Report from Europe Managed care growth seen as costs balloon

Report from Europe Managed care growth seen as costs balloon

By TOM CLARK BBI European Correspondent Although managed care has acquired an unpop-ular image in the U.S., European countries will also be forced to allow much greater private sector health care provision over the next 10 to 15 years as Europe’s health care systems emerge from imposing cost- and utilization-control limitations toward health management. Europe’s health ministers met recently in Bad Tatzmannsdorf, Austria, to try to work out how to maintain standards of patient care while at the same time cutting public health spending. There is clearly no intention to frame any European Union-level leg-islation on quality in health care because welfare systems remain very much a national competence within the EU. “The EU member states are confronted to a large degree with similar developments which bring new challenges to health policy,” said the Manfred Sche-ich, Austrian minister of health, who chaired the meeting, “Demographic changes, new technological developments, a rise in the complexity of medical care, higher expectations and demands from patients and, last but not least, problems with the financing of health services. These are all factors by which cur-rent health policy is being influenced.” The European Commission has warned repeat-edly that health care systems in all 15 member states are in urgent need of reform. Problems caused by an aging population (the so-called “demographic time bomb”), coupled with changing working patterns, mean that EU governments all face the quandary of how to maintain generous systems which are becom-ing increasingly difficult to support financially. The way in which managed care is perceived in Europe will vary depending on how a country’s health care system is organized and financed. In countries like Belgium, France and Germany, with long-established purchaser/provider separation and social insurance-based financing, U.S. concepts have been adopted with some success, according to Anna Hajek of the U.S. health care services group MMI (Corona, California). Other countries with central tax-based health care systems, like Britain and Sweden, are now beginning to look at possibilities offered by managed care. Central to the European health ministers’ delib-erations was a 30-page document, Quality Assurance in Public Health, produced by a panel of health care experts, which contains a complex and technical analysis of the sorts of problems faced in many health systems today and which suggests possible solutions both for improving the quality of health care and for reducing costs. While there is no intention of harmonizing health care systems in the European Union, there are a number of common features and trends (see Table 4) which can be seen in the health reforms presently under way throughout Europe. NHS plans extra spending The British government has announced that it will invest an extra $34 billion in the National Health Service (NHS) during the next three years. Of this, an estimated $13 billion will be on capital investment, including medical equipment. For a number of years, shortages in funding for the NHS have resulted in arrears in routine mainte-nance and in non-replacement of old equipment. On average, the NHS has used medical equipment two years longer than in France, Germany, and the Benelux countries. Some professional bodies already have expressed doubts as to whether enough new money will be allocated to replace all outdated equipment and to acquire new technology. Some of the extra funding will no doubt go toward ensuring year 2000 compliance for medical devices and computer systems. The U.K. govern-ment has already informed NHS Trust and Health Authority directors that they will be held responsi-ble for problems relating to the Y2K bug, while many device companies are looking to insurance as a way of limiting their liabilities. The NHS Confederation (London), which repre-sents NHS hospital trusts and health authorities, recently carried out a survey to find out from its members how many extra budgetary allocations might be spent. In terms of capital investment, the replacement of existing outdated equipment and the purchase of new instrumentation was clearly the top priority, but the survey also showed throughout the NHS a backlog in equipment maintenance of $4 bil-lion to $5 billion alone. Private financing of public contracts Six years into the Private Finance Initiative (PFI) in the United Kingdom and a year into the new Labour government’s revamp of PFI, many of the legal and technical obstacles have been swept away. NHS Trusts and local authorities now have the clear-er legal authority to sign deals which banks and finance houses have been demanding. In the 12 months to June 1998, PFI contracts with NHS groups valued at more than $1 billion, 29% of all PFI con-tracts, have been signed. More than 25 countries have sent teams to Britain to learn from the experience of using private finance to provide public infrastructure and services. Switzerland to reimburse alt med As of July 1 of next year, the Swiss government will add homeopathy acupuncture, Chinese medicine and neural therapy to the list of medical treatments covered by the country’s health insurance system. Ruth Dreifuss, Swiss Health Minister, said that those therapies’ positions would be reviewed in 2005 and that their performance would be evaluated dur-ing the six-year period. An estimated 70% of Swiss citizens use some form of complementary medicine. A good year for patent applications In 1997, the European Patent Office (EPO; Munich, Germany) received almost 100,000 patent applications, up 14% over the previous year and more than three times the annual figure anticipated when it was founded 20 years ago. On July 1, 1997, procedural fees were cut by 20%, reducing annual income by $80 million. The EPO also reduced to marginal cost levels fees for accessing EPIDOS data services for patent searches, etc. The administrative council also has reviewed addi-tional measures to reduce translation and validation costs for granted European patents, which amount to about 40% of the total cost of a patent. In its “package solution,” the EPO has formulated a proposal that will allow translation costs to be cut by as much as 80%. The proposals have generally met with approval, but many feel that they do not go far enough. Last year, the European Commission published a discussion paper on EC patents and the patent system in Europe, and issues relating to harmonization with national law. The ongoing debate and conclusions drawn by the com-mission are likely to provide the basis for action pro-posals during the next 12 months. Cancer diagnostic update Bone sialoprotein (BSP) has been proposed by researchers at the University of Liege (Liege, Belgium) as a prognosis indicator in prostate cancer. Since there is a significant risk of prostate cancer metastasing to bone, their study was to determine if BSP expression in prostate cancer tumors could predict disease progres-sion. On a three-year follow-up, they found that 36.7% of patients with high levels of BSP in tumors at surgery relapsed, compared to 12.1% relapses in patients with low or undetectable BSP levels. Ian Fentiman of Guys Hospital (London) and his group at eight European cancer clinics used the Biofield Diagnostic System to help distinguish between benign and malignant lesions in breast can-cer. The system, developed by Biofield (Roswell, Georgia), uses sensors on the skin to detect and ana-lyze changes in electrical charges in epithelial cells in breast tissue. When epithelial cells divide at a faster than normal rate and become cancerous, the electri-cal charge reduces and the change can be detected. Fentiman said preliminary results showed that the system had 90% sensitivity and 55% specificity. In his view, use of the Biofield system could reduce the number of biopsies by more than half. He indi-cated that the test could provide an alternative method of detecting early cancer. Although the test is unlikely to replace standard breast cancer screen-ing in the general population, he said that it could do so in certain women for whom mammography is technically difficult. Biofield plans to launch its diagnostic system in Europe before year-end. Cervical cancer trials, using the Polarprobe detec-tor from Polartechnics (Sydney, Australia), have been under way at the Whittington Hospital (London) for the past three years. Initial patient trial results have showed that the device has a sensitivity of 97.6% and a specificity of 91.1% for the detection of carcinoma of the cervix. The device emits five electrical pulses and four different light wavelengths. The probe head is swept across the cervical surface and returned sig-nals are analyzed to classify the tissue under exami-nation as normal, pre-cancerous or malignant. Albert Singer, leader of the Whittington Hospi-tal group, said that present tests such as Pap smear test, missed from 20% to 40% of pre-cancerous lesions. Final trial results are due to be presented at the First European Congress of Colposcopy and Cer-vical Pathology in Dublin, Ireland, this month. CanAg Diagnostics (Gothenburg, Sweden) has developed a double monoclonal antibody enzyme immunoassay for neuron-specific enolase (NSE) detection in serum. Elevated NSE levels are common-ly found in patients with malignant tumors, such as small-cell lung cancer (SCLC), and measurement of NSE levels can help in differential diagnosis of non-small cell lung cancer (NSCLC) from SCLC, as well as providing prognostic information and input on mon-itoring therapeutic response to chemotherapy. Researchers at the Cancer Research Campaign (CRC; London) are using a new computer-based technique for analyzing the results of a magnetic res-onance spectroscopy brain scan. They have devel-oped a software program that recognizes mathemat-ical patterns in the scan. It interprets patterns creat-ed by nuclei of chemicals that resonate at different frequencies in the tumor tissue when subjected to a magnetic field. According to John Griffiths of St. George’s Hos-pital Medical School (London), who is project leader, European trials indicate an accuracy of around 85%, which could significantly reduce the need for brain biopsy. Surgery developments Loss of cerebrospinal fluid (CSF) during spinal column and brain surgery can be prevented by the use of FocalSeal-S made by Focal (Lexington, Mass-achusetts) and currently undergoing first clinical tri-als at three university medical centers in France, the Netherlands and Switzerland. Minimally invasive microsurgery, as for example in endoscopic heart bypass procedures, can be car-ried out with the Zeus Robotic Surgical System from Computer Motion (Santa Barbara, California). Karl Storz Endoscopy (Tuttlingen, Germany), which al-ready cooperates with Computer Motion on instru-ments for its Aesop system, has now extended the agreement to designing and non-exclusively market-ing a new line of surgical instruments for use in the Zeus robotic system. King Systems (Noblesville, Indiana) is to coop-erate in marketing jointly worldwide its anesthesia and respiratory care products together with a similar line from Medisize (Hillegem, the Netherlands) and B & P Beatmungs-Produkte (Neunkirchen-Seelscheid, Germany), both companies being subsidiaries of the Swiss holding company Gurit-Heberlein. Researchers from the London-based hospitals, Whipps Cross and North Middlesex, have compared laparoscopic hernia repair procedures with open surgery in 400 patients. Their recently reported results showed faster recovery in the laparoscopic repair group, with fewer episodes of wound infection, geni-tal swelling and constipation, although urinary reten-tion episodes were more common.

COPYRIGHT 1998 A Thomson Healthcare Company

COPYRIGHT 2004 Gale Group