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11 November 2015
"Why is that innovations that have proven to be cost-effective in the long term, are not invested in, in the short term?" – Kay Swinburne (ECR, UK)
This question was at the heart of the second meeting of the European Parliamentary Interest Group on Innovation in Health and Social Care. Opened by Co-Chair Kay Swinburne (ECR, UK), the question she posed went to the heart of how the European Parliament can work together with stakeholders to encourage Member States to look at investment, rather than just cost-containment, in health systems.
Ms. Swinburne, Ms. Kadenbach (S&D, AT) and Health First Europe Honorary President John Bowis all highlighted particular innovations that should be taken up by healthcare systems to support sustainability. From at-home remote monitoring tools for cardiac health in rural areas, to rapid screening technologies for appropriate antibiotic prescribing, the innovations cited by the speakers showed clear benefits for patients and health systems. So why aren't they invested in more broadly?
Providing an overview of the implications and complications of health system investment, Christophe Schwierz from DG ECFIN, suggested fiscal sustainability in the short term is still imperative if we are to find investment for innovation in the long term.
In his work with the European Semester process, (itself an innovation), Mr. Schwierz noted that, "We don't know the price or value of innovations in Member States" and therefore "haven't solved problems related to health care proficiency and hospital efficiency." While innovation in benefits packages have been pursued by some Member States, innovation in efficiency (i.e. primary care, eHealth, health promotion) has not been pursused by many governments - instead focusing reform efforts on savings.
In order to understand the choices and trade offs faced by national health ministries, Dr. Paul Thewissen from the Health Insurance Directorate in the Netherlands discussed the questions his Ministry had to answer when reforming the system 10 years ago. The Dutch opted to introduce competition into the health system and mandated all citizens to be insured. He explained that over time, the Dutch system increased in efficiency, reduced hospital mortality and length of stays, and saw a growth in hospitals focusing on services they could provide well – as opposed to trying to provide all services. Suggesting "you get what you pay for," Dr. Thewissen noted the decline in length of hospital stays after the reform ceased payments for hospital beds.
So what can be done to incentivise investment in proven innovations? Some suggestions included greater reliance on health technology assessment to measure cost-efficiency, limiting unnecessary procedures, utilization of information and communication technologies, and changing health system governance. Bearing in mind efficiency increases will not bring enough savings for fiscal sustainability in most health systems, there is still work to be done to convince Member States to invest in innovations for efficiency now.