Apples and Oranges

Before I attended the Health Financing Forum, I understood that financing healthcare would be a massive and complex undertaking. However, after the forum it was not much clearer.

The main goal was to describe how good decisions are made,  how money should be spent and costs contained. The  examples given were from healthcare systems in the Netherlands, Germany and Austria.

The last presenter,  M Pearson  stood out to me the most . He was quite frank in his topic  “ System of Health Accounts” . He expressed that his work could only be done when good comparable data is available. Here we come to the crux of the matter. Everyone seems to be using different indicators and from the beginning these indicators are not defined the same way.

What also struck me was if only data which are comparable are used, what happens to all the other data? Its apples and oranges!! So the result of all this academic work and projection , what does it really say? Health systems within the EU are constructed and financed differently and its almost impossible to give a true projection or solution for cost containment.

By: Cherisse Mark, a MCI student
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Workshop 11: Ageing in action

This workshop asked what our ageing society means for how society views older people – and how it looks after their health.

Rebecca Taylor, from the International Longevity Centre, summed up the current situation. People are living longer, and there are more older people. Conventional policymaking regards this as a massive challenge, as the dependency ration – the number of ‘productive’ working age population for each ‘unproductive’ older person, becomes ever smaller. By 2050, there will be fewer than two workers to support each non-worker in most OECD countries – around half as many as now.

Graph from

Source: Graph from


Following on from this, current policy thinking was described as a ‘zero sum model’, with older and younger people fighting for jobs, wealth, public spending and, ultimately, health, with some countries now considering drastic measures to limit the cost of cares.

Yet the session also outlined an alternative approach. Part public policy framework, part philosophical outlook, the ‘life course model’ emphasises that both young and old have something to give to society – and something to gain from each other. Such a model can act as a driver for a number of innovative approaches to care – including telemedicine and moving care from hospitals into the community – all based on the idea that, rather than causing economic despair and catastrophe, the increasing number of older people can play an active, and healthy, role in society.

And it isn’t all about medicine. Speakers stressed the importance of integrating healthcare, social care, and wider participation in society. One described the enormous pleasure he received from looking after his grandchildren – not to mention the benefits to his daughter!

After this discussion, ‘dependency ratio’ doesn’t seen such an appropriate term after all.

By: Michael West, a Young Gasteiner

PS. On a different note, the session also included a debate about older people’s involvement in clinical trials. The problem that “medicines are tested on 50 year olds, but the real patients are 85” should perhaps be more widely known than it is.

Workshop 10: Healthcare Financing

The workshop about Health Care Financing gave me an interesting input about the different perspectives of the presenters.

First of all I would like to comment on the new Dutch reform presented by Mr Groenewegen. Certainly on the one hand the new health insurance reform of Netherlands is a very positive step towards improving the healthcare system in the country, because it forces the whole population to be insured in order to have free access to the system. On the other hand, although Mr Groenewegen said that not only monitoring but also funding mechanisms are crucial, there is no real control instruments to seek out individuals who fail to insure themselves. So at least a small percentage of the population has no insurance to cover their health care costs.

In Addition to that I would like to highlight another important aspect of the Dutch Reform. I was asking myself during the presentation whether it should be seen as a strength of the reform to allow patients to choose their insurance companies freely and to change them whenever they want. This development will probably lead to a market competition where insurers have to increase quality of service and in the same time they are obliged to offer attractive premiums to attract as many people as possible. But subsequently this trend implies the danger of an indirect risk selection because otherwise it is not possible to offer cheap premiums with high risk people in the same time.

Furthermore, another interesting topic was the System of Health Accounts 2011 (SHA). The revision of this system is, as far as I can see, an important contribution to global health, because contrasting different systems from different countries is not possible without the comparable methodology which is provided by the SHA. Mr Pearson highlighted the importance of SHA with a statistic which showed that the Dutch system is apparently spending much more money for mental health than the Swedish system. But if we analyze the results more precisely we figure out that mental disorder does not always mean the same for these countries. So a clear definition and a transparent methodology are needed in order to be able to compare the results. Surprisingly, it became apparent during the discussion that public health is still ill-defined, although it is widespread all over world with a very high importance.

By: Necmiye KISAT, a MCI student

Rare diseases, an example of the patient power (W6)

The workshop on rare diseases, was for me a very powerful session, where you were able to see the strength of the united Europe. It was the session which shows how powerful the “bottom-up” influence is. The first initiative came from the affected people, who saw their chance in the union of Europe, to have the opportunity to create a network of experts to increase their healthy life. By sharing their knowledge of diagnosis and treatments in a broader field, they got the chance to gain better and faster health care. In particular, cross boarder health care is a tremendously help for these people, but also here more expert centers should be developed and are still missing.

I think this concept is not just important for specified diseases, it would also be a big, big benefit for other chronic diseases, like cancer, to establish expert centers and better coordination and collaboration of the member states, to be able to increase chances for patients.

It was great to see the empowerment of patients, like how to encourage people to lead a better lifestyle. From my perspective the decisions are made every day by each of us, and maybe patients are more aware of their own health than we think.

I would say the example of rare diseases shows us that policy makers should listen to people, and should put more emphasis on bottom up influences. Everyone is in a certain way an expert of his health; most of them know very well where the problems and gaps in the health care are.

Another question which came up from the audience, which is always a big issue, was “how you are able to measure the outcome or the quality of life of patients after an intervention?”  We are talking about Health Technology Assessment, and return on investment, but very often it is more than just an economic perspective, which will improve.  We also need to include the very important factor of changed life conditions, which affects the whole family and society.

It was and it is still, according to all speakers, a hard and sometimes painful way to reach the necessary regulation, convince all stakeholders, and decision makers and I hope the hard developed guidelines from the EU will continue and will be a success in all member states.

By Alexandra Holzer, a MCI student
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Health Technology Assessment (Forum 6, session 2)

Evidence-based medicine, efficiency, effectiveness, risk-benefit analysis, innovation, health technology assessment … new words, mostly used by professionals

I must admit that I have attended the Forum and I was expecting to hear very technical presentations and new things that I have not heard before; and I did not expect to understand everything.

Instead, I was impressed by hearing the patients´ voice in the panel discussion and having the patient perspective on the HTA field. I am convinced that HTA should be done keeping in mind, all the time, the person who will benefit from the HTA.

I understand that it is very difficult to get patients involved in the evaluation process (due to symptoms of diseases, due to lack of time, due to lack of expertise or lack of motivation), but the patient’s perspective is and should be very important. As personal-computers were developed considering the needs of users, HTA must take into account the needs of patients in the first place.

In the end, the goal is to offer a better live for those who have a disease.

For those interested in technical aspects of HTA and in the role of stakeholders: EUnetHTA Conference 2011 “HTA in cross-border healthcare in Europe”; will take place on 8-9 December, in Gdansk, Poland.
By: Eugenia Bratu, a Young Gasteiner
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