Wednesday 30 September 2009

European Commission launch of the European Partnership for Action Against Cancer

I spent the day at the launch of the Partnership. It was quite an impressive show. It should be given that the objective of the effort is to ensure that all Member States have integrated cancer plans and a reduction in cancer by 15 % by 2020. I will just mention some of the highlights.

European Commission President José Manuel Barroso underlined referring to the current financial difficulties that he sees healthcare as a key issue in the coming years and that the partnership really can make a difference and set an example for the world. He seemed rather set on ensuring that the European Commission gets more directly involved in the healthcare sector.

Health Commissioner Androulla Vassiliou was quite interesting. First she explained that she wants to reduce the fragmentation and get focus in the cancer research. I’m not sure though that streamlining is what’s makes research work. Quite a lot of important discoveries have been off springs of other research rather then what original was searched for. Astra Zeneca´s Losec is maybe the textbook example. But she also said that she think believes in added value through demonstrating if the various healthcare systems are meeting high standards or needs to improve. I.e. that she believes in naming and shaming. Still not really PC – but she has my full support on this one. Further she quickly mentioned that it’s not fair that it’s depending on where you live what innovative drugs you get. I think the upcoming report on health inequalities in Europe and the European Commission’s conclusions and proposals based on this report will be very very interesting and controversial.

The panel discussion never really took off but from the civil society there were 2 remarks that made me think a little extra. One was a polish mother of child with cancer who pointed out that when IARC and others specify the various stakeholders and actors in care parents should be specially remembered. This is quite spot on. Key to early detections is to noticing changes in the body – either your own or in this case your child. It’s a different role compared to be a friend or regular citizen. Those close to a patient are often remembered but as a support factor – not as part as best practice in the process of ensuring early detection.

Finally one of the leading ladies in patient advocacy Hildrun Sundseth asked the profession present for common European treatment guidelines. On the surface this seems to make sense but I must confess that I do think it can be damaging in the long run. It cannot be good for further development if everyone is set to do the same – and guidelines agreed upon on a European level would by necessity be a committee product. And as everyone knows who seen the EU in action knows the final agreed result may not necessarily be whats known as best practice.

Today’s meeting did set the tone for the further work. It will be well organized, intense and high level. A good way but I hope those in leading positions can take a step back and let the diversity of all the European countries and various experts work its magic.

Tuesday 29 September 2009

Audit claims Public Health Programme 2003-2007 ineffective

Approximate 232 million Euros was spent on 352 projects for the Public Health Programme 2003-2007. Quite a lot of money if used properly. Unfortunately the Court of Audit have found that its not and that the Commission and the Members States ought to reconsider the EU´s funding approach in the field of public health for the period after 2013. The 2008-2013 Programme is already written.

This since the Audit found that the PHP: lacked strategic focus, that the results often where fragmented and that there was no systematic monitoring of actions already taken in the different priority areas leading to duplication of work.

The networking part of the programme seems to be the really big benefit, beside the recurrence of a European dimension. Rather hard words.

But its not so strange. Healthcare policy is the hometown of do-gooders and well meaning actions. Not all to the benefit of a sustainable healthcare system. Healthcare system and public health policy is to important and complex to not be managed more strategic and professional. Its nice to want to do lot of good things but nice ambitions doesn’t necessarily delivers good value. I hope the report give proper eco in European Institutions and that the work done in the future will be based in a more focused measurable strategy.

Next the report is being managed by the European Parliament. One of the rapporteurs is Swedish Member of the European Parliament Christofer Fjellner. Find the report here.

Monday 28 September 2009

The Netherlands yet again win the 2009 Euro Health Consumer Index (EHCI)

The Netherlands yet again win the 2009 Euro Health Consumer Index (EHCI) and with an increasing margin. Obviously it makes a difference that the Netherlands combines competition for provision AND funding. They actively support patient choice and that is something that now shows results in many areas. The general improvement is also seen in other reform making countries like Ireland and the Czech Republic. But the Spanish, Portuguese and Greek healthcare systems continues to decline. The 2009 index includes 33 national European healthcare systems and measures 38 indicators. The full result is as follows:

The individual category winners are:
  • Patient rights and information: Denmark
  • e-Health: Denmark, Netherlands
  • Waiting time for treatment: Albania, Belgium, Germany,Switzerland
  • Outcomes: Sweden
  • Range and reach of services provided: Belgium, Luxembourg, Sweden
  • Pharmaceuticals: Netherlands, Denmark

More about the index will be possible to find later today on the site. The report can be found here.

Wednesday 23 September 2009

Crying wolf – good or bad for healthcare budgets?

At the seminar on Progress in Respiratory Diseases Professor Trevor Jones from King’s College London presented the estimated future impact by COPD. His claim was that by 2030 it will be the 3rd largest cause of death in Europe. In Sweden already today 3000 every year die from COPD. The cause is smoking, basically its smokers cough, so no real positive change in incidence rate can be expected in the near future. And with no known cure there is no reason to doubt his figures.

At the same time I always hesitate when I hear about the new threat that we all will die from. These type of estimations are quite common in Brussels – and btw the media. Most disease areas have representatives that fully credible manage to claim that specific disease area is the one that really will be the most heavy burden for society in the future. Now they cannot all be right can they? (Swine Flu, SARS etc) And if they are not all right does this mean that they are just crying wolf?

Yes and no. They do cry wolf since its estimations and not known facts and it’s not possible that more than very few of the diseases will actually be the most costly and problematic disease area. Some because other disease areas increase of importance are not part of their calculations. Some because with new innovation and general development they will just not be as burdensome as calculated with current knowledge. But I would also say no they do not cry wolf because the wolf actually do come and we only see a positive development in some are because they got attention and the issue where dealt with in time. There are good examples of when things were taken seriously early enough and we can in retrospective see the benefits for the health budgets.

Also at the seminar where leading expert in Asthma Professor Stephen Holgate at the University of Southampton and Susanna Palkonen who is the Executive Officer of the European Federation of Allergy and Airways Diseases Patients. I come across these two earlier when I attended the Summit for Change in Asthma in 2006 and have with interest followed the work in this field. Especially the Finish experience that Susanna used as a good example in her presentation. Professor Tari Haahtela presented this work in Brussels at an event I attended last year. What Finland did was creating a long-term strategy to ensure better care for the patients at a lower cost for society. It’s a cross sector effort being calculated and evaluated cross sectors beyond the regular healthcare silos. In short I would describe the efforts as that they by increasing the knowledge in the healthcare sector about Asthma and thereby ensuring more regular visits to the GPs and healthcare centres in combination with an increased use of pharmaceuticals (basically double the spend on both these part of the care) the Finns where during a 10 year time able to cut the total cost for asthma management. The cost where saved on less days of sick leave, early retirement and hospital days. Something that beyond the positive effects it had on the state budget also of cause meant quite an improvement in the quality of life for the patients!

Now we will have to see if we could have similar efforts in the area of COPD – there is quite a lot to be done and the postcode lottery is widespread. The Health consumer Powerhouse have looked into the various regions in Sweden and compared the support given and found a lot of differences. I’m know that if similar criteria’s for example with regards to help to smoking cessation would be measured country by country in Europe one would find that it’s not that many countries that actually actively help their citizens stop smoking. But if the right levels listens to Jones we should be able to ensure that we never have to face the a situation where COPD is the 3rd largest cause of death in Europe.

Monday 21 September 2009

Change in Leadership for the WHO Europe

Mrs Zsuzsanna Jakab have been nominated as the WHO Regional Director for Europe. This means that the ECDC needs a new Director for European Centre for Disease Prevention and Control (ECDC) by February 2010. Even if processess like this is slow the European Commission has already started looking for a new ECDC Director, since Mrs Jakabs had a 5 years manadate due to expire in 2010. In the European Commission that is the rule - all senior officials have to move position every 5 years.

Friday 18 September 2009

Private insurances do not create two tiered healthcare

A new Danish study done at the Syddansk University by professor Kjeld Møller Pedersen shows that additional private healthcare insurances do not lead to inequalities in care. The study is the largest in its kind in Denmark and has been conducted with 5000 respondents.

The findings are that those with private health insurance do not use more healthcare than those without neither in the private nor the public sector. The reason for this being questioned in Denmark is that there from 2001 the amount of health insurances paid by the employers have gone from 45.000 to 900.000. During this time there have been quite a lot of discussions on whether this undermines the solidaric healthcare system creating a two tiered system. The researchers now states in Danish media as a result of their findings that this do not seem to be the case.

But I also not that given that one of the reason behind the findings is said to be that many simply just do not use their insurances the employers might want to renegotiate the terms with the insurance companies so that they extras enough for the insured to use what they paid for. And it should be able to offer something better given that even if info in Danish healthcare is quite good – outcomes is another issue.

Thursday 17 September 2009

Differentiated pricing of pharmaceuticals

I had the pleasure of listening to Jacques Gorlin make a presentation earlier this week. He pointed out that the issue of healthcare its often said that developing countries should receive medicines at a lower prince something quite easy to agree with at first - well until you start looking at what countries actually define themselves as developing countries.

I would have thought that there is some kind of standards used to define what countries that are developed, developing and the least developed countries. Now usually the WTO classification is used as a reference point but when going to the WTO website I learn that there is no real definition of “developed” and “developing” countries. Instead: “Members announce for themselves whether they are “developed” or “developing” countries. However, other members can challenge the decision of a member to make use of provisions available to developing countries.”

Well as Im a bit sceptic to governments I would assume that as many countries as possible try to define themselves as developing countries. And yes: 2/3rd out of the 150 WTO members classifies themselves as developing. Now there is another category – the least developed countries. That list is more strictly composed but maybe to narrow.

I would say we need help the poorest in for example India and Brazil without the rest, the middle class and upwards, of their population free riding on behalf of for example the citizens in some of the poorer EU member states. So how do we get a clearer definition of who ought to benefit from for example differentiated prices? Maybe the Ministries of Health, the EU Commissions DG Sanco etc needs to ask for help by the Trade Ministers etc.

But for differentiated prices to become a reality rich countries like for example Saudi Arabia first has to be willing to stop aiming at getting a price as low as some of the countries they actually give foreign aid to...

Friday 11 September 2009

The DG Sanco´s collection of health reporting systems

On DG Sancos website you can find something that is calledHealth reporting systems at national levelOf cause I had hope that this would have been a portal to various sites where I as a citizen could find information on health outcomes etc in the various member states. But no. Some of the links do not work anymore. Some ends up in general governmental health policy sites.

Well please find here some alternative recommendations:

For Sweden the "Quality and Efficiency in Swedish Health Care" measurements.

In Denmark: Sundhedskvalitet a site for Comparison of prices, quality and accessibility
And my personal favorite: the German Quality indicators for patients from BQS.

Thursday 10 September 2009

HIV - ENCAP Manual for Harm Reduction

I have received the Manual for Harm Reduction Service Providers from the ENCAP (Expanding Network for Comprehensive and Coordinated Action on HIV/AIDS prevention among Interactive Drug Users and Bridging Population) project. Well maybe not really a manual it’s quite an extensive introduction to the work on Harm Reduction. The book goes through the pros and cons of harm reduction as well as the various methods and also the problems the people working with harm reduction faces including stress management and how to work with media, municipalities and the police.

It’s quite easy to read but aim at covering too much well at least the focus is in some parts on the wrong areas. I think that chapter 2 could be lost and I would also have liked to see a little less focus and details on the media part especially since better checklist already are quite ready available in various PR guides. Instead maybe a bit of more work on how to work with local municipalities and police could have gone into the material – quite difficult areas but I would assume key factors to reach long time success.

In the methods of harm reduction it always comes down to the basic education, condom distribution, testing and counselling in various phases and of cause the more controversial issue of syringe and needle exchange. So also here. Not very new but it do highlight the issue of female condoms as well – an underused possibility of ensuring that women can be better protected.

All in all I think the book is well worth to read for the professionals in the field. You should be able to get it from the project via

Off Topic - the Swedish Presidency in L´Anglophone

If you deal with the Swedish Presidency you might be helped by reading my column in the new english magazine L´Anglophone. The magazine is brand new and beside columns from me you will also find Belgian and EU news, legal Q&A, Jaro Vantos columns and all you need if you happens to have time also for a social life in Brussels.

Monday 7 September 2009

Choice is good - also in healthcare

One often gets to hear that yeah choice is good for those that can afford. Now this is in reality only the establishments snobby way of saying that we don’t believe that those with less money and education of cause cannot be trusted to manage their car them self.

But in reality they are quite good at it – actually much better than the establishment is in securing their healthcare. And they know it - at least if you believe the British Social Attitudes Survey 22nd Report (2005) where one can find that the group who where the most thinks that people should be allowed to choose which hospital to go to is those with semi routine and routine work. 67%. In managerial level the figure is 59%. When in the same study the population is devided on income and educational level instead you still see the same pattern.

And one do understand why it is those with less education and income that wants choice when you take a look at 2 studies published this year – one from the UK and one from Sweden. 2 of the healthcare systems in Europe where healthcare is really an issue of governmental planning limiting patient choice.

Earlier this year a report was published by SKL on how social class determinate the reception and outcome you get from Swedish healthcare. A system where you in most regions still have to go to the doctor practising closest to where you live. The report can hardly be questioned since it actually was produced by the co-operation organisation for the regions responsible for organising the Swedish healthcare. The report points out that white collar workers gets better care with more modern medication and methods compared to blue-collar workers.

And recently a retrospective study of waiting times for elective hip replacement, knee replacement and cataract repair in the UK published in BMJ by Cooper, McGuire, Jones and Le Grand points out the good effects of the changes in NHS system from 1997 to 2007. In the UK there have been quite a lot of concerns raised that the reforms of the NHS with regards to choice would lead to increased inequity but the study shows that rather the opposite have been the results. In equality between various social groups have during this time period have actually decreased. Usually you have to be a subscriber to the BMJ to read their articles but luckily this article have been deemed to be of such importance its accessible in its full text here.

Tuesday 1 September 2009

Interview State Secretary Mrs Karin Johansson Swedish Ministry for Health and Social Affairs

Tomorrow in the ENVI committee of the European Parliament Swedish Minister for Health and Social Affairs Mr Göran Hägglund will present his visions for the presidency. I recently interviewed his State Secretary Mrs Karin Johansson. We had a good an open meeting where we talked about co-operation cross borders, swine flu and why the Swedish presidency have not chosen any particular disease area to put a focus on.

The reason for the last Q originates from my interest in how the policy agenda is set. I know both industry and NGO representatives aiming at getting their causes on the Swedish presidency agenda without success. Mrs Johanssons explanation where simply that when planning the agenda it was already quite loaded so they had to really focus on key concerns meaning the structural issues. It still doesn’t really put an end to my curiosity since all others also inherits heavy agendas but still seems to really want to make one or another disease their signum. How these disease areas become so important is still to be investigated. Is it mere personal experience or is it giving in to national interest or just that they are more receptive for clever lobbyist arguments than the Swedes?

Well the Swedes resistance and focus on structural issues can also be seen in their work finding out what incitements are needed to find new antibiotics. Here they even tried hard to get the bilateral discussions between the EU and the US going since they realise that it’s not possible for the EU alone to succeed.

On the other hand admittedly the most concrete issue they are dealing with is the swine flu (not the least because several of the civil servants in the Swedish ministry of health actually have been hit) but it’s not within her responsibilities. Still Mrs Johansson underlines that the ECDC, WHO and EU have different recommendations with regards to the swine flu raising the obvious question how a member state relates to these different recommendations. Her conclusion is therefore that there is from the Member States a clear need of getting the international players to synchronise their work. She explained that this goes also for other areas like rare diseases. I wonder what this will mean for the system and structures if it will include HTA and definition of what equal care for all EU citizens means?

In principle I must say I’m proud of what my current government does in the area of healthcare. They are quite pro patient choice and empowerment also when it means actually lessen the governmental control over the healthcare system. I think it will in the long term pay off with better outcomes and better value for money.

One of the time I noticed this was after Mrs Johansson pointed out that healthcare becomes more and more specialised leading to a smaller and smaller patient base resulting in a need for further co-operation cross border. So far most would agree - in principle. The interesting thing with the current Swedish administration is that this insight also has implications on the application of policy positions and conclusions with regards to how international co-operation needs to be managed practically. Mrs Johansson admits that this is inevitably leading to a more integrated view of healthcare in the EU but the development needs to take its time due to the budget constrains – but she also points out that in the end nothing is more important than the delivery of good healthcare so this issue cannot be impossible to solve!

One of the more surprising statements was probably that she sees competition in itself as a force for development meaning that it’s positive that the different healthcare systems are being put through competition! In Sweden they are working on enabling this on the regional level and of course this is something that also should be achieved on an international level.

This naturally led my thoughts to the current debate on the directive for patient rights across borders. Now it turns out that the Swedish presidency sent out a compromise proposal the last week of July. Negotiations will start in September. As reported earlier on this blog commissioner Vassialou has made it clear that this is a majority decision. So I had to ask if Mrs Johansson thought that Spain really will be overruled. Here she hesitated pondering if given how watered down the proposal in its current version is if it’s not better to just let it be and instead let case law develop. As the Council was not even prepared to take a discussion on the rather compromise friendly decision of the European Parliament one must wonder if she isn’t right.

Of course in this directive the pre-authorisation process is what’s really troublesome beside the issue of how far reaching the co-operation should be. With a smile she adds when I ask that it seems that those with the most problems with the right that the directive gives patients with regards to choice seems to be the same as those that have the least problems with the chapter 4 enabling various ways of co-operation between member states. And of course it’s an issue of who decide of the allocation of recourses etc. Now this means power and not many are willing to give up power.

When it comes to access to medicines as a key - partly as a follow up of the Pharmaceutical forum and the topic for one of their seminars - they try to establish a test case for international co-operation. The structures for co-operation need to be developed in real life situations in order to be robust. She also expects some proposals at the next council meeting on how to move forward with Pharmaceutical Forum 2.0

And by now we was at the end and could just contemplate that even if they are very much pro a more liberal legislation with regards to patient information this is an area where there is no way forward. Strangely enough. But maybe Mr Hägglund while in the European Parliament can convince some of the sceptics – one live on hope. Given the tone and the answers I gotten from Mrs Johansson I actually do have hope for the cross border care directive as well as actually the patient information issue.