08 / 03 / 2016
Person-centred care in Europe: a cross-country comparison of health system performance, strategies and structures
The Picker Institute, February 2016
This briefing by the Picker Institute provides an overview of health systems’ performance and strategies in person-centred care across Europe. It focuses on five European countries as exemplars and highlights general learning from them. In each country, the briefing looks at both policy and practice in areas linked to person-centred care, including patient choice, patient information, patient involvement and public satisfaction with the health system.
The report’s author notes its limitations, in particular that its scope focuses only on five countries in the more developed nations of Europe; the limited data available to support quantitative comparisons of performance showing a need for more evidence, especially on patient experience of using health services internationally, to supplement the currently limited evidence base.
While all stakeholders in healthcare have important roles to play in providing more holistic, person-centred understanding of value, the role of providers is key, according to the author. Moreover this report recommends that providers’ boards and senior leadership teams should commit to the value agenda and the discipline to progress through the inevitable resistance and disruptions that will result.
The international context for patient centred care is also taken into account. A forthcoming “global strategy on integrated people-centred health services 2016-2026 for the World Health Organization” has called for a paradigm shift in the way health services are funded, managed and delivered. In addition, this report suggests that a global people-centred strategy would help to achieve universal health coverage, improved access to care, improved health and clinical outcomes, better health literacy and self-care, increased satisfaction with care, improved job satisfaction, improved efficiency of services and reduced overall costs.
Key findings on quality and efficiency levels across the five European countries include:
- As far as the NHS in England is concerned, the paper notes that recent inquiries on the failings at Mid Staffordshire NHS Foundation Trust and the Freedom to Speak Up review have led to greater prominence placed on delivering high quality, safe and compassionate care. By international standards, access to care is excellent, but according to the latest OECD Health at a Glance report, the quality of care is still patchy and lags behind many other OECD countries.
- The German health care system is accepted worldwide as providing good quality care, short waiting lists and attentive service. A key element of this is the significant amount of money spent on health care. Greater efforts are needed to improve continuity of care for people living with long term conditions.
- In Italy access to care is automatic and universal for each citizen and indicators of quality of care for both primary care and hospital care are above the average in many areas. However, Italy is lagging behind in some areas, like long-term care and prevention of non-communicable diseases. The Italian health care system has been recently considered the third most efficient globally, as judged by Bloomberg Rankings.
- In the Netherlands, the introduction of universal private insurance is said to have created a culture of practice innovation. This has resulted in more focus on prevention and delivery of more care for chronic conditions through primary care. As for quality indicators, the Netherlands spends more money on short-term admissions for mental and behavioural disorders than other OECD members. Almost one-quarter (23%) of total expenditure at Dutch hospitals including mental health institutions is on account of mental health care services.
- The Spanish healthcare system is shown to have significant measures adopted nationally in the past few years in order to achieve better efficiency: salary reduction of 7.1 per cent; slight increase in working hours for GPs and nurses in primary care; reduction in pharmaceutical expenditure; reduction of the national health budget by 13.7 per cent in 2012 and 22.6 per cent in 2013. Consequently, there is evidence of gaps in the continuity of care for the growing number of people living with one or more long-term conditions.
Cost-effectiveness of person centred care: the value-based approach
The adoption of value-based models to healthcare has taken different shapes across Europe. The paper describes how different health systems are pursuing their own value agenda:
- England and Germany have been at the forefront in introducing many aspects of value based healthcare, including cost benefit assessment of health technology and evidence-based protocols for individual health condition.
- The Netherlands have also been early adopters, with the latter benefiting from its position as a smaller country with a collegial community of healthcare providers.
- In contrast, in other large European economies such as Italy and Spain, implementation of value based healthcare has been fragmented, with individual institutions often taking the initiative.
In conclusion, the report explains that the overarching approach by all five European countries is to make person centred care provision and cost-effectiveness the fundamental elements of healthcare systems. It accepts that many barriers to full implementation still exist in these countries. The briefing also recommends that patient involvement needs to be in all policymaking that affects patients’ lives.