TO REACH: a EU funded project on Health Systems Research Stefano - - PowerPoint PPT Presentation

Health Systems Innovation and Transformation: Accelerating Cross Border Learning

TO REACH: a EU funded project on Health Systems Research

Stefano Vella MD Istituto Superiore di Sanità (the Italian National Institute of Health) Rome

• 1. Our (EU) Health System

A VALUES FRAMEWORK FOR HEALTH SYSTEM REFORM

(Reinhard Priester. Health Affairs 11, no.1 (1992):84‐107)

From Individual values to community values

The Tallinn Charter: Health Systems for Health and Wealth

THE BISMARCK MODEL

• Germany, Japan, France, Belgium, Switzerland,

Japan, and Latin America

• Named for Prussian chancellor Otto von

Bismarck, inventor of the welfare state

• Characteristics:

– Providers and payers are private – Private insurance plans – financed jointly by employers and employees through payroll deduction – The plans cover everyone and do not make a profit – Tight regulation of medical services and fees (cost control)

THE BEVERIDGE MODEL

• Named after William Beveridge – inspired Britain’s NHS
• Great Britain, Italy, Spain, Cuba, and the U.S. Department
• f Veteran Affairs
• Characteristics:

– Healthcare is provided and financed by the government, through tax payments – There are no medical bills – Medical treatment is a public service – Providers can be government employees – Lows costs b/c the government controls costs as the sole payer

• This is probably what Americans have in mind when they

think of “socialized medicine”

HEALTHCARE MODELS

• 2. The context

Common challenges

People live longer and have less children. People migrate within and between countries, cities grow bigger. Health systems face rising costs. Primary health care systems are weak and lack preventive services. Public health capacities are

• utdated.

Infectious diseases, such as HIV, tuberculosis remain a challenge to control. Antibiotic‐ resistant

• rganisms are

emerging. Non communicable diseases dominate the disease burden. Depression and heart disease are leading causes to healthy life years lost.

The changing health systems landscape is preparing for the “perfect storm”

Demographic and epidemiological transition Professional differentiation Technological innovation Populations needs and demand

Health Systems

The waves of demand and supply

DEMOGRAPHY: By 2050 over 1/3 of EU population will be over 60 years old (UN)

% of EU population aged +60

Million

1950 2050

Demand

Source: Projections of global health outcomes from 2005 to 2060 using the International Futures integrated forecasting model. WHO bullettin 2011.

Chronic diseases

J.A. Gray, W. Ricciardi Better value health care, 2008

Things that make our health services ineffective and inefficient

Treated too late Treated in the same way Unwarranted health quality variation Patients treated in our silos Uncertain about what really works Frequent medical errors (not notified) Irrational workflow Patients ignoring our advice Proactivity Personalization Decision support Integrated care Real World Assessment Safety (monitored) Integrated care Involvement

Three Decades of Dynamic Change in Health Systems 1980s  2010s

• Changes in information technologies (electronic medical

record, e‐health capacities, tablet‐based patient management, centralized Big Data)

• Changes in citizen expectations (choice of provider,

equal and rapid access, privacy)

• Changes in patient expectations (participation in

decision‐making, second opinions, international quality standards, patient rights)

• Changes in payment systems (public and private): case‐

based payment, penalties for poor outcomes (re‐ admission, re‐treatment), volume based contracting

• Changes in provider configuration (consolidating

hospitals and services, integrating health and social care)

17

Richard B. Saltman Emory University

Heal Health th sy systems di differ er wi widel dely but but fa face co common mmon challeng challenges es

• Differences in finance, organisation, outcomes
• Part of (and subject to) wider political, cultural, economic

environment

• Challenges relate to
• Rising costs / need for cost containment
• Demographic changes
• Technological advances
• Increasing public expectations
• Common goals
• Ensuring accessible health care of high quality that is responsive,

equitable, affordable and financially sustainable

The changing health systems landscape: preparing for the “perfect storm”

Scarcity of resources Chronic diseases, multimorbidity Growing expectations

• f patients/citizens

Expensive breakthrough medicines and biomedical devices Demographic change and population ageing

Health Systems

The commonest chronic conditions are costing the EU countries more than 1 trillion Euros per year, which is expected to increase to 6 trillion Euros by the middle of the century.

• 3. Health Foresight

Foresight for Health: Identifying the exogenous health drivers

22 25.06.2017

Grand Challenges for Health and Health policy

Demographic shift Climate change Rising costs of health care Changing patterns in infectious & chronic diseases Changing status of women Disease prevention and lifestyle changes Healthcare innovation and regulation Shortage of medical and healthcare workers Cognitive enhancement

Short‐ , medium‐ and long ‐ term developments

Demographic change

Urbanisation

Agriculture & global food chains Climate change and low carbon transition

• % Pop aged 65 and above ;
• Old‐age dependency ratio
• % urban pop living in slums etc.
• % urban pop growth (annual)
• Greenhouse gas emissions
• % pop using safe drinking water
• Consumption of pesticides

Citizens empowerment Innovation in medicine Equity Innovation (global)

• R&D expenditure in health sector
• R&D staff in the health sector
• General Health Literacy Index
• % pop using the Internet
• Patent counts (or finer innovation

index)

• Employment/unemployment rates
• GINI Index
• % pop living below national poverty

line

Demographic change

Increase of healthy life years and

Urbanisation

Increased exposure to air pollution Decreased exposure to air pollution

v

Decrease of healthy life years

Agriculture & global food chains

Unhealthy diet Healthy diet

Economic pattern and tech change

Stagnation Decrease of life standards

Growth and higher life standards

High impact on population health

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Citizens empowerment

Low access to information for prevention and healthy life styles Spread access to info for prevention and healthy life styles Increase in extreme events and heat waves

Climate change and low carbon transition

Decrease in extreme events and heat waves

Equity

Decrease of GINI index

Innovation in medicine

Increase of GINI index Limited impact on population health

WHERE WE ARE – BUILDING SCENARIOS, COMBINING TRENDS

4 2 3 1

Demographic change

Increase of healthy life years and

Urbanisation

Increased exposure to air pollution Decreased exposure to air pollution

v

Decrease of healthy life years

Agriculture & global food chains

Unhealthy diet Healthy diet

Economic pattern and tech change

Stagnation Decrease of life standards

Growth and higher life standards

High impact on population health

Citizens empowerment

Low access to information for prevention and healthy life styles Spread access to info for prevention and healthy life styles Increase in extreme events and heat waves

Climate change and low carbon transition

Decrease in extreme events and heat waves

Equity

Decrease of GINI index

Innovation in medicine

Increase of GINI index Limited impact on population health

WHERE WE ARE – BUILDING SCENARIOS, COMBINING TRENDS

Desolation Health We will Health you The rich get healthier Healthy Together

The rich get healthier

Desolation health

“We will health you”

Healthy Together

• 4. The action

TO‐REACH Contact: to.reach@iss.it

TO‐REACH: THE BEGINNING…

• Health care and services research is the multidisciplinary field of

scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well‐being.

• The main goals of health services research are to identify the most

effective ways to organize, manage, finance, and deliver high quality care to citizens

Why Health Systems and Services Research is needed ?

The challenge of health service and health system research

• The domain of health services and systems research is an area in which

voluntary European collaboration and information sharing are of added

• value. Health systems are becoming increasingly inter‐dependent as they

are shaped by global trends. Many countries are individually exploring solutions to ensure sustainability of service delivery, e.g. by strengthening preventive and community care, redesigning hospital care and de‐ institutionalizing long term care with care provided closer to home, and placing more emphasis on patient involvement and self‐management.

• There is a need to further expand the area of Health Services and Systems

Research in a full European perspective, addressing aspects such as service delivery; information and evidence; access to innovative health technologies; health workforce; health financing; leadership and governance.

• As the current research funding landscape for health system research is

fragmented, there is a need to create better synergies across Europe and to work towards the development of a common research agenda.

Our goal is to identify the European Health Care common challenges and organizational needs, and to propose possible solutions to improve health system performance and to identify the most effective ways to organize, manage, finance, and deliver high quality care to our citizens

TO‐REACH

TO‐REACH Contact: to.reach@iss.it

29 partners / 21 countries

TO REACH

European countries explore similar solutions to improve service delivery for citizens: how to better learn from such initiatives in other countries, using Europe as a natural laboratory?

• Effects of health care reforms on major health outcomes, such as changing the

funding of health insurance or privatisation of care.

• Understanding the optimal relationship between hospital care and primary care

and community care

• Ensuring service provision that is safer, of higher quality, and more patient‐

centred

• New approaches to health technology assessment and to the economic and
• rganisational consequences of introducing health technologies.
• Effectiveness and efficiency of performance indicators and their linkage to other

governance policies.

• Exploring the reasons (and suggest the solutions) for the existing disparities and

inequalities in health care provision.

• Implementing biomedical innovation in health services and systems

Towards the ERA‐NET Research Agenda: identifying metaquestions, themes and policy areas

TO REACH

European countries explore similar solutions to improve service delivery for citizens: how to better learn from such initiatives in other countries, using Europe as a natural laboratory?

• 1. Identify Strategic

Priorities

Identify future challenges and priorities (roadmapping)

Main objectives

• 2. Building Research

Infrastructure

TO REACH: objectives and tasks

Provide knowledge synthesis and analytical framework (meta‐questions)

Main tasks

Prepare a common and sustainable platform by research funding bodies (strengthening the network) Enhance cooperation and linkage with other funders networks (embedding the network)

PERT diagram of the TO REACH Project

TO‐REACH: stakeholder involvement

Project partners PAC Scientific Advisory Committiee Policy Advisory Committiee

Fellow interna‐ tional initiatives

Alliances of regional or local authorities

Sector or provider associations International bodies Fellow funding bodies including charities Citizen and patient plus caregiver

• rganisations

Media & General public Politicians and policy makers Scientific community Payer and insurer

• rganisations

• 1. Identify Strategic

Priorities

Identify future challenges and priorities (roadmapping)

Main objectives

• 2. Building Research

Infrastructure

TO REACH: objectives, tasks, outcomes

Provide knowledge synthesis and analytical framework (meta‐questions)

Main tasks

Prepare a common and sustainable platform by research funding bodies (strengthening the network) Enhance cooperation and linkage with other funders networks (embedding the network)

Strategic Research Agenda

Outcomes

Only Evidence‐based decision making can fix it

Our Strategic Research Agenda will pave the way to future European Joint Research Initiatives supported by Member States to tackle the challenges ahead of us.

Where am I? You are 30 meters up in a balloon

You must be a researcher…

Yeah, but how did you know?

Because you gave me a very accurate but totally irrelevant answer

And you must be a politician…

Yeah, but how did you know?

Because you don’t know where you are, you don’t know where you are going and you are blaming me for all this mess..

Thank you

to.reach@iss.it