Adapting healthcare strategies to changing demographics.

Ministers from Netherlands (NL), Poland (PL), Russia (RU) and Estonia (EE)

Dr Schneider: Ministers, what are the most urgent issues on your desk?

NL - Biggest question will be demographic change and what we do about it. We’ve tried to make fundamental reform to the structure of insurance to help with this by increasing competition between insurers and providers. We want to see higher volume at lower prices and innovation in the system. We need to deal with the issues of labour shortage by investing in our people.

PL - I’ve had only 4 months in my job but it’s been 4 months of hard work. 2 big issues - 14% of our population are over 65 and that our medical specialists 70% are over 45. Newly educated polish doctors emigrate abroad not because they can’t find well-equipped hospitals but because they earn too little. the existing insurance and healthcare system allows them to earn less than the national average salary so we’ve spent time negotiating wages with doctors and nurses. i made it my personal task to build and arrange the healthcare system around patients and their rights and finance based on real cost and real health needs. Today when we have one public payer and the service provider that is the doctor in hospitals we often people grappling with the way these institutions work. Hence one of the purposes of my reform is to decentralise the payers. We will now make hospitals the reference point because it is there where polish doctors should earn much better. another major problem is the policy on medicines which has been focused on prices. A system in which the providers and payers will be competitive I want this system to reduce the waiting times so as you can imagine there is huge work to be done but owing to education that I get from this conference i will go back home convinced that you can improve systems and I promise you that i will do it in a strongly determined way.

RU - Samara
We have similar problems to those that face all Russia - for patients - accessibility to treatment, waiting lists, low quality care, high co-payment rates for physicians - low salaries, access to medical information and lack of equipment as well as no professional insurance. for government - poor health status of the population, poor efficiency in healthcare, low rates of satisfaction and high disparities between the regions. The National Project in Healthcare by 2010 changes such as 4x budget and double salairies in primary care renewing up to 80% of equipment, special programs for children and maternity.

Big problems since 1990 have been low financing, lack of medication supply on outpatient level, nursing staff deficiency, poor resource management. So the president has set aims to raise life expectancy from 66.7 to 75 and decrease mortality to 10% from 15%. We’re introducing better information support - we think this is one of the best ways .

EE - One of our key objectives is to improve digital services and interoperability between information systems. We expect much from EHR - efficiency increases and better quality. Also patient services will be better, faster and more developed by more competent clinical staff. Patients will have a comprehensive overview of their medical records and so be better informed. We also expect to be better able to gather medical statistics to improve planning. Less paperwork also reduces the workload of doctors giving them more time to focus on each patient.

Q: Do you have a solution for larger countries like India where insurance model cannot work.
A: NL - to increase economic growth and aim for universal coverage P - there is no perfect healthcare system in europe - it’s probably good to use european experience and to use the ideas which are born here and translate them. healthcare cannot be separated from the cash resource you have which is why it’s so difficult but there is nothing more important than health RU - you have strong traditional medicine, I would recommend taking step by step and not throwing out tradition wholesale. It’s important to invest in healthcare sufficiently.

Schneider - looking at China, they are made up of cosmopolitan world citizens - let them have their disneyland and fund it themselves - then there are more middle class people for whom integrated european model - then the urban migrants need walk-in clinics where they have a medical home - then the rural population where a little bit of money comes from local people but a lot has to come from government. So you need a 4-tier system. Plus educating people and persuading policy makers that healthcare is investment in economic productivity not a cost. in the US we do have similar disparities ironically enough - so you’re not totally alone.

Q: What drivers are there for innovation?
A: NL - we’re trying to get more competition between providers to stimulate innovation. I think the state can do someting to create a climate for providers to be interested in innovation. Technical innovations such as health records are important but we’re also trying to build networks of professionals around patients needs. We lead with incentive and example.

Q: In Israel, we have 4 HMO’s competing on quality, not on fees. I’d like to understand better what you mean about increasing competition.
A: NL - prices are fixed and we’re trying to liberate them (and lower them) but we have central levels of quality that we can’t go under

Q: I would like to hear about dealing with professionals in places where salaries are low are there problems of people focusing on their own salary rather than the patient
A: RU - we want to introduce payment for performance.
PL - what I want is that the Polish doctor is paid for what he actually does rather than just turning up! We put a value on the work of the doctor and the nurse in every procedure so that we can measure this. We want to prevent overwork and we have a program for newly-qualified doctors and we want to help them specialise and to make the career path shorter and make sure that 100% of graduates can specialise and we encourage them to move into those areas for which we have shortages.