Market Medicine

Commentary, Healthcare & Welfare, Johan Hjertqvist

Among European economies, health care consumes roughly 10% of the average nation’s GDP. When examined as a service market, the volume is enormous and the advantages great. And that is what EU Health Commissioner Markos Kyprianou might have in mind as he works to create an internal market of health services.

Last week, Commissioner Kyprianou declared his intention to find “a clear legal framework within which patients and health-care professionals have the chance to move freely in Europe” to receive and provide medical services. This followed on from his earlier calls to “ensure legal certainty for cross-border health care under EU law.”

Such a market would help repair some of the weaknesses of European health care. When my organization analyzed the realities of health care among EU members for our 2006 Euro Health Consumer Index, we made some remarkable, even shocking, discoveries:

· One in two health-care systems denies patients access to their medical records or to a second opinion.

· Only one EU country has created a list and ranking of health service providers.

· Waiting times are common. In three out of four countries, cancer patients likely face waits of more than three weeks to begin treatment.

· In just a handful of countries can patients find a consumer-friendly, comprehensive catalog of available pharmaceuticals that includes with information about medication options and side effects.

· In two out of three countries, government delays the introduction of new medicines into the reimbursement system.

A legally regulated internal market will help patients by helping them to cross borders to access better or more timely care than at home, and by encouraging new providers to enter their national market. To entrepreneurs ready to export their services, an integrated market will be of significance. For far too long, political bias and misguided cost-control ideas have prevented new treatments and management concepts from being established around Europe.

As our research shows, weak access to consumer and patient information is a key problem in Europe. No market functions without information. If the right of mobility is to do any good, patients must be able to compare the treatment options and provider quality in various markets.

To locate the best offers at home, consumers would look for ratings of hospitals with short waiting lists. And to learn more about medication, they might demand advice from sources other than their doctors and pharmacists. To have a real impact, the internal market project will require a significant improvement of information.

But today there is very little—if any—reliable information available on the national level. This means that at least four out of five Europeans are denied knowledge of vital health-care conditions, which are available only to an informed elite. (If you understand English and are a skilled Internet user, the situation is far better.) This divide challenges strong European values of equality and justice.

No wonder, then, that the conclusion drawn at the annual EU health policy summit in Austria in October was that there is a need for consumer empowerment through medical guidelines or best practice on the EU level, to address the quality gaps and to improve outcomes. There was even discussion of a pan-European patient safety agency, tackling quality issues becoming even more important as cross-border care will grow. My impression was that the EU “health policy family” represented at the summit wanted the Commission to clarify and regulate the sector so that everyone has the legal, informational and financial resources to be able to cope with this development.

What often is labelled “health tourism” is quickly becoming a reality, as new companies are offering health services that are attractive both for their low cost and their high quality.

A Briton or a Swede can save thousands of euros by going to Poland or Hungary for virtually all dental care beyond regular checkups. The prices in these countries could be as low as half the level they’d find at home. But even these low-cost dentists are worried about Romania, as it is slated to join the EU next year. Once that happens, consulting with a high-quality dentist in Bucharest could save a health tourist an additional 30% off his bill. Such figures indicate the potential for restructuring and price efficiency in favor of the consumer.

The market perspective will bring another dimension into the European arena: the competitiveness aspects of health care. Assuming the present economic stagnation remains, the EU’s future looks rather bleak, as the labor market faces increasing pressure to provide for the health-care needs of the Continent’s aging population. If managed in an innovative way, health care could instead become the growth industry Europe badly needs. But such a shift requires a different kind of governance, not the least regarding how to reform our health-care systems.

Over time, active consumer choice among providers and therapies will push inferior producers out of the market, or at least force them to improve their performance. This bottom-up pressure to be more productive and efficient is key to improving quality in any industry, and health care is no different. But even though “health care reform” is much debated across Europe, it is quite evident that the government approach remains top-down.

Rather than long-term consumer empowerment, the focus is short-term cost-cutting. This is a harmful situation. If consumers had better access to information about their health and how to navigate the health-care system, they would be capable of addressing the inequalities and malfunctions of today.

As such, information is the key to developing the healthcare systems of Europe. If market information is available to support informed choices, the Kyprianou market strategy can prove successful. Given the power to make decisions regarding their own care, consumers will act to define a new balance between rights, equality and fairness on one side, and access, influence and responsibility on the other.