Johan Hjertqvist
President
Health Consumer Powerhouse
Stockholm/Brussels
In analysing European public healthcare from a consumer point of view you will find a lack of responsiveness in many ways: not involving the patient/consumer, inequalities in care, obstructions for mobility and choice, and so on. There is a price to pay for such a lack of consumer expectation compliance, such as overmortality, waiting time, loss of quality of life and unnecessary information costs.
The Euro Health Consumer Index
The Euro Health Consumer Index (EHCI) 2006 points out the most consumer-friendly healthcare system in the EU, as rated by 27 Index indicators. The 2006 Index includes all the 25 EU public healthcare systems, plus Switzerland for reference. Using this instrument for analysis, what can we learn from the Index’s findings? We can learn that public healthcare will be under growing stress to deliver – and to deliver quickly to a care consumer who is becoming better informed and more active and demanding. Today’s conditions are not satisfactory from this point of view:
• Access to personal medical records is limited/nonexistent among two out of three EU members. The same goes for the right to a second opinion.
• There is a consumer-friendly pharmacopoeia giving advice on medication in only three EU countries.
• In two out of three countries the majority have to wait more than three months to have a knee/hip joint replacement; is good European access a myth?
• The Index reveals huge variations in survival after heart infarct, breast cancer mortality and MRSA infections in hospitals among the national healthcare systems.
• There are large spans in “systems generosity”, measured by indicators such as the volume of cataract surgery and polio vaccination among children. Here, funding seems to be just one explanation.
Findings
The 2006 EHCI findings confirm that public healthcare systems are still victims of a traditional rationing paradigm, where the risk of “overconsumption” is the key political focus. To meet the demands of “cost control”, consumers have to wait for a treatment. Sooner or later these patients must have a hip replacement; the wait is cruel to the individual, costly in a wider sense (there are costs attached to sick leave and painkiller treatment) and a token of inefficiency for the system/provider. Still the consumer is provided with little information to navigate the systems and explore the potential of healthcare to make their own choices. There is a blatant lack of transparency which would never be tolerated in any other complex service industry. Imagine wanting to buy a holiday but being unable to learn about the hotel you want to stay in!
Consumers’ opinions
What do we know about healthcare consumer expectations? Are they happy with the present situation? This is an area of growing knowledge. Some outcomes from our own research or surveys, performed together with other stakeholders, can be summarised as follows:
• Four out of five European citizens find waiting times a good indicator of healthcare service quality – but only one in four is satisfied with the present waiting-time conditions.1
• Three out of four say that giving the patients more information about their illness would improve the standards of health services.1
• By 2020, patients foresee a multitude of information sources about treatments and treatment options, with a mix of public and private information providers; essentially, it is thought that governments should set rules, not provide content.2
• Travelling long distances for care within the EU will be fully accepted by 2020.2
• Current knowledge of the option to go abroad for medical treatment still seems to be limited, despite debates taking place in the EU. One of our polls shows that the majority of people in Germany, France, UK, Poland and Spain are not aware of this right.3
As these examples show, the European healthcare landscape is shifting in a rapid and rather dramatic way. The weak patient waiting in line will soon become a thing of the past, and be replaced by an articulate care consumer, for whom accessibility, excellent outcomes, wide choice and consumer-friendly information will be looked upon as a given. This new breed of patients will also be able to manage their own health and make the key decisions.
In addition, the ageing population of Europe means that there will be a growing number of senior citizens with multiple conditions, often living alone but in need of care. Will healthcare systems then be able to meet these needs? With the present system’s design, that is hard to imagine. However, with a radical rethink, there are reasons to be optimistic!
Incentives
What would such a new direction potentially mean? What are the signs? After having tried every other possibility to improve outcomes, the remaining option for governments and hospital managers is incentives. Economic rewards are well known in the private healthcare sector, although they are generally un(der)used in public healthcare. Measurement systems such as diagnosis related-groups are built upon better foundations for rewarding the best performers (and correcting the poor ones).
In the private sector it is well known that well-managed operations meeting their targets achieve more freedom to make own decisions. It is a matter not only of money but also of a more pleasant working environment. Instead of performing acute costcutting programmes you can focus on delivering added value to care consumers and purchasers.
In the UK, the NHS has quickly developed from a monopoly provider into a compulsory insurance scheme with growing choice for the consumer. Contractors are reimbursed according to delivery.
In Spain, the number of hospital contractors working within the public sector is growing as a consequence of the flexible funding system and reimbursement solutions to deliver high-quality services. Forty percent of all German hospitals are now operated by private providers, which are better suited than the public players to deliver services. However, price competition between hospitals within the NHS has now become so tough that private players such as BUPA have decided to leave this sector.
Regardless of who is the owner – the public sector or a private operator – European healthcare should prepare for even more demanding “customers”:
• The empowered consumer will ask for personalised offers and solutions, and “one size fits all” will soon be history.
• Reimbursement will follow suit.
• Every government will move to make prevention and integrated care a reality. You might have heard this call for many years – economic realities eventually will turn ideas into action. This means that every healthcare system will require new, value-added care models from contractors and care partners.
• Self-management among patients will be a major movement, as a consequence of a strong demand for controlled and personalised care and because of current constraints on public budgets for healthcare.
• Long-term care will be a growing field, challenging European values of equity, as individual purchasing power will become key. In the long term there will be a severe shortage of nursing staff in Europe, and this will be a most attractive market for entrepreneurs.
• There will soon be a EU market for healthcare services, with healthcare tourism, crossborder treatment and operators working in many markets. The legal framework of the EU will support such a development. There will be increased specialisation in this market, with providers (even Member States) offering treatment packages to “care tourists” while other providers will settle in countries with a demand for certain services (such as cheap dental services). Such movements can offer interesting opportunities for low-income Member States to retain medical staff, which otherwise tend to emigrate to better markets.
• Consumer/patient education and training will flourish within the context of consumer empowerment. There will soon be a breakthrough in consumer information about healthcare, allowing informed choice, self-management and partnership with the healthcare system in a radically new way. This will lead to a strong shift of power to the individual. This will be the biggest change in healthcare relationships as we know them. Care providers will increasingly be paid according to consumer satisfaction, either directly by people able to pay the full costs of a general practitioner visit or indirectly as consumers in insurance- or tax-funded systems. In the latter case, patients will be asked to rate their visits to care providers, and the rating will affect reimbursement.
• Finally, there will be international interest in the future of health insurance, savings and care delivery in Europe. As single-payer systems are considered unsustainable, there will, over time, be an important market for US, Indian and Chinese capital and business to introduce personalised savings products and care models.
Conclusion
Tomorrow’s European healthcare systems will change considerably. Private hospitals and other players already used to client focus and added-value approaches ought to be in a favourable position to benefit from these new trends.
Resource
Euro Health Consumer Index
W: www.healthpower
house.com
References
1. Disney H, Horn K, Hrobon P, Hjertqvist J, Kilmarnock A, Mihmthe A, et al; Populus. Impatient for change: European attitudes to healthcare. London: The Stockholm Network; 2004.
2. Health Consumer Powerhouse/Patient View, 2006.
3. Health Consumer Diagnosis, 2005
