Industry leader: Health care ‘should be designed like car insurance’

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Decentralisation of health care and according more responsibility to citizens would set the best conditions for the uptake of new technologies Javier Mur, managing director of Accenture's health operations, told EURACTIV in a recent interview.

Javier Mur is managing director for health operations across Europe, Africa and Latin America for Accenture, a global consultancy company.

He was speaking to Gary Finnegan.

To read a shortened version of this interview, please click here.

In your opinion, which member states are most advanced in implementing the new technologies that already exist in health care?

The Nordic countries are at an advanced level, as is the Netherlands. The UK started long ago but has not progressed as expected and France is delayed but is launching programmes such as one on health imaging.

Health care in Germany is organised differently as large public bodies are involved, meaning that whilst hospitals have good IT adoption, the market is fragmented and information is not shared sufficiently.

Are health issues easier to manage at regional rather than national government level?

I certainly think so. Spain is a clear example of this, having undergone decentralisation in 2002. It has since progressed faster than centralised countries like France, Germany or the UK. This model has helped us to lead in terms of managing solutions and implementing changes.

In terms of information sharing, how difficult will it be to have hospitals communicating and even member states eventually sharing information?

The difficulties lie in the way health care is organised differently in each country. In Spain for example, each region's health authority has the power to make decisions. Primary care therefore all depends on the same organisation and hospitals can all follow the same direction.

Italy is also organised regionally but is more fragmented. In Lombardy for example, hospitals have a lot of flexibility and independence but regional authorities don't have the same powers as in Spain. In Germany it is really difficult as there are different organisations that compete and are not well-connected, like in the US.

Are there competitive issues that will prevent the sharing of information between providers?

Indeed, and the division of funding between payers and providers with different interests also makes things more difficult. In some cases, sickness funds that provide money to citizens do not have the information on treatment that providers have.

Have most governments decided that investing in health technology will save money, or are some sceptical that it will pay off?

I think that more and more governments are realising that using technology will bring synergies and save money. There are two obstacles to this however. One is political, as primary care depends on municipalities whilst other entities can depend on the national level. In some cases, different political parties are running health care at these different levels.

Another problem is the financial crisis and budget deficits. Anything that has to do with IT doesn't have a short-term investment return. Normally, investments are of a significant size and governments have a lot of difficulty in implementing large-scale public programmes these days whilst cuts are being made.

Is there much evidence on whether technology is value-for-money in most cases?

The evidence is not clear. One area now under discussion is that health care in general is organised for acute care in Europe. 70% of costs are driven by chronic patients. There are ways to do this better and more cheaply and technology is just one the components for doing this. Some regions are already doing so, such as the Basque country, investing 15 million euros.

Do you think that the people who work in the healthcare chain are prepared for what's required or are they a barrier to the implementation of the technology?

Healthcare professionals are not the best users of technology, but this is changing with the new generation of doctors. The key thing is really to convince physicians that this technology is useful in their work, saving time and money. Change management is key in any process of IT adoption.

Has there been much research into whether patients prefer the new systems or face-to-face contact?

We recently conducted a survey on this, involving both patients and professionals, and we found great openness. In most cases they like the idea of more flexibility and greater access to the system, meaning the shortening of waiting lists, for example.

What can the EU do given its limited competence in the area of health?

It's not easy, as healthcare decisions, sometimes political, occur at national and even regional level. What the EU can do is encourage the sharing of good practices, creating a think-tank to explain what can be transferred.

Regulation could also ease the process. For instance, if we decide nurses need to have a different role in the provision of chronic patient health care then we can introduce specific regulation for member states to implement.

Is there sometimes professional jealousy between doctors and nurses when they take on new jobs?

Yes, this can happen if things are not done transparently and with good communication. In acute care, healthcare provision is generally well thought through.

If something can be done by a nurse, normally doctors are pleased to let them as they are already quite stretched. Nurses do a lot of initiative work that may not require clinical knowledge that can then be passed on to an administrator.

It is a case of choosing the best profile for the job and the cheapest way of doing it.

Are there other things that can be done in terms of reimbursement systems that could make this easier? Video calls are not always accepted for payment, for example.

That depends on the country. Health care is usually almost free in most countries. In Spain it is free to see your GP and medication is free for over 65s, rendering the system overused. Spain has 40-50% more GP visits than the European average, for example. In Italy you must pay, meaning that there is less abuse of the system.

We need to find a mechanism for managing limited resources and educate citizens that they must only use healthcare systems when it is really needed.

Do you think we need to change how we incentivise patients, with rewards and punishments for good and bad patients?

I would like to do so, but I'm not sure it would be possible. For instance, someone who smokes costs the system a lot compared to someone who doesn't. We are entering into questions of personal freedom, however.

It is like car insurance – you pay less if you don't have any accidents. I think we should start thinking like this in the field.

Is preparing patients and doctors for the revolution some say we can expect something the EU can do?

I'm not sure if the EU can help, but probably. Citizens have to understand that health care is expensive. Everyone has to have in mind that we must manage resources in a good way. The best way to learn this is to be made to pay something, I think.

Secondly, healthcare costs depend quite a lot on how you take care of yourself in terms of prevention and good habits. We must be responsible for the costs of our health.

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