European Healthcare Systems and Vision 2020

It is a tragic paradox of modern times that archetypal Western European welfare states and healthcare systems which were fashioned after the second world war, during the period of relative prosperity, are facing financial wrecks.

Compared with late 20th century, the early part of 21st century has manifested some of the most fantastic advances in healthcare such as advent of Biological Agents which is a completely new treatment system, genetic scientific advancements, robotic surgical systems and many more. At the same time there are economic developments independent of any material warranties and social stability reflected by mixing of races, nations, dissolution of borders and introduction of new levels of ethics never seen before. Assumptive and in air financial policies with no material warranties – apart from multiple other factors - have deteriorated financial foundations of the healthcare systems which could crumble unless policies are changed quickly.

The basic problem is the spiralling cost of healthcare, which is expected to rise unceasingly. The rise in the cost of healthcare continues to surpass economic growth with no realistic chance of slowing down. European governments and other contributors are trying to slow that upward spiral, but they are far from agreeing how best to do so.

A key question is how healthcare systems can be redesigned without damaging the foundations upon which they were originally built. Underpinned by the principle of solidarity, Europe’s healthcare system is paid for by the population at large, with the risks of medical expenditure essentially pooled. Most European citizens agree with this shared-risk principle and would resist any efforts to change it and thereby remove the promise of universal healthcare coverage. However, the financial contributions required for healthcare have risen steadily, to the point where governments realise that further increases are no longer possible or politically acceptable.

To look into the future of healthcare in Europe with reasonable degree of accuracy, we analysed 21 leading healthcare systems through the views of their experts. The aim of this analysis was to examine hopes, fears and predictions for European healthcare systems for the next at least two decades. We have in particular taken into account the details of fiscal factors in healthcare, impact of changing population distributions and, the major forecast trends for the near and distant future. Although this analysis is based on factual but assumptive reviews, this will greatly help to clarify the current debate and future planning for these universal healthcare systems which are in real danger of extinction like dinosaurs.

All reviews agree that healthcare costs are rising much faster than the available funding which is mainly based on taxation, public funding and insurance. The key factors which are raising the costs include;

1.   New costly treatments for a large number of diseases which include new medications such as ‘biological agents’, new antivirals such as Sofosbuvir for Hepatitis C (costs up to ￡80,000 for a single course of treatment) and many other state of the art medications as well as new diagnostic/therapeutic equipments.

2.   Rapidly aging population with consequent increase in number of patients with chronic diseases raising all round costs including hospital stay, treatments, social care, home visits etc.

3.   Patients demands of new or even experimental treatments/facilities determined by higher awareness of options, internet and media.

4.   Less healthy life style resulting in early onset, more aggressive diseases requiring higher level of care.

5.   Environmental factors, modernisation of societies and mutation of organisms such as viruses resulting in redistribution of incidence and prevalence of diseases apart from adding other factors such as Ebola epidemic, AIDS etc.

6.   Rise in immigrant populations redefining disease incidence and distribution apart from having unrealistic expectations from European healthcare systems.

7.   Outdated priorities and funding structures which do not take into account any of the major changes, some of which are listed above.

Whether the European governments and other contributors of their healthcare systems like or not, the future of healthcare will change and is changing as we speak. The question for ruling authorities in Europe is simple; do they want to be in control of these changes and mould it in their best interest or they want to let the nature take its course which may not be in the best interest of anyone including directors, planner, contributors, benefactors, consumers and patients. The future of healthcare will change and is changing due to multiple interconnected trends and factors. An urgent action is needed to stabilise the healthcare systems. The following observations are based on our wider analysis;

1.   If Europeans want to keep universal healthcare model then consolidation of services, improvement of delivery systems, adequacy as well as availability criteria of treatment protocols, and in some cases rationing of services will be inevitable as the populations continue to grow and public demands and diversities increase.

2.   It will not be possible to stale or freeze the healthcare funding not only due to inflationary drivers but also because of the growing recognition of policymakers that healthier nations are the wealthier nations.

3.   A new and independent system of healthcare resource distribution will be inevitable. Currently, in many EU countries, this can be more appropriately regulated by groups of primary care physicians who are best placed to co-ordinate the treatment of patients with multiple chronic health issues. They unfortunately also need training to effectively deploy the available financial resources as this was not and still is not the part of training to become a physician or specialist. Leaving this task to non-medics such financial experts with so called medical advisors will never solve this problem.

4.   Prevention is better than Cure. Easier said than done. This is one of the most critical area, fruits of which will take couple of decades to come. This requires addressing many factors such as lifestyles, smoking, drinking alcohol, obesity as well as factors added by multiple immigrant populations such as higher incidence of cardiovascular and gastrointestinal disease as a result of different diet and environmental relocation.

5.   Even if the universal healthcare model is retained, patients need to take more responsibility of their health, treatment and care. Public education policies including those beginning from primary school curriculum must be in place if this plan has to be effective.

6.   Healthcare data rules must change and all governments need to find effective ways of collecting this data not only to prioritise investment decisions but also be able to use these data sets to monitor the progress and effectivity of their policies.

7.   Governments need to change the way bureaucracy works. Shifting bureaucracy from one group to another will not suffice. Rules need to change to give more authority to healthcare professionals. Nonprofessional managers - who are there to obstruct and produce results by hook or crook which are mostly false results - must be removed from immediate effect. Regulatory authorities are working under antique rules and most of their members are nonprofessional so-called lay members who can’t tell the difference between right and wrong. These authorities, their structure and regulations must be reformed. All these factors artificially and un-necessarily raise the healthcare costs as well as the cost of vital medical research.

Although a great deal of debate continues and a great deal more can be added to this by different interested factions; what we need most is innovation, adaptability, and practicality. Self-interested factions such as nonprofessional managers, insurers, privateers, bureaucrats, investors require independent adjudicators to rectify their proposals in the best interest of public and patients. Some of the practical proposals which can be implemented right away to save the European healthcare systems may include the following;

1.   All European nations join forces to create a single pan-European healthcare system although new trends such as UK leaving EU can create problems. Nevertheless, there is a possibility that leaving nations would be willing to join this system.

2.   Preventive medicine should take precedence over current system of patient care.

3.   Although controversial, European nations may think of privatising the entire healthcare system, including its funding. There are many lessons to be learnt in this area from Soviet Russia’s breakaway states who had universal free healthcare prior to disintegration.

4.   New healthcare system should focus more on vulnerable members of society which in long run will not only save money but also will increase the production of wealth in certain areas. Important factor is that they should get this policy right prior to implementation.

5.   E-healthcare has a potential to take away many obligations in number of healthcare sectors particularly in the areas of chronic healthcare management. Technology advancements are there to be used with right ideas and plan.

These are some initial steps to save the future of European healthcare systems although there is a huge possibility of extensive debate across Europe on the details of these reforms and rightly so as each nation has its own individual needs and specific population distributions. Public, over time, has the ability to shift these discussions in the right direction and in the best interest of wider population.