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Sustainable healthcare – a mirage?

By David Somekh, Network Director, European Health Futures Forum

EHFF has as its philosophy that it is a network of networks, aiming to support the development of a holistic view of health and wellness in society, recognising that collaboration with and by business and education are as important as healthcare services themselves in bringing about constructive change. EHFF treats knowledge as open source and aims to create a multi-stakeholder, inclusive and intergenerational platform to support its activities.

Our organisation arose as a response to the perception that the prevalent model of healthcare delivery is no longer fit for purpose and is not sustainable in the current turbulent context. Given the inherent rigidity and dinosaur-like nature of large organisations, we have identified four major levers for change, which we believe provide the logical areas for us to be active in. These are: patient empowerment, innovation (i.e. transformational change, which entails new ways of delivering care), eHealth and a major shift in the education of healthcare professionals.

These principles are the context within which we would consider the question of how pharma can help healthcare become sustainable. The first question one might ask is, is Big Pharma itself, with its current business model, sustainable? These companies have huge resources, but some commentators suggest that they waste billions, world-wide, in patenting molecules and attempting to develop them, when only a tiny proportion lead to products that are effective. This drives up the costs of medications once they come to market in a disproportionate manner, inevitably impacting on healthcare resources.

One could also look to parallels with the health-tech. industry where there is a reluctance to give up old models of product development and move to co-production and early end-user involvement with fast iterative cycles of early-stage design. Although the latter has proven to be a more effective means of delivering products with good end-user take-up, the share-holder driven focus on quarterly returns hinders a more strategic approach to product development which might involve slightly more resource initially but makes wasteful failures later at the stage of launch of new products (a common phenomenon) less likely.

In regard to the SDGs, there are undoubtedly some worthwhile initiatives, but it is all too easy for companies to use some low-cost gesture, such as claiming to ‘empower’ citizens via free information or to ‘touch their lives’ in some way, to promote the use of clean water or modest energy savings, as sufficient to ‘tick the box’ for its corporate social responsibility target. Rarely are such companies able to provide data to show that such approaches yield a significant impact. If they cannot, then we must conclude that they are paying lip-service to the CSR ideal.

Better investing in health
In appendices 1 and 2 we provide just two examples of how the areas of changing the business model and of introducing more co-production are being proposed. The first is the conclusions from a soon to be published (public consultation took place in late October) paper from the independent panel of the European Commission, the Expert Panel on Effective ways of Investing in Health (EXPH), which in this case had the mandate to report on innovative payment models for high-cost innovative medicines. The second is a paper from a colleague in AstraZeneca on their model for engaging patients and co-producing better and more effective medicines.

One of the EXPH recommendations is for dialogue platforms with all relevant stakeholders as a means of moving the agenda for change forwards. We wholly subscribe to this concept and have ourselves begun to explore the idea of trying to influence large companies by ‘talks about talks’, using a dialogue platform model, with representatives from, on the healthcare side, policy makers, providers and patient groups; from the business side, representatives from pharma, health tech. and insurance companies. We think that collaboration is the key. There is a real issue about different stakeholders being able to understand each others’ point of view, or perhaps, being willing to understand, if this might mean embracing a different concept of the way forward.

Innovative business models for pharma
Are we looking to a bright future? Probably not: there are still too many stories of drug companies exploiting the market to a disgraceful extent while still insisting that what they are doing breaks no law. The primary ethical consideration here appears to be ‘greed is good’. While this overall pattern is unlikely to change for the foreseeable future, what we believe should be strongly supported are the efforts by a handful of more thoughtful, innovative companies, or individual staff within the bigger companies who are willing to explore alternatives that show that alternative business models can produce cheaper, more effective options that benefit all sides, not just those with the most financial power.

Finally, there are other collaborative opportunities where pharma can commit resources that might constitute in part a pro bono activity but in part would enhance their societal impact, such as engagement in health and wellness education (already happening to some extent, but there could be more), supporting innovation (e.g. Johnson and Johnson’s sponsorship of the European Health Parliament- a young persons initiative) etc. – so there a good initiatives out there, but we certainly still need a lot of work in connecting the dots.

 

About European Health Futures Forum
European Health Futures Forum is an open interactive network, seeking out, processing and exchanging knowledge and information in real time to influence the future of health and healthcare in Europe and provide a better understanding of future possibilities for healthier lives and communities. The Forum is the living architecture for transformational change in healthcare. Read more about the community here https://ehff.eu/

 

Appendix. 1.

Innovative payment models for high-cost innovative medicines

  •  EXPH (EXpert Panel on effective ways of investing in Health), Opinion on Innovative 
payment models for high-cost innovative medicines
  • http://ec.europa.eu/health/expert_panel/index_en.htm

Summary:

The growth of pharmaceutical expenditures due to new high-cost innovative medicines, under the current institutional framework, creates financial challenges to health systems. The recognition that the current path of growth cannot be continued indefinitely leads to the search of new ways to ensure that innovation “that matters” is produced, that patients have access to innovation and that health systems are financially sustainable. This context leads to the discussion of innovative payment models for new drugs that improves the way the three above-mentioned objectives are met.

It is unlikely that a single payment model will be optimal for all situations. Some broad principles should be observed when defining specific payment models for innovative medicines and deciding on rewarding R&D in pharmaceutical products:

  • Greater price and cost transparency, including the acknowledgement that high prices 
(high costs to payers) may or may not have underlying high costs of R&D.
  • Revisit the rules of protecting innovation through patent law and market exclusivity, as other mechanisms to promote and reward high-value innovations can and should be devised. This is particularly true when clear areas of neglected attention can be identified in a consensual way. The patent system is the current best option for decentralized innovation efforts when consumers are price sensitive, but not necessarily otherwise. This opens space to explore new models of promoting innovation that will encompass novel payment models which may or may not be associated with different rules in R&D funding (say, making use of prize-awarding 
mechanisms)
  • Develop methodologies to measure the social value of pharmaceutical products
  • Have an assessment of exercise of market power in each price negotiation, as a 
result of insurance protection set by health systems, reducing the role of consumer’s 
price sensitivity in limiting price increases of new products under patent protection.
  • Set better rewards for higher therapeutic value added, so that innovation efforts are 
directed to the more relevant areas.
  • Payment systems should evolve in the direction of paying for acquisition of a service 
(treatment) and not of a product (pill).
  • Explore non-linear payment systems, including bundling, differentiation across 
geographies and across indications.
  • Create dialogue platforms involving all relevant stakeholders.

 

Appendix 2.

How do I put the patient first? (AstraZeneca UK)
Putting the Patient First is the open and sustained engagement of the patient to respectfully and compassionately achieve the best possible experience and outcome for that person and their family. We know that patients and their experiences are what make our science meaningful. At AstraZeneca, it’s not just about what we do for patients … it’s about what we do with patients, for patients.

Engaged patients are more likely to participate in our research, help us define the medicines that are most meaningful to them, engage with their disease more effectively and commit to improving their disease control, ultimately improving adherence to medicines and health outcomes. By putting the patient first, we deliver benefit for patients, healthcare providers and for AstraZeneca.

Introduction to 3i Framework for Putting the Patient First
We aim to build a long term productive partnership with patients that will deliver co-created, life-changing medicines and services that support patients, families and their carers. With this in mind, we have created the 3i model – a way of working that effectively connects us with patients and enables us to co-create with them.

  1. Insight: Start everything with patient insight
  2. Innovate: Use insight to co-create solutions with patients
  3. Impact: Measure meaningful impact

 

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