This article is part of our special report How can we create sustainable healthcare systems?.
An outcomes-based approach for incentives in the pharmaceutical sector would help optimise the entire healthcare systems, Nathalie Moll told EURACTIV.com in an interview.
Nathalie Moll is the director general of the European Federation of Pharmaceutical Industries and Associations (EFPIA).
She spoke to EURACTIV’s Sarantis Michalopoulos on the sidelines of the “Life at what cost? – hard choices in healthcare” panel discussion organised by Friends of Europe together with Celgene and EFPIA.
Many speakers today talked about the need for all relevant stakeholders in healthcare to come closer and coordinate. What is the best way to achieve that?
To start the conversation around the desired outcome that everybody shares. So rather than saying as an industry our objective is the following, the hospital matters are these ones etc, we need to seek the best outcome, meaning the best possible solution for patients. A solution that is sustainable also for the future generations with the least possible cost.
That’s the shared objective. And around that, we need to see what is the treatment we need to deliver, when, who needs to deliver and how, what is the waste.
Moreover, what are the incentives that are being given to every different piece of the healthcare system, are they the right ones or we are incentivising interventions instead of outcomes?
If we have very clear the end point, then we can have a conversation around optimising the healthcare delivery and sustainability for the future.
You insist on an outcomes-based approach, but are you sure EU member states can be convinced to turn to this model?
Some member states are already doing it really successfully. In Italy, for instance, they have adopted an outcomes-based approach on oncology for years; they have registries, they get data and they incentivise success in treatment in oncology. They don’t incentivise non-success.
Other countries are using it for individual indications or individual companies are proposing it, so it’s happening already. In the US, I know there is one, which is quite revolutionary, where the whole system is incentivised for the care of the patients- the hospital treatment, every carer in between- have to get it right to get reimbursed and therefore everybody has to do the best possible. This will lead to the optimisation of the whole system.
The good news is that there are already examples out there that are successful and sustainable. We just need to make it more of a general practice.
Considering that the EU public healthcare systems are already under huge pressure, what’s the fine line between sustainable innovation in the pharmaceutical sector and drugs affordability?
Why are the public healthcare systems under huge pressure? Where is the money going? If there is a percentage of waste, and it’s identified as approximately 20%, it needs to go. You cannot waste anything in healthcare.
In addition, are you incentivising intervention or the final result? I think it’s not only about the method, because treatment on its own is not the solution. A patient gets the treatment, but then does he take the treatment? Is it [treatment] given properly and at the right time?
Thinking that there is a patient and a medicine is really limiting the conversation to something which is unrealistic and this is the problem with the one-sided approach. We each discuss our own budgets, our little silos and we forget this is a journey and there are no silos for the patient.
How do you see the role of the European Commission in enhancing the coordination among EU member states in this direction?
I think the European Commission has had incredible results in terms of some of the directives and regulations that put out to incentivise healthcare.
Today they talked about the cross-border healthcare; there are also creative things like the European Reference Networks, but also the regulation on orphan drugs. So, they have a stimulating role they can play in areas of unmet medical need and where incentives are needed. They also have an important coordinating role in order to ensure that as much as possible healthcare is universal.
We saw a particular focus of the EU’s next long-term budget for 2021-2027 on health issues. How do you interpret it?
I see it as a re-assuring message that health is also a value for society in terms of a healthy population, a population that can contribute to society.
It’s great to see that the Commission recognised the value of health in the general democratic set up of the EU. I understand there is an element of health in environment, industrial policy and in research. This will be the change that we are looking for. We want to see that reflected in all policies where the health element is and how we can make sure that we are not creating policy for one area that is then going to be harmful for health.
How about the Supplementary Protection Certificates (SPC) manufacturing waiver discussion?
It is right that the Commission has a conversation on the incentives that exist in Europe today for the pharmaceutical industry because you have to look back and see what you have developed is the right thing to do.
We have two big studies coming up, the Copenhagen Economics and Max Planck Institute. But I would have hoped that any decision on incentives would have been made after those studies were published and debated and the analysis was done.
The SPC manufacturing waiver seems to come out on the side and I am not sure we have all the information that we need in order to make policy decisions in an isolated area without looking at the broader picture.