Health Systems Innovation and Transformation: Accelerating Cross Border Learning

TO – REACH: organizing health service and system research in Europe

Stefano Vella MDIstituto 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): case-based payment, penalties for poor outcomes (re-admission, re-treatment), volume based contracting

• Changes in provider configuration (consolidating hospitals and services, integrating health and social care)

7Richard B. Saltman Emory University

The changing health systems landscape: preparing for the “perfect storm”

Scarcity of resources

Chronic diseases, multimorbidity

Growing expectations of patients/citizens

Expensive

breakthrough medicines

and biomedical devices

Demographic change and population ageing

HealthSystems

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

oDifferences in finance, organisation, outcomes

oPart of (and subject to) wider political, cultural, economic environment

oChallenges relate too Rising costs / need for cost containment

o Demographic changes

o Technological advances

o Increasing public expectations

oCommon challengeo Ensuring accessible health care of high quality that is responsive,

equitable, affordable and financially sustainable

2. A look into the future

DEMOGRAPHY: By 2050 over 1/3 of EU population will be over 60 years old (UN)

% of EU population aged +60

Million

1950 2050

Demand

Source: Projections of global health outcomes from 2005 to 2060 using the International Futures integrated forecasting model. WHO bullettin 2011.

Chronic diseases

Coping with Innovation

Personalized / Precision Medicine: is it affordable ?

Foresight for the exogenous health drivers

21 18.08.2017

Grand Challengesfor Healthand Health

policy

Demographic shift

Climate change

Rising costs of health care

Changing patternsin infectious & chronic diseasesChanging status of

women

Diseaseprevention andlifestyle changes

Healthcareinnovation andregulation

Shortage of medical andhealthcareworkers

Cognitiveenhancement

Short- , medium- and long - term developments

Demographic change

Increase of

healthy life years

and

UrbanisationIncreased

exposure to air pollution

Decreased

exposure to air

pollution

vDecrease of

healthy life years

Agriculture & global food

chains Unhealthy diet Healthy diet

Economic pattern and tech change

Stagnation Decrease of life

standards

Growth and

higher life

standards

High impact on

population health

Citizens empowerment

Low access to information for prevention and

healthy life styles

Spread access to

info for

prevention and

healthy life styles

Increase in extreme events and heat waves

Climate change and low carbon

transition

Decrease in

extreme events

and heat waves

Equity Decrease of GINI

index

Innovation in medicine

Increase of GINI

index

Limited impact on

population health

BUILDING SCENARIOS, COMBINING TRENDS

DesolationHealth

We will Health

you

The rich get

healthier

Healthy Together

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

Coordinated by the Istituto Superiore di Sanità – Walter Ricciardi

29 partners / 21 countries

Our Transatlantic Partners

✓ Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, USA

Arlène Bierman

✓ McGill University, Montrteal, Canada

Robyn Tamblyn

TO-REACH: stakeholders

Project partners

PAC

Scientific AdvisoryCommittee

PolicyAdvisory Committee

Fellow interna-tionalinitiatives

Alliances of regional or local authorities

Sector or provider associations

International bodies

Fellow funding bodies including charities

Citizen and patient plus caregiver organisations

Media & General public

Politiciansand policy makers

Scientific community

Payer and insurerorganisations

Our Scientific Advisory Committee

Kieran Walshe - UKDiana Delnoii - NLRafael Bengoa - SpainPedro Barros - PortugalJacqueline Müller-Nordhorn - GermanyTuula Tamminen - FinlandKarine Chevreul - France

1. Identify Strategic Priorities

Identify future challenges and priorities (roadmapping)

Main objectives

2. Building Research Infrastructure

TO REACH: objectives, tasks, outcomes

Provide knowledge synthesis and analytical framework

(meta-questions)

Main tasks

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

Outcomes

• 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

Towards the ERA-NET Research Agenda: identifying metaquestions, themes and policy areas

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 youto.reach@iss.it