333768_water_and_sky_dualityThe song said that whoever had the three important things of life – health, money and love – could thank God. Leaving love aside, it is indisputable that an efficient healthcare system is good for our health and it is good for our economy. It is an essential service for citizens and it is also a driving sector and an opportunity for diversification for the business fabric as a whole. All issues related to health are and will be key in the future. With a life expectancy that grows at the rate of one year every four years and the continuous reduction in the birth rate, the weight of older people in the population pyramid is becoming greater. This will form a demand for services that will give rise to a new economic fabric in which health and the issues associated with it -food, assistive technologies, care services, biomedicine- will be a priority.

And improving the economic fabric is neither the only nor the least of the benefits of this bet: investing in health means investing in quality of life, and therefore investing in people, who are precisely the productive force of any economy. In a moment of crisis like the current one, it seems impossible to spend at the rate at which healthcare has done so far. Minister Bengoa himself has just stated, in the presentation of the Expenditure Containment and Improvement Plan, that increasing the health budget at the rate at which it has been growing in recent years would imply using 50% of the budget of the Basque Country in 15 or 17 years . Something clearly unfeasible.

For economic reasons and for reasons of efficiency, logic drives to optimize the performance of each euro invested in health. The plan itself defines certain measures, among which some stand out such as the increase in the use of generics, agreements with private companies, alternatives to hospitalization, telemedicine, reorganization of clinical analysis laboratories and, in general, management improvements. Leaving aside some of the controversies that this plan has caused among companies in the pharmaceutical sector and other interest groups, the approach of the current Department of Health seems clearly the most correct.

There are numerous international examples of optimization of health management that have generated not only a reduction in costs but also, and what is more important, a substantial improvement in the service offered to patients. Some of the keys to success observed in these initiatives and that can serve as a reflection framework for the Basque case are:

Systemic vision, which makes it possible to plan interventions in the health system at all levels of action. The changes introduced at the micro level have to be coherent with the advances of the health system as a whole. It is essential that all actions are oriented in the same direction towards common objectives.

Thematic specialization of the different institutions, organizations, laboratories, etc., which implies a more effective use of economies of scale, reducing the logical inefficiencies of maintaining different teams with material resources, infrastructures and different people carrying out similar tasks in various work centers.

Integrated approach to health treatment, demonstrating a high capacity to address the set of problems and issues related to health and the economy from a multilevel, transversal and interdisciplinary perspective.

Proactive public administration, which demonstrates a high capacity for leadership and effective management, with an investment plan focused on quality management and service innovation, where the patient is configured as the central element of the strategy.

Financial autonomy, so that, as far as possible, public and private sources of financing are diversified, thus dedicating additional resources to the development of new solutions.

Networks and alliances, which reinforce the weak points of the Basque system with knowledge, technology and specialized personnel. This collaborative approach is common in most of the world’s most advanced healthcare systems. A very interesting example is the cross-border initiative Innovation4Care, which has brought together private and public partners from Sweden, Denmark and Norway, from healthcare to industry, technology and science to create one of the most powerful healthcare communities in the world thanks to to the collaboration of all agents.

Continuous control of the strategy, measures and actions taken, so that their suitability for the proposed objectives can be verified, even in the face of changes in the economic and health environment. Efficiency depends, without a doubt, on introducing into the system mechanisms that allow its benefits to be adequately evaluated.

Another point in common that almost all successful innovation initiatives in healthcare management have is the willingness to change and exchange. Change of attitude towards a more open vision and change from obsolete management models that respond to needs of the past towards models in tune with the new environment, creative and collaborative. And exchange of knowledge, technology and people that allow us to increase the capacities of our health system and respond satisfactorily to the new demands of the economy and the market, especially in an adverse economic context such as the one we are experiencing.

Article published in The Mail on June 21, 2010