Cyril Titeux, senior VP mid-sized markets EMEA & strategic leader at Janssen, argues that the current focus of many health systems on efficiency, streamlining, and reducing spending is leaving them ill-prepared to absorb the shock of future crises. Titeux instead posits the need for the building up of resilience and flexibility, with greater investment into innovation and a view towards prevention.
Numerous crises over the past few years have highlighted our need for resilient healthcare systems – none more so than COVID-19. Resilient systems are those that can stand up to any sudden change which might shake (or break) them, whether that be a pandemic, an epidemic, or a financial or civil crisis, because we know all of these will more than likely happen again.
What do I mean by a resilient healthcare system?
For me, being resilient means being efficient but also sustainable. When COVID-19 hit the world, we were forced to think about the larger picture in healthcare, too. How do we practically offer care during a crisis? Are we forced to prioritise? Will existing patients miss out, and what are the long-term consequences of that? Or can a system be resilient enough to manage that crisis while still treating everyone in need?
Of course, some countries have managed it better than others. I was particularly impressed with Germany’s response – seeing empty ICU wards that could even take patients from other countries. The reason they managed so well, though, is because they had flexibility. They couldn’t have predicted COVID-19 exactly, but they had the equipment ready to put in motion once the pandemic hit.
Resilience in healthcare is not a new concept. In 2014, the European Commission identified it as a key objective.1 The EC highlighted long-term stability of resources, strengthening governance, and responding efficiently without making sacrifices. Since then, the concept has broadened, but what can industry leaders do to help a system become more resilient?
Start with prevention
COVID-19 – and our response to it – has really shone a light on the importance of disease prevention. If we want to become more resilient, we now have key learnings we can apply to other infectious diseases, non-infectious diseases, and healthcare in general. Why prevention? Healthier people means less strain on our systems, and that in turn means we‘re better prepared to manage crises.
Healthcare functions as an ecosystem, requiring each of its sectors to stand strong and engage with each other: not just primary and secondary care, but care homes, social care, community programs, academia and so on. A sound prevention strategy includes tactics to improve public health, through basic measures such as raising awareness of health risks and offering more effective education on how to address them, something I think must start from an early age. Newer approaches like population health management also aim for prevention by easing inequalities in society and looking at deeper sources of poor health. We must also look at detecting diseases early, and developing the right therapies to treat them.
Of course, success requires the right financing and investment. Resilient systems need the right combination of monetary resources, stable funding and a skilled workforce, as well as the flexibility to redistribute resources accordingly if there’s a surge in demand. In short, they need a flexible approach to deliver care, not just an efficient one.
Cost-effectiveness versus smart investment
Unfortunately, today’s health systems often focus entirely on efficiency, streamlining, and reducing spending, rather than on building resilience and flexibility. But this approach means we simply can’t absorb the shock of a crisis. Take for example the demand for PPE, critical medical products, and vaccines during the pandemic. Everyone wanted them at the same time, which resulted in massive supply chain issues.2 We saw this effect personally in our supermarkets!
Decisions made pre-pandemic had a huge impact, too. Hyper-specialisation made it difficult to transfer HCPs to other areas where they might be needed. The lack of spare beds in many countries was a result of efficiency-only thinking. In the UK for example, austerity cuts left the healthcare system more vulnerable to COVID-19. The resultant knock-on effects and treatment delays will shift on to patients (and increase costs) in the future as well.3 Countries in Central and Eastern Europe often have underfinanced healthcare systems, and as a result suffered disproportionately more than others in the region.4 Similarly, economic reforms and decentralisation in some West African countries weakened their healthcare systems prior to the Ebola epidemic, in turn affecting the quality of care during outbreaks.1
To drive the health of our populations into a better place, and therefore be better prepared for crises, we should see healthcare spending as an investment, not a cost! Reconsider what effective spending looks like – not just for this financial year, but in the future. How will what we spend today leave our system better off in two, five or ten years?
We also need to look towards innovative medicines and treatments that benefit patients more (and benefit more patients), reduce hospitalisation rates, and help people live healthier lives, while also trying to make our planet healthier. Just like in other industries, stimulating innovation can help us meet current unmet needs, and encourage competitiveness within the pharmaceutical industry.
The problem with taking an ‘efficiency only’ approach is that countries often overlook the value of providing the most efficacious treatments (whether new or existing) first. Instead, they often resort to the ‘save the best until last’ tactic. This strategy means that innovative therapies, even when there’s an unmet need, aren’t seen as high priority.
It’s true that in most cases new interventions and innovations mean greater effectiveness but higher costs versus existing therapies. If this is the main concern, we will see fewer new, potentially more effective, therapies, and have to settle for already existing pathways as the final response; as ‘good enough’. But the discussion we need to have again and again is whether investing in new options, and using the more expensive treatment from the beginning, could lead to avoiding the need for subsequent treatments and therefore be more economical in the long run altogether. For healthier populations, I think we need to ensure that the care we’re providing gives us the best outcome as soon as possible.
With the right data on how effective our systems really are, I think we will better see the bigger picture, and the holistic one. We can see where the leakages are. Unfortunately, though, healthcare still lags miles behind other industries in this respect.
Resilience means looking at the future
Health system resilience requires flexibility, and a view towards prevention. It also requires funding and investment – not just for innovative treatments to come to market, but for them to reach the patients who need them. That’s a lot to consider, and a big step for budget holders. I believe now is the time to call upon industry leaders and governments, healthcare experts and patients to build on the lessons learned in recent years, and make 2022 a turning point.
- European Observatory of Health Systems and Policies. Strengthening health systems resilience. 2020. Available at: https://apps.who.int/iris/bitstream/handle/10665/332441/Policy-brief%2036-1997-8073-eng.pdf Accessed October 2021.
- The Conversation. From PPE shortages to COVID-19 vaccine distribution, the supply chain has emerged as a determinant of health. 31 August 2021. Available at: https://theconversation.com/from-ppe-shortages-to-covid-19-vaccine-distribution-the-supply-chain-has-emerged-as-a-determinant-of-health-164223 Accessed October 2021.
- Austerity – COVID’s little helper. 8 October 2021. Available at: https://www.bma.org.uk/news-and-opinion/austerity-covid-s-little-helper Accessed October 2021.
- Why do we need to create more resilient healthcare systems? 24 June 2021. Available at: https://www.globsec.org/2021/06/24/why-do-we-need-to-create-more-resilient-healthcare-systems/ Accessed October 2021.