Europe's unequal healthcare
Christian Pruszinsky reports from the 11th European Health Forum Gastein in Austria: `Achieving the level of healthcare of the older EU member states will remain a long-term project for new members´ .
600 participants, working in healthcare politics, science, industry, medicine, healthcare administration and non-governmental organisations in 45 countries, attended this year’s European Health Forum Gastein in Austria, when a range of topics vital to all our countries were discussed. These included the stark inequality of healthcare in the expanding EU.
Europe cannot be described as ‘united’ in terms of healthcare – not even within the EU. The differences in quality between healthcare systems and the health of their populations, if comparing the old and new EU member states, are enormous. ‘If the infant mortality rate in Romania is six times higher than in Sweden and the cancer mortality rate in the new member states is drastically higher than in the old ones, you can actually talk about an Iron Curtain,’ said Alojz Peterle, former Slovenian Prime Minister and member of the Members of the European Parliament against Cancer initiative.
The EC is certainly aware of this problem, confirmed Andrzej Rys, Head of the Department for Public Health in the DG Sanco (Directorate General for Health and Consumer Affairs) in Brussels, who pointed to numerous, current schemes to reduce economic (structural funds) and health-related differences (programmes for the different social groups). ‘However,’ he added, ‘achieving the level of healthcare of the older member states will remain a long-term project. Apart from the different economic conditions … key facts, such as life expectancy or healthy years, reflect the positive and negative influences during someone’s entire life.’
The error rate in healthcare has remained relatively constant for the last 20 years. ‘Those responsible on all levels don’t take the dimension of the problem seriously enough,’ said Günther Leiner, President of the European Health Forum Gastein. However, the improvement potential does not lie primarily in the avoidance of classic ‘malpractice’ but in the areas of hygiene; acceleration of processes in acute cases; diagnostic safety and the reduction of waiting times (e.g. for transplants). ‘Sometimes it is not even money that’s required, but just a different attitude towards a problem,’ he pointed out. Indeed, studies presented at the forum revealed that around 10% of all hospital patients are affected in some kind of medical error and that the number of fatalities resulting from treatment errors far exceeds that of the road accident victims. According to European Commission data, 10% of hospital admissions involve treatment errors.
Jo Groves, Managing Director of the International Alliance of Patients’ Organisation lamented the current error rate and demanded open disclosure procedures, i.e. error analysis without legal consequences, as well as better training for doctors and other medical staff, in terms of more communication and cooperation with patients and their surroundings.
A further prickly topic: Apart from normal legal reviews of mistakes, opportunities are needed for scientific reviews, where causes and effects can be discussed without consideration of possible legal consequences.
Ethics councils gain acceptance
An ethics advisory council neither aims to impede nor prevent progress; it only wants to ensure that progress benefits society. However, those involved in medical and scientific ethics have often been viewed as potential antagonists by the healthcare industry. That scene is changing – they are increasingly accepted and even seen as ‘partners’ to industry in the EU.
Albert Weale, Chairman of the UK’s Nuffield Council of Bioethics, said: ‘…the voice of the council is being heard and can influence decisions sustainably’. Even if the resistance of the council against the increase of DNA databases was unsuccessful, the weight of ethical advisory bodies on the whole is on the rise – particularly through the scientific competence of their members, he said. ‘Formal regulations, which enforce the integration of ethics advisory committees into decision-making processes, are one kind of approach, but ultimately we have to convince through competence.’
Ségolène Aymé, Head of the French action plan for rare diseases – with 7,000 of these currently classified – introduced this initiative, which is worth over e 100 million. He pointed out that the most important cornerstones are a network of 132 national competence centres for rare diseases; comprehensive patient information on the internet (www.orpha.net – in five languages) and ensuring that the study of rare diseases becomes part of the curriculum for medical degrees.
For cases of rare diseases are too low in number to enable all individual countries to provide the necessary facilities and experts, making international cooperation vital. However, treatment can be, and should be, organised on a national level. ‘Efficiency doesn’t mean that patients should fly criss-cross all over the continent,’ he pointed out.
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