare performance.
- Highlight the role of health data for improving health outcomes and reduce inefficiencies in healthcare.
- Increase health spending in countries with poor health outcomes and access to health services.
Find the full recommendations here.