Since the days of the ancient Greeks, healthcare has been described as a ‘problem’. In ten years’ time, technology will have advanced to such an extent that you will be able to grow organs in pigs and transplant them into human beings – but you will not be able to get a doctor to make a house call (at least if you live in Sweden). Eventually everybody will become dissatisfied with healthcare provision unless something radical is done. In Europe alone, the public healthcare systems consume roughly 1,000 billion euros a year and employ 10-12% of the total workforce. But what is this money being spent on? Reform is taking place - there have been over 1,500 major healthcare reforms in the EU over the past fifteen years. Slovakia alone is responsible for a large proportion of them.
Something rather dramatic is happening to public perceptions of healthcare. Healthcare is no longer viewed as an elitist topic but has become part of the wider public policy debate. Now we note more and more open meetings addressing healthcare. People are not willing to wait to take action, and are concerned with viewing the healthcare issue from the perspective of the consumer.
If you search for health on the Internet, the number of matches now outnumbers that for a search for pornography. When health becomes more important than sex something serious is happening to public perceptions!
The intensity of the debate is also creating confusion among casual observers, however. This is because we are moving fairly quickly from a top-down system, which is designed to deliver but does not invite the consumer to take part in the process, to what can be described as a kind of partnership. The new system invites the consumer to take part in the decision-making process. It is only by treating the patient as a customer that we can be successful.
The experiences of the newest EU members are instructive when considering healthcare reform. A number of the new member states - Slovakia, as Martin Bruncko has mentioned, but also others - are in the process of healthcare reform. While every country’s experience is different, it is impossible not to notice how the trend is generally to do away with the old tax-funded systems. Evidently the state-run, state-funded models of the UK and Sweden are not very attractive any more. What seems to work better is a system of fairly independent social security systems.
After an initially difficult period following independence for the former communist states, there is now a tendency to build balanced social markets. By ‘social markets’ I mean that the consumer is invited to take part in the funding in a much more active way than takes place in a traditional, socialised, tax-funded system.
Today there is generally good access to pharmaceuticals in the new member countries; in some there has been a tenfold increase in the number of drugs available to patients. This has given the consumer much greater choice.
Many health systems still lack patient rights or consumer opportunities, and measures of quality control, which can lead to disillusion. But this is also the case for many of the established systems in Western Europe – including those of France, the UK, Sweden and Germany. It is not simply a matter of technique or system change, but also of adapting to the political culture.
European integration will create much more cross-border mobility. Decisions made by the European Court already actively support the mobility of patients. This will encourage competition in the field of healthcare, as well as impinging on issues such as taxation and employment law.
My organisation, the Health Consumer Powerhouse, has tried to contribute to the debate by building benchmarking systems. In the summer of 2005 we presented to the European Parliament what we call the ‘Euro Health Consumer Index’, a tool to allow us to start benchmarking the member systems within the Union from the point of view of consumer friendliness.
It is encouraging to note that a number of the new member states have tried to opt for a new balance between an empowered consumer and a viable system by introducing new insurance funding models. When the health consumer becomes more active and obtains more rights, this increased consumer power must be balanced with a responsible attitude towards funding, a balance that must be considered more seriously than it was when the older social systems were created. I see a number of promising examples among the new member systems.
Unemployment was once the big issue in Europe. More recently, taxes supplanted this. I am convinced that tomorrow’s big debate will be over the future of healthcare, a make-or-break issue for many governments.
© Copyright; Foundation for Economic Growth and various authors. Individual authors retain their own copyright.
Top of Page
|
