JULY / AUGUST 2005
FEATURE
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| 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.”
| KEY
TOPICS OF DISCUSSION The scaffolding of health care systems All health care systems must address similar problems, which include efficiency and equity. They can be compared in terms of the nature of regulation as it creates a balance of solutions to these universal problems. The allocation of financial risk Balancing access to care, quality of care, and the cost of care involves the distribution of financial risk among the participants in health care: patients, purchasers, and providers. Finding the right balance between government regulation and a free market framework is key. The role of technological innovation The dynamics of innovation and its diffusion into medical practice is a key driver of quality and cost. Increasingly efficient tools for the economic analysis of costs and benefits of technological innovation are being developed. Improving quality in health care Processes by which care is delivered are crucial in improving quality, reducing waste and inefficiency, controlling medical error, and improving patient safety. The role of consumers The aging of the population is a key element in understanding both the demand for health services and the ability of countries to pay for health care. The role of consumers as the agents of demand for services is also radically changing. Managing the political environment The political environment and the media profoundly influence health care. Health care leaders must understand their dynamics if they are to be successful in reorganizing systems of care. Strategic decision-making Efficient strategic decision-making is critical to promoting innovation in health care. Good decisions take into account organizational capability, support, and added value. Ethics in health care Health care professionals are increasingly facing challenging ethical issues. This is notably the case when dealing with questions of innovation. |
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.
Copyright 2006 Harvard Medical International
In addition to the regular program, Shore and Holly also organized an “Executive
Session” that brought together government representatives from Germany,
Italy, Denmark, and Switzerland, as well as executives from organizations based
in the United Kingdom and Switzerland. Professor Frank Hartmann of the Kennedy
School of Government at Harvard University served as the facilitator for a day-long
discussion on the role of technology in European health care innovation. This
program took place at the Rockefeller Foundation’s Bellagio Conference
Center.
Underlying the global stresses driving the discussions among health care leaders
is the rapid acceleration of medical technology, the result of dramatic breakthroughs
in the medical sciences. This presents governments in Europe with a daunting
paradox: how to stimulate economic growth by encouraging medical innovation,
without making the costs of providing high-quality health care prohibitive.
“The executive session resulted in a very interesting and significant discussion
of the issues related to technology approval and regulation by governments,” said
Shore. “The participants have decided to continue these conversations,
and we are currently planning follow-up meetings.”