Thursday 28 May 2009

Danish magazine to rock the European healthcare silos?

You should never underestimate the impact Danish magazine Monday Morning has on national politics. Denmark has set the standard for consumer friendly healthcare information in Europe the last couple of years with their public quality ranking of hospitals etc. A lot of these initiatives started soon after MM late 2006 and early 2007 published healthcare reports on consumer friendly healthcare and patient choice. So watch out when they now take on the healthcare sector again! In Marsh, they published a report on the future healthcare with a focus on the healthcare professional. It’s in Danish but you can find it here. The report use the Physiotherapists as an example and starting point for how specific groups in healthcare can ad value and help solve the issues for the future healthcare system. I think they are spot on even if report at a first glance is not very ground breaking.

One of the main points of the report is that in the future there is a need to ensure a better continuity for the patients. The various professions in the healthcare sector just has to start co-operate. One might think this was obvious but its not. Power plays in between various groups are sad to stay in the way. The report also points out that physical activity is the next generation pharmaceuticals and the need to recognize physical activity as an integral part of healthcare. Another point is that new competences are needed to be thought through for the professionals. As an example; training in patient management leading to the profession being “experts in empowerment”. Here its suggested that the physiotherapists should take a lead since it is more obvious for them than others that if patient do not believe in a treatment it does not work and all patients have different needs. The reports ends in taking on the healthcare silo management mentality – it claims that the healthcare sector needs to be looked up!

This may be obvious truths for healthcare policy specialists. However, messaging is not only about the fact and about figures it is also about finding the right channel and audience. This is the right channel: it is a report from a seriously heavy political magazine and think tank. They reach and change the mindset of a wider audience than is common for healthcare reports. Reaching this wider audience is essential for abolishing the silo mentality in care. Since this is not a concern only for the traditional healthcare providers – it is an issue of ensuring that parts that traditionally belongs to social care, the social insurance system etc join forces with the traditional healthcare part. It gives me hope and I’m curious to see the effects. They might certainly with some years delay, really rock European healthcare silos. I hope MM have more in the pipe-line.

Wednesday 27 May 2009

Today is World MS Day

The way in which Multiple Sclerosis is managed throughout Europe varies greatly depending on one’s location. To learn more about the situation in your country in the MS Barometern click here

To check the today launched Pocket Guide to the European Code of Good Practice in MS click here

Should the EU deliver the one shop stop for health info?

European Voice yesterday organised a debate on patient choice. Since all agreed that some choice is good and necessary it was more a discussion about how patients can be helped to make the right choice. On the panel was - Mrs. Katja Neubauer, European Commission, Mr Christoph Talheim, European multiple-sclerosis platform, Dr Günther Jonitz, president of the Berlin chamber of physicians, Professor Josep Figueras, European Observatory on Health Systems and Policies.

At one point it felt like one where transferred to the HC Andersen saga The Emperor's New Clothes. Albena Arnaudova from the WHO Brussels asked what’s next with regard to the patient information proposal from the European Commission now in the hands of the European Parliament and Council. It’s quite controversial with some countries finding it way to liberal (!) and some countries not being able to support it since it goes against their constitution on freedom of speech so the panel didn’t really want to take the discussion on the proposal - Katja Neubauer from DG Sanco, in the picture to the left, just declined to comment explaining that it is something that can be said a lot about but it’s a proposal from DG Industry. Then as always in Brussels the question was raised if good unbiased information isn’t something the EU should deliver? Well what could the panellists do but agree and mention the good use patients can have already now of the EU Health Portal and that this of course is a good solution.

All business as usual until Tim King from European Voice, the organizers of the discussion, who himself admitted that he usually do not follow healthcare matters, like the child in the saga who asked why the Emperor is naked asked the panel if the European citizens who usually are not very keen on EU information really would seek and trust healthcare information from the European Commission? Silence.

He might not know healthcare matters but there are surveys supporting his suspicion. Both Euro barometer polls and the Health Consumer Powerhouse 2020 survey shows that patients do not think European Union healthcare information would be trustworthy. Patients seem also here to want to do their own choices with regards to information thus multiple sources are needed …

Tuesday 26 May 2009

Swine Flu and the media hype - the role of government

We get regular media hypes around new not so known diseases, Bird Flu, SARS etc. And for good reasons: In end April a global outbreak of Swine Flu was "imminent" according to the WHO. Dr Chang said "It really is all of humanity that is under threat in a pandemic." The European Commission’s highest ranking civil servant on health issues, Robert Madelin Director General at DG Sanco pointed out at the same time that "Every year 2,500 people die of the flu in Europe. The question now is not whether people will die, but whether it will be thousands, tens of thousands or hundreds of thousands.".

When statements like this lands in the inbox of journalists it would be surprising if they didn´t get going telling the world what’s happening. But the effects for other healthcare areas are devastating - how much money is spent now on Swine Flu that could be used better elsewhere? We could hope that the civil servants and politicians before we find the next new disease have stopped following the PR consultancies handbooks for issue management (they are created for corporations and excellent for them just not aimed at being used by governments) and instead try responsible leadership.

Hans Rosling at Gapminder always has interesting statistics:

Monday 25 May 2009

Trying to find wet AMD treatments info

My grandmother called yesterday and was worried about her deteriorating eye sight. She thinks the issue this time, she has already been operated on both eyes, it might be the so called yellow spot - wet AMD. She now wanted to be a bit prepared before going to the eye clinic and wanted to check if it was correct that there was treatment but it had not been approved jet.

Well some checking showed that since a couple of years back there are a couple of treatments approved across the EU. But its not that strange she didn´t know this - the authorities have a tendency to not inform overly much about new expensive treatments and the industry is basically not allowed to to tell. Now there are of course allways ways to see what medicines are available, how they work and should be used, who produce them etc - in Sweden you find the information on I checked for approved treatments and Novartis Lucentis and Pfizers Macugen but only Lucentis is reimbursed in Sweden.

So having managed to find out that there is a treatment, and that its approved and also reimbursed could we feel safe that my grandmother gets the treatment? No - its a very expensive treatment so if the regional level have the drug on their lists of drugs allowed to be prescribed by the doctors is next question. Not all think the taxpayers should spend around 10000 Euros a year on medicines to a 93 year old woman... Even though keeping her sight might mean the different between going into a some kind of longterm care or her being able to continue to live on her own. Even if there is an approved treatment its not sure you can argue your case and get it due to for example silo budgeting where costs for longterm care is managed by one authority and costs for pharmaceuticals by another!

(If you live in the UK the RNIB, an patient association for blind and partially sighted people, have a support number if you have been refused treatment: 0845 766 9999.)

Wednesday 20 May 2009

Cross border care - Techniker Krankenkasse survey

The Patient Directive for Cross Border Care was voted upon in the European Parliament in April but it doesn’t mean it’s a done deal. It is now in the hands of the European Council and the negotiations are said to not go to well. Most likely we will have to continue the fight for this one, in the capitals to convince the member states, call or mail your Ministry of Health with your view on this, and in the European Parliament to convince the new MEPs at the second reading in the EP.

I found some statistics that might be useful in the discussions: Techniker Krankenkasse in Germany (2n largest statutory health insurance fund) have done an analysis of cross border care by looking into the statistics around the 34000 of their members who did ask for reimbursement in 2007 having used medical services in other EU countries. When taken their figure on members that experienced cross border care 2007 and extrapolate it to all Germans this must mean that 680000 people in Germany received care cross border in the EU. It’s an issue concerning a lot of the European citizens!

40% of those served by the TK having received planned care – the rest acute care. The most popular countries to be treated in where Spain then Austria and Italy, the Czech Republic, Poland, France, Switzerland and Hungary.

The reasons given didn’t differ much from the results in the Eurobarometer 2008 and the Health Consumer Powerhouse survey from 2006 on the same topic. But the no 1 was a surprise for me – admittedly the need for better quality care in other countries might be less of a driver to seek care across the border if you live in Germany compared to some other EU countries…

Greater comfort in treatment 14%, Savings on services for which co-pay­ments are required in Germany 13%, New treatment methods 7%, Treatments not acknowledged in Germany 7%, Facilities with which TK has signed contracts 6%, European specialists, 5%, Doctor of trust based in another EU country 5 %, Special clinics in border regions 3%, Other reason 40%.

Interesting is also that only 5% of those with real experience of healthcare cross border where less satisfied or unsatisfied. It’s when it comes to the billing the problems start. Looking into detail of why there are not satisfied the high additional costs, 30%, were the main reason while low quality where 21 and language problems 18%.

Two other area you often hear a lot about the need of improvement, also from me, seems to be areas that actually are less of an issue at least if you believe this survey: Information deficits on the part of doctors or hospitals 6No follow-up treatment 5, No guarantee claims 4. Multiple answers where possible. Since direct private billing allows higher prices there is no financial incentive for the care providers to ac­cept the EHIC. I.e. EHIC is not accepted by all care providers. So 41 percent of the TK members surveyed stated that they had tried to pay for the treatment with the EHIC but failed. Jet another reason for transparent pricing of healthcare services! That member states are fighting this I really cannot understand.

Find the full survey here

Tuesday 19 May 2009

ECJ decides ownership and operation of pharmacies can be restricted to pharmacists alone

The European Court of Justice has today ruled on the infringement procedures against Italy and Germany started by the European Commission. Not in a good way I must say as they declare that ownership and operation of pharmacies can be restricted to pharmacists alone.
And they do it based on such a strange perception of humans that I really don’t know where to start. To quote from their press release:

“It is undeniable that a pharmacist, like other persons, pursues the objective of making a profit. However, as a pharmacist by profession, he is presumed to operate the pharmacy not with a purely economic objective, but also from a professional viewpoint. His private interest connected with the making of a profit is thus tempered by his training, by his professional experience and by the responsibility which he owes, given that any breach of the rules of law or professional conduct undermines not only the value of his investment but also his own professional existence.”

So since the court seems to believe that profits are made by hurting others, not realising that manage any business successfully means ensuring that you have a good reputation and that you follow the rules of law etc we are stuck with the old, inefficient and very costly guilder systems in Europe for pharmaceutical distribution.

Organ donation

Danish Liberal MEP Karin Riis-Jørgensen handed last week over a list with 1,500 signatures to Health Minister Jakob Axel Nielsen. The petition is calling for change of the current organ donation system. The aim is to have an assumed consent principle for organ donation with a voluntary opt out possibility. The rational is to increase the donation rate. Denmark have today 11.5 deceased donors per million, compared to 33.8 donors per million in Spain.

Karin Riis-Jørgensen donated a kidney to her 18-year-old son in 2001.

Patients healthcare guide - do you use one?

I wish I had written this excellent guide aiming at enable patients to be active partners from the GP visit, over the hospital stay, to the following up phase. It contains the basic info one needs, it helps you put down the things you need to be able to remember, offers checklists to ensure you ask the right questions as well function as a diary where you can keep track of your treatment.

And even though its Danish from The Danish Society for Patient Safety – its in English. If its 131 pages are not enough and you want more detailed info you can try to search for Dr Ian Banks various manuals, for example the Man Manual, in the UK – to be found on Amazon. Even if some of them by now are a bit old.

The guides 10 top safety tips
1. Speak up if you have questions or concerns
2. Let us know about your habits
3. Take notes during your stay
4. More ears listen better
5. You can let somebody else handle your consultation
6. Check your personal data
7. Ask about your operation
8. Tell us if it hurts
9. Before discharge remember to ask about how the treatment is to continue
10. Know the medication you are taking

Monday 18 May 2009

Should you be in the DG Sanco Stakeholder Dialogue Group

It’s for 4 years, every year you should go to 4 full days’ meetings. 10 places are up for grabs this time. Gives more insight than money but most important of all: one can actually impact in one of the areas I think the EU will impact most the upcoming decade. Job description” is to be found on the website if you click here.

As always: “recruiting stakeholders from the new member states is an important goal”. You have until the 16 June 2009 to send a CV and a coverletter to

Friday 15 May 2009

European Multiple Sclerosis Platform seminar

Paul De Raeve from the European Federation of Nurses gave a passionate overview of how organizations need to work in order to find funds for key activities. He pointed at the need for some good detective work and for co-operation with others. He did so building on a solid organizational overview from johan ten Geuzendam from DG Employment at the European Commission that in detail explained how the different structural funds operate. He also gave some examples of what opportunities there is for patient associations to seek support from them – underlining that it’s the countries that are in charge of the prioritizations for them. He also pointed out that for the ERDF 2007-2013 period it’s quite a lot of money ear marked, 5 billion Euros, for health infrastructure efforts. Looking closer at his slide it did say however that this was only 1,5 % of the total funds. One wonder to what the rest goes.

David Lowe Head of the Secretariat of the European Parliament´s Petitions Committee gave an interesting overview of the work they do and the possibilities one have to impact via them by referring to one Italian and one Polish case. In both cases of the petitions sent to them concerned issues within the Member States responsibilities but they had anyway managed via influencing and personal engagements by the MEPs succeeded to help the patients in need.

I didn’t had not the opportunity to participate in the full seminar. That doesn’t mean that the other presentations was not as important or interesting – I just didn’t have enough time …

Patients to report side effects directly to EMEA

Dr Isabelle Moulon presented the European Medicines Agency, EMEA, work to actively involve patients in their work. Dr Isabelle Moulon from the European Medicines Agency explained at the European Multiple Sclerosis Plattform seminar that the benefits from their work to activly involve patients in their decisions is that patients bring input about “ real life implications”.

Something EMEA now are trying to take a step further than just having representatives in various committees and the management board. Ie they are now looking into establish a possibility for patients to report side effects from usage of medicines directly to the national competent authorities (national medicines agencies like Afssaps in France, MHRA in the UK, Bfarm in Germany, Läkemedelsverket in Sweden).

Already today there is 2 observers from the patients associations in the Pharmacovigliance working party– a working party that with up-coming new legislation could become a recognized committee.

Lets hope they succeed – its about time that side effects can be reported directly by those using them to the authority directly responsible for allowing medicines to be sold. Find more on EMEA´s other efforts to involve patients here then you can find the 2009 Workplan of the EMEA patients' and Consumers' Working Party here.

Cross border care

Rita Baeten, Policy Analyst at Observatoire Social Européen, questioned at the 5th Annual World Health Care Congress Europe 2009 if the proposed Directive for patient rights at cross border care really is about patients rights. One of her key objections was that the aimed legal certainty isn’t achived. I can see the problems this creates but I actually want the directive mostly for the new rights it aims to give patients! It do not only codyfy current case law. It also somewhat liberalize the demand for prior authorization and allows patients to go abroad not only for same care offered in the home country but also for similar care. Key for those seeking methods not used in the home country for example for rare diseases.

Rita Baeten also raised concerns that the proposed directive will lead to new actors entering the publicly funded systems. I can only welcome that development. Interesting was also her point that according to the European Court of Justice health care provision is an economic activity and claimed that when it comes to the provider side almost any regulation is a potential non allowed restriction. She underlined her point with the following list of cases:

- Opticians only 1 shop: not proportional (ECJ 2005)

- Quota system for psycho-therapists based on established rights: necessity not proved (ECJ 2007)

- Prohibition on television publicity for aesthetical surgery: not justified (ECJ 2008)

- Authorization to set up a private outpatient clinic: not justified (ECJ 2008)

As mentioned in an earlier blog post infringement procedures have been started in several member states with regards to variations of restriction around establishing pharmacies. All together it makes me contemplate how the healthcare systems in Europe will be organized in a couple of years if companies and the EU commission will continue to push cases through ECJ.

Wednesday 13 May 2009

Not a lot of hope for change in Portugal

After listening to Maria de Belém Roseira Pina, Chair of the Parliamentary Health Committee in Portugal I understand why Portugal scores so badly in all the Health Consumer Powerhouse rankings of healthcare. She actually said:

“The Patient should have what he needs and not what he wants”

I hope that she at least thinks it’s the patient´s physician and not her committee that should be the judge of what patients needs.

On the positive side in Prague

Jana Petrenko from the Coalition for Health in the Czech Republic: “we have to convince patients to be involved – they have to financially contribute to their wellbeing.” Now things like this you might have heard before but how often from a patient association representative?

Christian Decoster, General Director at the Ministry of Health in Belgium: ”It is very important not to have waiting times. We don’t and I think it´s because we have financial and geographical access.” I hope that the representatives from Ireland, UK and Sweden listened to this!

And then some quotes indicating a shift in perception of for whom healthcare is organized:

Olivia Wigzell Deputy Director General at the Swedish Ministry of Health explained that “Healthcare have to be provided according to citizens expectations. We have to have the bottom-up perspective described by Johan Hjertqvist from the Health Consumer Powerhouse.”

James Breslin, Assistant Secretary the Ministry of Health in Ireland stated that “The Healthcare system is something of a maze. Using the motivation of patients will be the key for the future”

Healthcare part of the service sector?

It was quite liberating to listen to former health minister Thomas Julineks intervention in Prague this week. Julinek pointed out some problems with how healthcare today is viewed and organized and some steps forward to be taken. He stated with a not too controversial claim that the Ministry of Health should not organize healthcare - instead the role for the ministry should be to establish a framework and system.

But he then quickly became more controversial when he explained that he also saw a problem in healthcare being regarded as a special sector instead of a normal service and that he would like to see that healthcare was included in the general service directive. His explanation was that he would like to see that the free movement of services also included healthcare since this would give so much benefits even if the countries should still be able to direct their own systems. Since it is clear from other areas that it is possible to develop a regulated market he think this will be possible for healthcare as well.

He also wanted an open admission from everyone that the best is if we can combine private and public healthcare. Given the some of the other interventions on that panel from Hungary and Portugal I don’t think he will get it.

Follow the MS in Europe congress live

From 10 to 16.30 tomorrow Thursday you can follow the European Multiple Sclerosis Platform Congress live from here. The program contains for example:

Key note speeches by EU Commission & Parliament
Results from their European MS Register
More about the MS Barometer: Results and further actions
Code of Good Practice in MS – a living policy
European MS Consensus Papers – what is next?

The MS Barometer for example is an interesting example of patients measuring and ranking the care in various countries.

Tuesday 12 May 2009

My intervention - Public discussions on Healthcare reforms

Thank you for inviting me – I must say that when I received and read the introductionary presentations I really got seriously enthusiastic. Rare for me.

This is really good work done both with environmental assessment modeling by Katerina Pavlokova as well as the description of how to manage a change process by Ondrej Matl. Of cause I have objections on how it’s done, what’s in there and conclusions etc. But that is not the main point. The thing is to actually have some form of both things! This should be a given but it certainly isn’t in healthcare policy.

1. Ondrej Matl´s presentation –on how to practically run a change processes. In processes of change you need a vision, a strategy, the facts and an implementation plan before even start thinking of going there. Now politics are local so partly and what I have to say is based on my Swedish and Pan-European experiences. If I would try to build an alliance in Sweden I would invite different players. But one remark goes for all countries - you have to realize that if you want to change you cannot please everyone –it has to be enough to see your proposals go through and be accepted. Friends you get at the pub. Now how do you do it? For one – all communication is done on the terms/conditions of the other part – the other part here being the voters. Two – timing. Three –go for the stomage.

So back to no1 voters: Your ideas needs to be seen in their communications channels, formulated in their language, and your examples needs to be in line with their interest areas. Now Peter remarks Internet is not enough – no not if Internet is used just like print media with newsletters and postings on the website – basically push information. Socialmedia on the other hand means something different. Socialmedia has its background in the discussions to convince your friends – when you besides the fact are out there investing your face, your reputation your personality. Its real communication/dialogue. And today, at least in my home country Sweden, voters expect this from their policy leaders. It will come to you all.

Timing: What I didn’t see from the presentation but as Professor Peter Mihalyi so rightly pointed out there is only a small window of opportunity so you need to build your 51% before the elections:

Alliansen in Sweden, the 4 party coalition that are currently in government, was created based on the experience in this area from the last time they where in government and their working groups before the election lay the foundation to quite a lot of radical change directly after the election – not in all areas but in some.

Here in Czech Republic we seen the efforts like -Im convinced one of the reasons Senator Thomas Julinek was one of the longest lasting health ministers in Czech Republic since 1983 despite his tough reform agenda is his preparation. Good and needed initiative and quite a lot of change have been taking place

The reason for this is that if you start building these alliances after coming into government you do not have time to also implement the changes – and you cannot get acceptance until after implementation. Not real public acceptance. Only acceptance from those that lift the phone to call a politicians or who answers and consultations on the web. Normal people just don’t do that – the moment they do they stops being normal.

Why that’s because of the third point. The stomage: Whats acceptable healthcare policy is about the citizens trust and perception of security the day the need it – our perception of security is very much an issue of gut feeling. I worked with nuclear waste management – all the money invested in R&D and communications programs in the world do not help unless you take people to the site, let them see the waste with their own eyes and notice that there is no reaction on the radioactivity meter on their chest. Then you break through the fear and can start arguing rationally and prove your case with facts and figures.

In Stockholms with regards to the the privatization of the St Görans hospital also shows this. When the social democrats won the election and they was faced with the situation that the nurses union was against the county taking back ownership. When people have lived with a new system they adapt - they might kick and scream in the beginning but if you like Peter Pazitny point out stand strong - they don’t want to change back. If after a couple of years where people tested out your new healthcare system in real life you still face opposition where probably wrong from the beginning.

1. Environmental assessment modeling – of cause in these estimations will not be correct, it’s impossible due to what is known as the butterfly effect (or as someone quoted yesterday – things happens). You cannot correctly predict the future. But in management and policy leadership you need to control the commandohights if you are to be able to lead the discussions in your directions and for that you need a description of reality to use as a starting point. Otherwise you will find yourself in meetings/debates where you have to start from someone else’s description/ model or similar. And trust me for people like me this is bread and butter business that we do for various organizations in order to facilitate their lobby activities….

Because those that lobby you know that if you set the agenda, if you own the problem formulation if you manage the commandohights you stand the best chance to reach your goals. And the way to do this is often by offering models like this but if they have build them it have been with their values, ambitions etc as a starting point. So you might not find the answers but you will be better equipped to win the debate.

Monday 11 May 2009

Health Systems Financing in the EU

In the afternoon sessions, discussing the conclusions and findings in the presentation of a new excellent report from Jan Zapal et al. on "Health Systems Financing in the EU" the discussion on incentives in healthcare seemed finally to take off.

What is most known is that in the UK pay for performance have been in place for a couple of years and although according to Sarbani Chakraborty from the World Bank not all the results are positive she still thinks this the way also Europe has to go.

What is most known is that in the UK pay for performance have been in place for a couple of years and although according to Sarbani Chakraborty from the World Bank not all the results are positive she still thinks this the way also Europe has to go.

The conclusions from Léon Wever the Director of Financial and Economic Affairs at the Ministry of Health that "money isn’t the problem but allocation within the system" I for one assume aimed at supporting this.

Miroslav Zamecnik who is a Member of the Czech Governments National Economic Council underlined with a smile, not so strange given the turnover of health ministers trying to reform the Czech system, that we can discuss levels but it’s pretty obvious that we have to do it even if its political costly. The session mostly underlined the need for something to be done while next session where Professor Reinhard Busse presented we got more hands on exemplified what this means for example with regards to chronic disease care management. It was mentioned that for example in Denmark where a system of Year of care payment are in place, in France where a per patient bonus system are used. Busse also suggested in his presentation that cost sharing with chronic disease patient groups is the next step in these efforts.

Former deputy minister of Finance in Hungary Professor Peter Mihalyi raised the question to the panel about their views on Health Technology Accounts. Czech Deputy Minister Pavel Hrobon answered that this technically is a very good idea but there is some basic problems meaning for example that they need to be obligatory and that this politically still is not possible. It would be interesting to see if they are not both front-runners in a debate that are just taking off.

The Zapal report deserves a more in detail presentation so I will come back to this document later. Presentations will be available after the conference on

Financial pandemic as a catalyst for change

That healthcare spending do not automatically decrease in situations of financial pandemics was showed by Cristian Baeza at the Czech Presidencies Sustainable Finance conference. He had looked into 2 other periods of economic hardship in first 80-83 and then 99-93 to see if countries decreased their spending on healthcare just to find that yes some but not at all. So is it all just more of the same?

Czech Deputy Minister Pavel Hroboň took a slightly different angle in his opening remarks aiming to set the agenda for the 2 days discussion by pointing out that the way forward in the financial crisis could be to “use the current challenges as a catalyst for change”.

Several speakers followed his example for example former Dutch Health minister Aart de Geus who pointed out that healthcare spend will not decrease and now is the time for recruitments from other sectors. He claimed that cost sharing is essential for building a good healthcare system and pointed out that there is a need for incentives also for providers to take the good decisions. I would say that it should not stay there - also patients should be part of this cost/risk sharing in order to facilitate really good health management.

The other presenters then more exemplified what opportunities there is for change - the most uplifting example came from the Lithuanian Health Minister Algis Caplikas who pointed out that they in their efforts to make balanced investments in healthcare have taken a range of steps, for example looking at the issue of salaries but also by starting a discussion on co-payment of patients. One could guess that this comes as reaction partly to the conclusions and findings in the Health Consumer Powerhouse report Patient Empowerment where it is pointed out that those countries without co-payment like for example Lithuania are also those scoring badly in the Euro Health Consumer Index. Whatever the reason it is a small step forward.

Friday 8 May 2009

In Spain and Ireland you are not allowed to work if you have MS

Next week the European Multiple Sclerosis Platform will gather for 3 days in Brussels. One of the things to be discussed is the action to be taken based on the results from the MS Barometer.

The MS Barometer is a benchmarking tool built by data collected by the national MS Society in the various countries and shows that best country in Europe for MS patients are Germany followed by Denmark, Iceland and Sweden while Romania, Polen and Bulgaria are in the bottom. A ranking not very surprising - most of the rankings done by the Health Consumer Powerhouse for example have similar results.

What is surprising is to learn that in Spain and Ireland its not legally possible to remain at work if you have MS! I have a hard time understanding why?

If you want to learn more the conference will be live webstreamed and more info can be found on

Thursday 7 May 2009

B.I.R.O = better data on diabetes?

Today was the official presentation of the B.I.R.O. project. Professor Massimo Massi Benedetti from the University of Perugia leads this excellent initiative where clinicians and technicians have been working together to create a new international system for benchmarking of quality and outcomes in diabetes.

At the presentation Dr George Olympios explained with enthusiasm the importance the project has for Cyprus and did so by refereeing to what Professor Benedetti continuously have stated during the project: “What we cannot measure we cannot manage effectively”.
Quite a refreshing view in an area where the professionals usually have lots of excuses for why healthcare cannot be measured. And for me it seems like he his very obviously right! How could something as complex and important as healthcare, where the knowledge and conditions have changed so dramatically the last decades due to increased knowledge etc, be managed without benchmarking and measurements?

The whole project is also according to Dr Fabrizio Carinci based on open source software, transparent and done with highest respect for data privacy. A good cocktail for success - especially important since diabetes is an area that in Europe is in a serious need of better data.

Wednesday 6 May 2009

New WHO campaign - Clean your hands

WHO have launched a new campaign – Save lives: Clean your hands. Very much needed indeed. One might think that the campaign target the citizens because of the swine flu but no. Despite the all the knowledge we have today about the essentials like this in healthcare those that seems to be targeted with the campaign are healthcare workers.

I find 3 basic instructions, first the My 5 moments on when and then the more practical instructions on How to handrub, and How to HandWash. Its good but not enough for safe care – the patients need to be in on it as well.

Drs Roizen and Oz with The Joint Commission published in 2006 “You the smart patient An Insider´s Handbook for Getting the Best Treatment”. It is an easy and enjoyable book to read – with some very good advice. The type of handbook everyone should have read, well it is a bit American, before any dealings with the healthcare system. Their take on this is radical – Declare Germ Warefare with some hands on tips of how to avoid the germs. Given for example the problems with MRSA in Europe today their small tips are well worth memorizing for when the day comes and your have to go to hospital.

Tuesday 5 May 2009

466 Swedish state owned pharmacies for sale

The list of those for sale as a result of the long awaited decision last week in the parliament to abolish the pharmacy monopoly can be found here.

In all there is today 946 pharmacies today in Sweden. 466 of them will be sold to large or middle sized buyers like the finish Kronans Droghandel, German Celesio british Alliance Boots and Phoenix/Tamro.

150 of them will be transfered to a special governmental company in order to then be offered to SMEs. The rest stay in the hands of the old monopoly Apoteket.

Already by the threat of deregulation opening hours became more flexible its going to be very interesting to see what new services and consumer adaptation real competition will lead to. Soon one might even be able to actually get your prescribed medicines also on Saturday afternoon even if you live outside central Stockholm.

The deregulation is a result both of the change of government but also by a small company going to the European Court of Justice. As the European Court of Justice also looks into if other national regulations in for example Germany and Italy, for more info click here, on pharmacy ownership and establishment is against EU law the much needed modernisation of European pharmaceutical distribution logistics will most likely continue pan European.

When cheap isn´t a bargain

Swedish largest daily Dagens Nyheter lead editorial today comments the announced slowdown of pharma costs in Sweden.

They do point out that this is not necessarily good, that Sweden certainly can afford to invest in medicines to its citizens. Especially the new innovative pharmaceuticals that do for some patients have quite a real life changing (or life saving) effect. The conclusions is that not only is the attitude to always save on expensive drugs not necessarily a wise one but even more problematic is that the different cost saving efforts leads to a post-code lottery where Swedes gets different quality of healthcare pending on where they live.

I hope DN will manage to drive opinion in Sweden for the perception of healthcare as a long term investment instead of a mere cost to the government. This could ensure a more open minded starting point when equality in care and access to pharmaceuticals are discussed under the Swedish lead at various EU meetings. It is time for quite a lot of member states to realize that they too can and should spend more on healthcare to their citizens. Because they can´t afford not to.


Rarely impressed by the NHS but the info on swine flu they sent out is quite good - even if I think they could have placed the "CATCH IT, BIN IT, KILL IT" instructions more upfront. After all what citizens have most use of is not more info on what the governments are doing (or as on Swedish governmental sites endless travel advice) but clear messages on what they themselves could do in their daily life.

Monday 4 May 2009

Give patients financial incentives to care

Hope you already read the Health Consumer Powerhouse Patient Empowerment report. The report covers all EU member states and shows the degree of patient empowerment in the various countries. The report points out that real empowerment isn’t just about give more and more to patients but rather by actually offering financial incentives, to hand over the power over information and to let patient make active choices.