How to enhance the value Europe gets from its healthcare expenditure

Across Europe, there are marked inequalities in health outcomes: in 2012, the gap in life expectancy between the highest and lowest performing European countries was 8.5 years.

There are also striking variations in the outcomes of treatment and care. To take heart attacks as an example, mortality rates following an attack range from 3 per cent in the best performing country, to 14 per cent and higher in others, according to Health at a Glance Europe 2014, produced jointly by the OECD and the European Commission.

These differences are in part attributable to unequal resources, but variation within countries, and between countries with similar income levels, tells us that this is also due to differences in the way health care is delivered.

Such variation is not only harmful, it means there are avoidable inequities between European citizens – a situation that urgently needs to be addressed by policy makers.

Getting the worst of healthcare systems to perform as well as the best would both enable Europe to extract better value from its significant health budgets. The data required to achieve this would also provide the foundations for further innovation.

Over the past 18 months, the European Brain Council has hosted a multi-stakeholder initiative, involving patients, medical professionals, scientific researchers, public health advocates, and industry, looking at how real world data – the outcomes for individual patients, receiving specific treatments, in different healthcare systems, can be applied used to improve the health for all. 

On 15 March, we launched our first report in the European Parliament. It focuses on the need for more widespread and systematic use of health outcome measures across member states.

Patient registries

Such outcomes data is already being used in innovative ways in some European countries. In Sweden, a long tradition of compiling patient registries enables outcomes across providers to be compared, leading to recommendations on how to systematically improve quality of care.

In the UK, patient-reported outcome measures (PROMs) have been used for hip and knee replacements, groin hernia and varicose veins since 2009. The outcomes data informs patient care, and has enabled some providers to demonstrate year-on-year improvements in patient outcomes.

PROMs remind us that when we measure outcomes, it should not simply be an administrative exercise. The patient perspective is crucial: is the patient free from pain? Are they able to carry out routine tasks? Do they enjoy a good quality of life?

Systematic outcomes measurement provides a vital tool to improve patient care, health system performance, and thereby sustainability.

It enables healthcare providers to understand and respond to what patients need, to see things through their eyes, and to innovate.

But we need political commitment and courage to unlock this potential.

Commitment is necessary to ensure that the right infrastructure and technology tools are in place to measure outcomes efficiently, without creating new burdens for medical professionals. Courage is needed to compare outcomes transparently, in order to learn from each other.

The EU’s work on health system performance assessment (HSPA) offers an important opportunity to share and adopt best practices and all member states should be encouraged to develop HSPA frameworks.

Outcome measurement should be a core component of HSPA, supporting health care decision makers to deliver the best possible care.

In January 2017 an OECD ministerial meeting will decide whether to mandate the collection of patient reported data from member countries. This could mark a crucial step forward – enabling identification of variations in outcomes and experiences across countries, and creating opportunities to improve.

Improving health outcomes should always be at the forefront of health policy, and never more so than today as we seek to address the challenges of ageing populations, chronic disease, constrained public finances, and persistent health inequalities. 

National governments and the European institutions must show the leadership necessary to deliver more outcomes focused health systems that ensure value for European citizens, and contribute to sustainable and inclusive growth.

The multi-stakeholder consensus document ‘Enhancing Value in European Health Systems: the role of Outcomes Measurement’, was launched at the European Parliament on Tuesday 15 March. The consensus document is on the website of the European Brain Council.