One of the key themes coming out of the -high-level meeting was the need for innovation, not only for progresses’ sake, but to protect solidarity.
Health systems have changed since 2008 and the difference between the have and the have nots has never been wider: according to Oxfam >80% of wealth generated goes to the top 1%. This threatens solidarity. But there is also good news, both in development and health, with life expectancy having increased rapidly across the European region. Nevertheless, the challenges of equity, demographics and AMR, amongst the myriad others, remain. And on recent projections, the OECD estimates that, without adequate action, 14% of GDP will be spent on health amongst its members by 2060.
But this expenditure, whilst often framed as a cost, has a strong potential to be seen as an investment. Indeed, the conference made a clear financial case for expenditure in public health, but also a detailed case for the need to innovate; innovation encompassing both health technologies and services.
Whilst innovation occurs in a context specific manner, the participants were clear on the requirement for sharing best practices across countries. It was even suggested that collaborative efforts to promote innovation across the region should be sold as the Marshall Plan was: that it is better to have wealthy neighbours than poor neighbours.
Currently, the European region’s ecosystem already performs well in producing innovation, but is hampered when it comes to spreading it. There was much discussion of the barriers for this diffusion, which have been extensively studied by the Innovate plenary session keynote speaker, Professor Greenhalgh. The desirability politically, in the clinic, and from patients, can aid or hamper an innovation. Other panellists added more traditional examples to the growing mountain of barriers discussed, with geographical, language and historical barriers mentioned. One key finding was that these challenges correlate with the complexity of the innovation, and its business case. For example, the interdependent routines of daily practice prevent the introduction of new innovations, such as telemedicine which can disrupt the flow of the waiting room and prescribing patterns etc. For the above reasons, creating an innovation ecosystem for clinical practice equivalent to that of the pharmaceutical sector is very challenging, principally due to the complex, cross-cutting nature of healthcare services.
Despite these challenges there are of course best practices. One way of ensuring innovation is to reduce their complexity. Spreading innovation has also required high-level political buy in, a strategy and having the resources set aside to bring them from pilots to the market. In Finland this buy-in has been sought with an inter-ministerial agreement, enabling a one-stop-shop for Ehealth data-access, benefiting both patients and researchers. Beyond the political and financial buy in, there is also the need for a “quadruple-helix” approach to early stakeholder engagement and early due diligence in assessment to ensure a “fail-fast fail-early” mentality is not punished, but encouraged.
Other practices to reduce human resource barriers were shared, such as the provision for professional residencies within and between countries. Or to provide financial incentives where, for example, Belgium offers premiums to clinics which use certified, innovative software. Italy, on the other hand, has legislated that doctors must follow guidelines, which can incorporate innovation.
The depth of experience and scale of these challenges oblige international cooperation, and this was further highlighted through the experience Kazakhstan has had in bringing innovation into its healthcare system – establishing an inclusive health technology assessment (HTA) process, based in part on Germany’s model. For HTAs in particular, there was agreement on the need for international cooperation in the assessment of real-world data. Here, Sweden is using registries to conduct real-world studies on pharmaceuticals and France has adopted pay-for-performance practices. It was suggested that EUneHTA should go further towards cooperating on the value side of technology assessment.
With the future in mind, innovations were seen as increasingly involving software, which update faster than we can assess, or that existing hardware and software can handle. Yet, we need to ensure their appropriate assessment and transparency. And, although the potential benefits on inclusivity of eHealth were recognised, digital literacy is affected by age, education and social class – posing worrying equity questions. These questions were highlighted as requiring greater attention.
Whilst the European region may already be competent at producing many small-scale innovations, there needs to be large-scale international efforts in implementing them. Innovation should be a tool to shrink, not widen health differences between and within countries. Participants were honest and clear that health systems based on solidarity need to be efficient, responsive and require reform. Innovation was viewed as key to these requirements and thus key to safeguarding the solidarity underlying our systems of universal healthcare.
This Blog was written by the Young Gasteiner Philip Hines