This year’s course drew participants from governments, health care organizations, and businesses in Germany, Greece, Portugal, Spain, and Switzerland.

Executive summary: European health care leaders untangle the paradox of progress at HMI-Lausanne course

Health care systems throughout the world are being scrutinized and rethought. Public expectations for better health and better health care are rising, driven by the spread of information, by growing political and economic empowerment, and by aggressive marketing by pharmaceutical and medical device manufacturers.

Harvard Medical International, the University of Lausanne, and the Institute of Health Economics and Management, for the second year in a row, have delivered an intensive executive education program focused on helping leading figures in European health care develop their capacity to confront these and other dilemmas having a major impact on how health care is provided, and paid for. The five-day interactive program, entitled “Your Future in Health Care: Matching Costs and Benefits,” drew participants from governments, health care organizations, and businesses in Germany, Greece, Portugal, Spain, and Switzerland.

The course was directed by Professors Miles F. Shore of Harvard University and HMI, and Alberto Holly of the University of Lausanne. Shore, who has been a consultant to a wide variety of community agencies, clinics, and hospitals, is Bullard professor of psychiatry at Harvard Medical School and visiting scholar at the Kennedy School of Government, and senior consultant and director, HMI. Holly is professor of economics and director of the Institute of Health Economics and Management at the University of Lausanne. The program faculty was drawn from Harvard University, the University of Lausanne, and other leading European academic institutions.

Shore explained that although the course was designed to address the specific concerns of health care leaders in Europe, the issues at the core of each discussion are rapidly assuming international importance as health care systems modernize and progress. The question of how to provide the best possible care without reducing accessibility to care—that is, without making it cost-prohibitive to many patients, a kind of anti-progress—is chief among these challenges. “Costs are increasing in most countries and the stark reality is that it is now possible to do more for patients than most countries can pay for,” said Shore.

While national health care systems differ greatly based on a few key variables—level of economic development, national culture, political organization, and history—for health care leaders today it is perhaps more instructive to compare systems in terms of the relationships among key players: patients, providers, payers, and administrators. The results of these relationships show up in fundamental characteristics of the system: cost, access, and quality. In many countries the dynamics of these relationships are not well understood by patients, by most providers, and even by many administrators and payers. The knowledge and skills required to understand these complexities and influence sustainable systemic changes was the focus of this recent course.

In addition to lectures from leading experts, the program challenged the participants to apply their own ideas to a series of group activities. Pascal Paschoud of the Institute of Health Economics and Management explained: “Over the course of the week they worked together to prepare specific recommendations for the design of an ‘ideal’ health care system for a developed country of their choice. The recommendations were to encompass the main aspects of a health care system, such as the role of the state, public-private mix, funding, equity in access, quality of service, and payment of providers.”

Shore and Paschoud agreed that the course’s interactive atmosphere was critical to encouraging a cross-functional reconsideration of health systems organization and dynamics.

“An underlying objective of programs like this is the simple matter of providing a forum for people in different roles and with different agendas to talk through these issues with one another, and to hear not only the viewpoints of other people, but to see how their own viewpoints are perceived by people outside of their regular domain,” said Shore. “We hope that participants leave this course with a better understanding of the political, social, economic, and technological dimensions to be considered in developing innovative solutions to health policy dilemmas. Only from that vantage point can they prepare themselves to apply the strategic decision-making skills that are also discussed.”

Plans are already in the works for next year’s program, to be held May 15-19, 2006. To learn more, visit the program website.