Health Systems Innovation and Transformation: Accelerating Cross Border Learning TO REACH: a EU funded project on Health Systems Research Stefano Vella MD Istituto Superiore di Sanità (the Italian National Institute of Health) Rome
1. Our (EU) Health System
A VALUES FRAMEWORK FOR HEALTH SYSTEM REFORM (Reinhard Priester. Health Affairs 11, no.1 (1992):84 ‐ 107) From Individual values to community values
The Tallinn Charter: Health Systems for Health and Wealth
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, Cuba, and the U.S. Department of Veteran Affairs • 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 • This is probably what Americans have in mind when they think of “socialized medicine”
HEALTHCARE MODELS
2. The context
Common challenges People live Non Infectious Health systems longer and communicable diseases, such as face rising costs. have less diseases HIV, tuberculosis Primary health children. dominate the remain a care systems are disease burden. challenge to weak and lack control. People migrate preventive within and Depression and services. between heart disease Antibiotic ‐ Public health countries, are leading resistant capacities are cities grow causes to organisms are outdated. bigger. healthy life years emerging. lost. The changing health systems landscape is preparing for the “perfect storm”
The waves of demand and supply Demographic and epidemiological transition Health Technological Professional differentiation innovation Systems Populations needs and demand
Demand DEMOGRAPHY: By 2050 over 1/3 of EU population will be over 60 years old (UN) % of EU population aged +60 1950 2050 Million
Chronic diseases Source: Projections of global health outcomes from 2005 to 2060 using the International Futures integrated forecasting model. WHO bullettin 2011.
J.A. Gray, W. Ricciardi Better value health care, 2008
Things that make our health services ineffective and inefficient Patients treated Treated in the Unwarranted health Treated too late in our silos same way quality variation Proactivity Personalization Decision support Integrated care Uncertain about Frequent medical Irrational workflow Patients ignoring our what really works errors (not notified) advice Real World Safety Integrated care Involvement Assessment (monitored)
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) Richard B. Saltman Emory University 17
Heal Health th sy systems di differ er wi widel dely but but fa face co common mmon challeng challenges es o Differences in finance, organisation, outcomes o Part of (and subject to) wider political, cultural, economic environment o Challenges relate to o Rising costs / need for cost containment o Demographic changes o Technological advances o Increasing public expectations o Common goals o Ensuring accessible health care of high quality that is responsive, equitable, affordable and financially sustainable
The changing health systems landscape: preparing for the “perfect storm” Scarcity of resources Health Chronic diseases, Demographic change and multimorbidity population ageing Systems Expensive Growing expectations breakthrough medicines of patients/citizens and biomedical devices 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.
3. Health Foresight
Foresight for Health: Identifying the exogenous health drivers Cognitive enhancement Demographic shift Shortage of medical and healthcare Climate change workers Grand Challenges for Health Rising costs of Healthcare and Health health care innovation and policy regulation Short ‐ , medium ‐ and long ‐ term developments Disease prevention and Changing patterns lifestyle changes in infectious & Changing status of chronic diseases women 22 25.06.2017
Demographic change Citizens empowerment • % Pop aged 65 and above ; • General Health Literacy Index • Old ‐ age dependency ratio • % pop using the Internet Urbanisation Innovation in medicine • R&D expenditure in health sector • % urban pop living in slums etc. • R&D staff in the health sector • % urban pop growth (annual) Climate change and low carbon Innovation (global) transition Patent counts (or finer innovation • • Greenhouse gas emissions index) • % pop using safe drinking water • Employment/unemployment rates Agriculture & global food Equity chains • GINI Index • Consumption of pesticides • % pop living below national poverty line
W HERE WE ARE – BUILDING SCENARIOS , COMBINING TRENDS 4 1 2 3 Increase of Decrease of Demographic v healthy life years healthy life years change and Decreased Increased exposure to air Urbanisation exposure to air pollution pollution Decrease in Climate change Increase in extreme events extreme events and low carbon and heat waves transition and heat waves Agriculture & global food Healthy diet Unhealthy diet chains Spread access to Low access to Citizens info for information for ??????? empowerment prevention and prevention and healthy life styles healthy life styles Innovation in Limited impact on High impact on population health medicine population health Economic Stagnation Growth and Decrease of life pattern and higher life standards tech change standards Increase of GINI Decrease of GINI Equity index index
W HERE WE ARE – BUILDING SCENARIOS , COMBINING TRENDS The rich We will Desolation Healthy Health get Health Together healthier you Increase of Decrease of Demographic v healthy life years healthy life years change and Decreased Increased exposure to air Urbanisation exposure to air pollution pollution Decrease in Climate change Increase in extreme events extreme events and low carbon and heat waves transition and heat waves Agriculture & global food Healthy diet Unhealthy diet chains Spread access to Low access to Citizens info for information for empowerment prevention and prevention and healthy life styles healthy life styles Innovation in Limited impact on High impact on population health medicine population health Economic Stagnation Growth and Decrease of life pattern and higher life standards tech change standards Increase of GINI Decrease of GINI Equity index index
The rich get healthier
Desolation health
“We will health you”
Healthy Together
4. The action
TO ‐ REACH: THE BEGINNING… TO ‐ REACH Contact: to.reach@iss.it
Why Health Systems and Services Research is needed ? Health care and services research is the multidisciplinary field of • scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well ‐ being. • The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care to citizens
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