More than 30 stakeholders from all over Europe participated in a lively debate about European Health Care Systems at a workshop in Valencia. Suggestions to shift focus towards prevention rather than continuing reinforcing more treatment.
On June the 7th, the European health network CORAL (www.europe-coral.eu ) organized a workshop about value-based health care in Europe. The workshop was organized with the aim of discussing if more focus should be shifted towards prevention rather than treatment. Statistics data reveals that increasingly many Europeans are suffering from chronic diseases, which is very connected to an increasingly number of citizens’ unhealthy lifestyles. For instance, 60 million people are living with diabetes in Europe according to WHO. This number has grown steadily over a long period and the expenses of treating patients suffering from diabetes are consequently increasing. Some European intellectuals, including Hans Martens, Senior Adviser to European Policy Center, argue that it could be relevant to change the way the health system approaches its citizens towards more preventive efforts. This would mean people would be approached long before they are at risk of developing diabetes (especially Type 2). The workshop began with some of Hans Martens’ arguments and examples on Value Based Health Care.
The workshop was a side-event to a meeting in the European Innovation Partnership on Active and Healthy Ageing (in short referred to EIP on AHA) taking place in Valencia, a three-star reference site in EIP on AHA. The EIP on AHA network has been initiated by the European Commission back in 2011 and its overall goal is to increase the average healthy lifespan by two years by year 2020. At this moment, we are nearly two years away from trying to accomplish this goal. The workshop was accordingly an opportunity to put more focus on due diligence in the health care systems to target this goal. It was also an opportunity to discuss if the goal itself is reachable based on the current “active healthy aging” policy agenda of the EIP-AHA. Should new policy agendas be included to reach the target goals and which? Thus, the event took the temperature on the regions efforts to counteract the sad statistical development on chronic diseases. How and when are they trying to cope with the rising costs from diabetes and other chronical illnesses?
The 32 workshop participants where split into 6 groups who discussed 4 main questions. Questions and answers are summarized below.
During the session, each group was asked to describe which authorities are responsible for the prevention agenda in their country. And how well they felt the governmental setup was ideal to administrate and execute intervention policies in terms of prevention of chronical diseases for the benefit of their citizens.
The question was used to identify whom the regions would consider the best actor to push the prevention agenda forward. As one could say, the political settings (in terms of centralization/decentralized systems) are very different in Europe and there is not one model that would be good for all. The question was used to get a sense of the diversity of the political setups in the different European countries. Should preventive efforts against chronical disease and other diseases be lead by the EU, the national or the regional and/or the local level or by several of these administrations? And how do we prevent that shared responsibilities for preventive policies does not fall between two chairs?
The feedback from the groups showed that the countries of Europe are of course governmentally organized very differently. And the ideal solution for a governmental set up is not evident. For instance, in Catalonia, Spain, it is regulated by local authorities, while in Germany it is first of all the Federal Health Ministry leading the discussion in terms of insurance coverage but it currently lacks power to lead the policy agenda. In Skaane, Sweden, the responsibility lays between two national authorities and the municipalities. (Group 1)
Serval groups suggested that the ideal solution would be to have guidelines developed at a national level and implemented at a local level (Group 3, 4, 5, 6). E.g., smoking cessation policies were mostly managed at a national level and proved quite efficient, but had to be supported by local efforts in some cases to solve specific local contextual issues.
Finally, group 5 added that the private sector also could play an impotent role with helping citizens improving their lifestyles. Group 6 noted that the executing authority should maybe be the municipalities, because they are closest to the citizens.
Group 2 noted that the discussion of prevention and value-based health care should be more clearly defined before going into a discussion about an ideal governmental set-up. It was mentioned that Italy has a regional plan for prevention, which was adapted very recently.
The second question had the purpose of finding out at which age the regions/local/national administrations start to provide prevention programmes to prevent chronical disease in their citizens? Is it possible to set a starting age to approach prevention for citizens? Should it be when a citizen is born, when they are 50 or are there other ways to set a framework for preventive efforts?
To this question, all six groups agreed that it makes sense to prevent from early age. One region said that they have been working with a concept called “lifelong coach” because it makes sense economically, when thinking of the high expenditures we have in the healthcare systems in Europe due to unhealthy lifestyles (Group 4). Another group noted that indeed by expanding the prevention efforts to citizens from when they are born would consequently mean that we would need to involve new stakeholders e.g. the education sector (schools) and the social care sector (group 3 and 6).
The groups were also asked to discuss best examples on prevention/value based health care initiatives.
They had several examples, which unfortunately due to limited time were not explained into details. E.g. in Wales a programme called 5 times 60 has been made for school children to have exercise twice/three times a week to ensure that children become more physical active (Group1). In addition, examples of nutrition education in school where mentioned (Group 3) and screening programmes for early diagnosis of diabetes was mentioned (Group 3).
Finally, the groups were asked to define in which cases they find it relevant to work with life-long prevention strategies and if they could also come with examples of cases where it would not make sense to decrease the number of chronical diseases. The answers were very diverse, reflecting the broad nature of the question asked.
The conclusion of group 1, 4 and 6 was that life-long prevention strategies are best to ensure healthy citizens and have no limits. Contrary to this, group 2 stated that there are no limits to the amount of money we can use spending on prevention. It is an illusion that we can prevent us away from expenses. The solution is managing resources and using the preventive actions to the point that it makes sense.
Group 3 noted that the discussion is much too broad and that both prevention and treatment is needed. How much the efforts should be used on one or the other strategy should be decided on a case by case basis.
Group 5 mentioned that the health system often has too many messages and that it is important that the messages be targeted in terms of gender differences (females live longer), cultural limits, economic gaps etc. We also to some extend must accept the individual choice to live unhealthy.
In conclusion, the workshop had a very general and broad topic to discuss in a short amount of time. Therefore, some questions where difficult to answer, however the intention of the workshop was to get a picture of the regional tendencies revealed within a complex field, where there is not one right solution to reverse the sad statistical development with increasingly many Europeans suffering from chronic diseases. The workshop showed us that the regional governmental systems are different but nevertheless and a first look into the answers shows that several regions have good experience with prevention policies developed at a national level and implemented at a local level (Group 3, 4, 5, 6). Even if this model would not be ideal for all governmental national settings in Europe.
The workshop made it clear that all the regional stakeholders attending the workshop expressed that it makes sense to prevent from early age and that it would consequently mean that we need to involve more / new stakeholders. For instance, like the education sector and the social care sector. In addition, all regions had many good examples of successful preventive activates in their region, targeting both young and elderly citizens.
Therefore, life-long prevention strategies are important and should be targeted in terms of gender differences, cultural limits, economic gaps, etc. While we also must accept the individual freedom to live unhealthy and be realistic about how much we can prevent based on the available resources in our health system.