Medical Device Daily Contributing Writer

BARCELONA — The accelerating costs of chronic diseases, the progressive aging of Europe's population and a hoped-for miracle to solve the problem through information technology (IT) drove the agenda at the World Health Care Congress Europe, held here late last month.

Behind the headlines was an unspoken but well-known theme: European state health insurance funds are sagging to the breaking point under current pressures and are poorly prepared to absorb the coming shock.

Six health ministers participated in the program, and key executives from health ministries in 10 other European countries addressed the gathering of more than 500 participants from 40 countries.

Immediately following the 50th anniversary celebration of the European Union (EU), the picture of European healthcare emerging from the congress was strikingly similar to the bewildering patchwork of the expanded union that now counts 27 member states. Under the treaty that underpins the EU, each state manages its own program and problems.

The moderator for the keynote session, Stanislaus Cozon, managing director for global public sector at Capgemini (Paris), acknowledged the widely different approaches and pilot projects for meeting the challenges of healthcare, but said, "considerable progress has been made since we met last year."

Marina G li i Fabrega, minister for health for Spain's Catalonia region, responded in discussions with the audience that "IT is good, but only with expectations set for quality metrics and measuring outcomes. This is what the systems are supposed to achieve."

Catalonia spends 11,100 per person per year, she said, "which is low but is also fragile," as 60% of the expense is for staff not paid very well and not motivated to meet ministry goals for care. "The burn-out factor is significant," she said.

"We are clearly betting on communities" to off-load a growing pressure on hospital centers," said G li, who described her strategy for mainstreaming health services through the creation of an agency promoting personal care and supporting neighborhood health plans with local governments.

Austrian Minister of Health and Women's Affairs Andrea Kdolsky reported a surplus of beds in acute-care centers and she said that the challenge is to convert capacity to elderly care facilities.

Across the Danube, the Czech Republic is struggling with financing. Minister of Health Tomas Julinek told the Congress flatly that problems cannot be solved with the existing financing formula. "A critical moment for the Czech Republic is coming in 2015 with our aging population," he said. "An increase in financing is impossible," given the current tax burden and level of insurance premiums.

"The only solution is to link responsibility of individuals to the healthcare costs that they impose on the system," he said.

Flavio Tosi, minister of health for the Venato region of Italy, reminded attendees that the EU includes 27 nations but is actually comprised of 250 regions. Spain, Italy and Germany are three of the largest EU member states and between them hold 53 separate regions with autonomous authority for delivering and managing healthcare, a decision-making that can be influenced, but not controlled, by national ministries.

The healthcare reform won by German Chancellor Angela Merkel in February and signed into law the week of the Barcelona conference, calls for a full capitation of the healthcare system by 2009 through a central insurance fund. That has created tension with the 250 insurance companies gathering and distributing funds.

"Yes, it is true," said Amelung, "but there will be an election before that. Healthcare is a topic that loses elections, a great way to burn your fingers as a politician."

"The health system in Germany is in a major period of reform," said Dr. Hans J rgen Ahrens, chairman of AOK-Bundesverband (Bonn, Germany), who said that he welcomed the reform law, saying it "creates new spaces for insurers, creating a wider playing field to offer different incentives and pricing."

Meanwhile, Spain is inspiring European ministries with diverse approaches to reforming healthcare delivery among the 17 autonomous regions. Catalonia and Andalusia are references for e-health initiatives on the leading edge of the federally endorsed roadmap, Plan Avanza, developed within the framework of the EU action plan i2010.

Valencia is attacking problems for public health financing directly by forming partnerships with private sector insurers. The Denia district in Valencia has granted a 15-year concession to Deutsche Krankenversicherung (DVK, Frankfort), a German health insurance company, for managing public health facilities and delivering health services for the 160,000 inhabitants. Denia is the third district in Valencia to grant management to DVK. In Alzira, where the model was tested in 1997, DVK took on the responsibility for building a needed hospital.

The Lombardy region of Italy is that country's showcase for e-health, with 5,000 general practitioners connected and 9.2 million users of the Carta Regionale de Servizi (health cards).

Walter Bergamaschi, IT director at the Italian Health Ministry, said the Lombardy program is a cornerstone for the federal architecture.

"We are watching the UK with great interest," he said, "but a central, federal database for Italy could only serve as an index. The big deal for Italy is creating a federation of regional databases. Each region has started something and the question is whether they are interoperable. Right now we are identifying standards."

Sweden is also broken into 21 regional and municipal authorities, each responsible for healthcare service delivery, and each of which is running relatively advanced e-health programs.

Kalmar County, with 238,000 inhabitants on the east coast of Sweden, was presented at the conference as a case study and the district's chief information officer, Peter Alvinsson, reported over 19 million in annual savings "that we measured ourselves, without consultants."

Despite the relative maturity of programs in Sweden, health executives from Europe took note that it is only recently, according to Alvinsson, "that for the first time we have a solid commitment to one national strategy for healthcare IT."

Anita Eriksson Pallinder, CEO of CareLink (Stockholm), an association of Swedish local governments, is charged with pulling together the diverse Swedish local programs into a national system and assure interoperability between regions and communities.

"We are now in the midst of procurement for a national patient record to include critical data such as lab results, medications, or a family doctor contact," she told MDD.

The long-term commitment of Denmark to an e-prescription service is now delivering tangible benefits for the healthcare system, according to Niels Kristensen, president of the Danish Pharmaceutical Association.

Kirstensen reported that the Danish Pharmacy Server went live in January, creating the world's first national database for medication, including a registry of all prescriptions and all medications dispensed. With a central national server, prescription information can now be registered to any citizen's medical profile, he said, "making the patient record more complete."

A tour of Europe is not complete until the Dutch, often the earliest adopters of change, have spoken. Cor Spreeuwenberg , dean of health sciences at the University of Maastricht, told conference participants, "Nationalization doesn't seem to matter, there are many helpful decentralized initiatives, and, personally, I like the mentality of managed competition. Encouraging managed competition between regional providers may contribute to effectiveness and quality of care."