Roberto Debono: “We must not speak about crisis, we must speak about a new reality”

Roberto DebonoThe title is a quote from a discussion between Vytenis Povilas Andriukaitis, the Minister of Health, Lithuania, and Spyridon-Adonis Georgiades, the Minister of Health, Greece, and it set the tone at the opening plenary of the 16th European Health Forum, which kicked off on Wednesday 2 October at 12.30 sharp in Bad Hofgastein, Austria.

Dr Helmut Brand, President of the International Forum Gastein, introduced the forum, this year entitled Resilient and Innovative Health Systems for Europe, to a full house of public health professionals against the picturesque backdrop of the Gastein valley.

In the words of Spyridon-Adonis Georgiades, the Greek Minister for Health and one of the five guests on the panel, the crisis (or new reality) “…will be with us for many more years to come,” and policy should be structured to address such a reality.
Also invited on the panel were Zsuzsanna Jakab (Regional Director, WHO Regional Office for Europe), Paola Testori Coggi (Director General, DG Health and Consumers, European Commission), and Fergal Lynch (Deputy Secretary General, Ministry for Health, Ireland).

Jakab called on member states to place primary health care at the centre of their systems. Testori Coggi pointed out the importance of values such as innovation, resilience, and sustainability. She was particularly vociferous on the importance of transparency in the pricing of healthcare systems—especially in light of the cross border directive taking effect this October. Lynch made a very engaging interjection which highlighted the need to deliver healthcare services in a more efficient manner. One of his mottos was: “Reduce the costs of services, maintain the quality of services.”

It was felt that the crisis uncovered a lot of wasteful practices that had been going on for many years. In his incisive and entertaining key note speech Uwe Reinhardt, from Princeton University, stated that 30% of the total health spending in the US is wasted. He also pointed to widening income inequalities in the US and a Gini index value that is comparable to China’s. The minister of the forthcoming presidency–Greece–revealed that his country managed to cut spending on pharmaceuticals from €12 billion to €7 billion in one year.
It is my impression that the economic crisis served to uncover inefficient and wasteful practices.

So, what will this New Reality look like?
Four years ago, when I attended my first forum, the financial crisis was viewed as a relatively short term problem. It was assumed we would resume business as usual as soon as economic growth picked up. The reality is that even though there is nominal GDP growth in Europe, there are a number of economic fundamentals that still need to be addressed. With unemployment rates running high in many European countries, unsustainable government debts, and the decimation of consumer savings over the last decades, now may be the time to adopt a fresh approach and to place policy against this backdrop. In the words of Fergal Lynch, we need to “separate perceptions from reality.” We need to stick to the facts, use evidence as a case, communicate the value of reform, and prioritise the reform our systems.

Protecting healthcare budgets and maintaining good services, especially in times of crises, has always been the message of the European Health Forum Gastein. As Reinhardt points out “health spending cannot be expected to grow as rapidly year on year as it once did.” This year, the forum discussed the importance of health as the ultimate priority within a new dimension – the dimension of a new reality and a new socio-economic backdrop that will be with us for many more years to come.

I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Roberto DeBono, resident specialist in Public Health Directorate Health Information & Research, and Young Gasteiner, Malta.

Correction: This blog was edited on 9 October 2013. It previously said that Raimondas Šukys is the Lithuanian Minister for Health. It was edited again on 10 October 2013. The quote in the title was originally attributed to Lithuanian Minister for Health, but it was first said by the Greek Minister of Health and then repeated by the Lithuanian Minister for Health.