November 2013

Facing the new financial reality: Health systems need innovation for health and for sustainability

While there are one or two hopeful signs of an upturn in Europe’s economies, the impact of the financial crisis continues to reverberate. The real-terms cuts in healthcare budgets since 2009 are not about to be reversed, and health systems now need to be reshaped to ensure the health gains that Europe made up to 2008 are not lost, says Professor Helmut Brand

“There is some light, but the train is not coming down the tunnel, and health systems must recalibrate and adjust to the new reality,” says Helmut Brand, Jean Monnet Professor of European Public Health at Maastricht University and President of the European Health Forum Gastein. “We need to learn from the current crisis and consider how we can bring in innovation in health care systems that will make them sustainable for the future,” Brand says.

“Healthcare systems must be made resistant, both to any future shocks like the financial crisis, and to the challenges we have all been talking about for so long, in the ageing population and chronic disease.”

The pressure to recalibrate will also let air into the system, shifting the power balance and opening the door to greater transparency and – it is hoped – to better governance. At present there is little will for change in established systems. “It is blocked by professional bodies that don’t want to know,” says Brand.  

Using innovation to deliver more and better care

This is not some trite ‘never waste a crisis’ rallying call, but rather about taking a considered and thoughtful approach to dealing with the new fiscal realities. For the first time ever, the crisis that began in 2008 led to cuts in health care budgets across the EU. As Brand says, “No one welcomed that.” However, it has prompted discussion about how to make better use of the resources that are available.

It has also focussed attention on how innovation can be applied to soften the effects of cuts, whilst at the same time driving efficiency and service improvements. The aim is to enable health systems to do more with less, and hence make them more sustainable. “We have to deliver more care and better care, with the same amount of money,” Brand says.

Living longer is a big success story. But rather than celebrating the huge gain in health that this represents - and the fact that it underlines how many European countries have created the best health systems the world has ever seen - longevity is portrayed as a problem.

“Ideas about how to manage the ageing population, about the need to reshape care, have been there for ten years or more, now in the crisis, it is time to accept change and to improve governance,” Brand says.

The immediate response to the crisis was for member states to make cuts that have variously translated through to longer waiting times, a shift from primary to acute care, reduced access to innovative therapies, a halt to planned infrastructure investments and increases in co-payments. The result has been greater health inequalities.

Making health care crisis-proof

In short, austerity programme budget cuts are undermining the sustainability of health systems - and cannot form the basis of a long-term response. Such knee-jerk cost cutting damages healthcare and results in higher not lower costs over the long term – as highlighted by the way in which cuts to the wages of expensively-trained health care staff have resulted in some leaving the profession; how reductions in primary care provision have put greater pressure on accident and emergency departments; or by the fact that infections such as HIV are on the rise.

Health systems urgently need to be made crisis-proof, so that they can continue to meet the demands placed on them even when budgets are being tightened. “In times of economic crisis, poverty and widespread mental health problems, there is urgent need to free up the space and financial resources required for innovation,” Brand says.

While there are funding constraints, targeted investment in reforming and modernising delivery could be paid back within two years. “By investing in health, we also invest in general wellbeing, prosperity and economic growth. There is no other area where citizens benefit more directly from innovation,” says Brand.

For Brand, measures to make health systems sustainable for the future should be assessed not purely in terms of cost, but also in how they enshrine the overarching values of universality, equity and solidarity. “Health is for people,” he says.

The focus that the Lithuanian Presidency has put on dissecting the impact of the financial crisis on healthcare and on how to confront the task of making healthcare systems receptive to innovation, is very valuable.

In summarising the outputs and recommendations of various meetings and events held during the Lithuanian Presidency, including recommendations from the European Health Forum held in Gastein from 2 – 4 October, and taking them forward to the conference in Vilnius on November 19 – 20, the Lithuanian Presidency has opened up a bigger conversation about health.

As a result, “We don’t all have to reinvent the wheel and we are keeping up the momentum for health reform,” Brand concludes.