This article is part of our special report Breaking silos in diabetes care.
The establishment of integrated budgets to tackle diabetes in Europe could bring much better outcomes for patients and simultaneously reduce avoidable costs for health systems of European countries, a new report has found.
The “Implementing integrated diabetes systems in Europe” report, commissioned by the EU pharma industry association (EFPIA) and conducted by The Economist Intelligence Unit, analysed the level of integration in diabetes care services in 28 European countries.
According to the report, 60 million people suffer from diabetes in Europe, a figure expected to rise to 68 million by 2045, while diabetes management already represents as much as 10% of overall health budgets.
Diabetes care is described as complex, as it requires the involvement of different professionals across the healthcare spectrum, ranging from primary and secondary to specialist care settings.
The report found that there are good elements of integrated care services across the EU that could help this happen. However, due to the lack of integrated health IT systems and integrated finances, avoidable costs are increased while poorer patient outcomes are observed.
“All 28 countries scored well in terms of the presence of integrated care elements but when we came to finances and health IT, we found much less integration,” Elly Vaughan from the Economist Intelligence Unit told an event on 20 November.
“Integrated systems really offer an opportunity to reduce the fragmentation of care in diabetes and raise the effectiveness of diabetes management,” she added.
Access to data
The Economist Intelligence Unit suggests a holistic, bottom-up and data-driven approach to tackle the disease. But when it comes to data, an integral part of this strategy, just over a half of the selected countries have a national diabetes registry.
The authors emphasised the need to adopt integrated IT systems and electronic health records in order for all providers along the diabetes care pathway to be able to access and share patients’ data anytime.
Chantal Mathieu, president of the European Diabetes Forum (EUDF), said data collection is a key element and a field where Europe could make a difference.
“When we say we have 60 million people living with diabetes in Europe, it’s hand waving. We have no clue how many have diabetes. So, data gathering is one of the most important things and that is where Europe can make the difference,” she said.
Danish MEP Christel Schaldemose said the EU is currently working on a European Strategy for Data as an integral part of Europe’s economies.
“But we are also talking about a data-driven healthcare system. And here, I do believe that the European Parliament (…) can put pressure on the European Commission,” the socialist MEP said.
According to the report, though, countries such as France and Austria, which had some of the highest percentages of their gross domestic product (GDP) dedicated to total health expenditure, do not have national-level registries in place.
Aligning budgets and incentives
Another key element, according to the report, is aligning or pooling budgets to ensure that funding for integrated diabetes services is equally distributed, supports cross-sectoral collaboration and helps to overcome financial divides between primary and specialist care.
Budgets could also incentivise outcomes instead of activities in order to reduce fragmentation and support patients.
Currently, patients pay different fees to different doctors (primary, secondary care or specialists), which results in a lack of clarity regarding the overall cost of treatment.
The report cited as an example the Netherlands, which introduced so-called “bundled payments” in 2007. In practice, Dutch diabetes patients pay a single fee for all the medical services involved in an episode of care.
Dr Loukianos Gatzoulis from the European Commission’s health department (DG SANTE) said more than €1.5 billion from cohesion policy funds are used to support the work on health system reforms and some of this goes to support the development of more integrated healthcare systems.
However, only seven countries scored fully in the domain of financial alignment within diabetes care in each country, the report showed.
The report also emphasised the role of incentivising healthcare professionals based on their performance in monitoring diabetes patients. According to data, only half of the 28 countries to reward care providers or clinicians with such incentives.
Mathieu said the biggest incentive is patients’ outcomes as well as the professional satisfaction for doctors, dieticians, and nurses in the system.
“Because they see that the work they do, leads to something. And that is so important. Do not underestimate the fact that if you have a smooth integrated system in place, everybody is happier, and in the end, that’s what we all want,” she said.
A practical example is France, which introduced a pay-for-performance pilot programme in 2009.
The programme provided that primary care physicians were incentivised to improve primary healthcare based on their performance in a number of indicators such as prevention, chronic disease management (diabetes and hypertension) and cost-effective prescribing.
For Dr Prabhav Trivedi from EFPIA Diabetes Platform, financial incentives are key in achieving significant behavioural influencers.
“And if we have appropriately built incentives into the payment mechanisms, these have shown to encourage multiple providers to work together and ultimately enable better care,” Trivedi said.
Determining these incentives may be complex in practice, he added emphasising that these incentives can be financial or otherwise, such as changes in the reimbursement model to acknowledge the time the providers have to devote to achieving integrated care activity.
[Edited by Zoran Radosavljevic and Frédéric Simon]