The Single Market for Healthcare in Europe: Learnings for the U.S.

When I asked my longtime colleague and friend Robert Mittman, with whom I collaborated at Institute for the Future for a decade, how he managed international travel and jet lag, he said simply, “The time zone you’re in is the time zone you’re in.”

This lesson has stayed with me since I received Robert’s advice over twenty years ago.

Over the next two weeks, as I work alongside colleagues and clients in the EU and soon-to-Brexit UK, I am in time zones five and six hours later than my home-base of US Eastern Time. But the time zones I’m working and living in are the time zones I’m in. Here, healthcare is evolving toward a Single Market in the EU. [When I’m in the UK later this week, I’ll address the challenge for the UK, Brexit and the National Health Service. This post focuses on the larger EU of which, for the moment, the UK is a member].

While national health services funding and delivery modes will still have local models of organization and control, some over-arching concepts and cooperation are being forged. Two key issues are in my work-radar this trip: digital health cross-border, and health innovation funding.

First, some context: in 1957, six European nation-states came together to create the European Economic Community (France, West Germany, Italy, and the Benelux countries). Today, the European Union has grown to 28 countries, and priorities have evolved to bring these nations closer together as a health community.

Last month, a document synthesized a vision for transforming health and care in a digital single market, adopted by the European Economic and Social Committee (EESC). In summary, three over-arching issues come out of the paper: ensuring health citizens’ secure access to their health data within nations and across EU borders; enabling personalized medicine through the shared European data infrastructure; and, assuring citizen empowerment with digital tools for feedback and person-centered care.

This report included survey data conducted among 1,400+ EU citizens to gauge their interests and concerns about digital health, finding that:

• 83% believe that sharing health data could be benefit to improve treatment, diagnosis and prevention of diseases across the EU
• 73% see improved possibilities for medical research as a reason to support cross-border transfer of their personal health data — greater than for the purpose of their own treatment (68%)
• Over one-half of EU health citizens are concerned about the risks of health data privacy breaches and cybersecurity.

Nine in ten Europeans say that citizens should be able to manage their own health data, the pie chart illustrates with data from the survey, with two-thirds “strongly” agreeing with the idea.

Note that 90% of health organizations agree (NET strongly agree + agree) that citizens should also manage their own health data.

The rationale beneath self-control of health data are the potential for better patient self-care/management, value for the healthcare system with improved outcomes and efficient care pathways, and economic and societal value translated into people being able to more fully participate in social and economic systems, continuing to earn incomes and bearing lower healthcare costs.

On the downside, major barriers to peoples’ willingness to share their health data center on risks of privacy breaches and cybersecurity risks. For organizations, the biggest concern is the “heterogeneity of electronic health records” and data quality and reliability. The former is a pain point especially shared by U.S. providers — the lack of interoperability.

There remains a gap in European health citizens’ access to digital health and care. That is, peoples’ demands and interests in accessing digital health tools and access channels isn’t met by the supply side of providers in the EU. The report concludes with the need for more and sustained EU investment in research and innovation, sharing best practices across EU nation border, and harmonizing approaches for feedback on quality.

Health Populi’s Hot Points:  The EU Digital Single Market report on healthcare transformation gives us a snapshot of the consumer (EU health citizen) demand side for digital health access. What of the supply side and innovation to meet those needs?

A new analysis from McKinsey identifies opportunities for investing in European healthcare. These hot areas range from infrastructure investments to niched patient-facing self-management tools. Being successful in this market requires deep knowledge of European healthcare systems — regulations, reimbursement schemes, the private healthcare providers, among cultural and clinician workflows region-by-region.

If you’re intuiting a fragmented landscape, you’re reading me right.

The McKinsey team characterizes this landscape in the graph here, doing a fine job at arraying the fragmentation continuum with market potential by healthcare segment. For example, Oncology clinics are extremely fragmented but have tremendous untapped market opportunity. At the opposite extreme, dialysis clinics are highly consolidated with low opportunity for investors, McKinsey gauges.

Among McKinsey’s recommendations is one I’m especially focusing on: forging “unofficial networks,” coupling with vertical integration.

What I know-I know from my time in healthcare working both in the U.S. and Europe is that it takes a village to re-imagine and re-make healthcare with the Quadruple Aim in mind. That village crosses siloes and market segments, and will design, build and leverage digital platforms that take advantage of data — created both in healthcare settings and via person-generated wearable tech and home/person-based remote health monitoring tools.

While our national health systems differ in terms of payor regimes and workflows, there’s one universality we find through comparing the EU report with the many health consumer surveys I cover here on Health Populi: patients around the world want access to their health data, and see the benefits of health data altruism: sharing with other patients and health citizens.

One of many questions for U.S. healthcare that emerges from my look into remote health monitoring across Europe is how the 50 U.S. States can forge a national telehealth approach, given professional state licensure regulations. There are virtual health programs operating across Europe — countries — whereas, in the U.S., it can be difficult to get a second opinion organized between a doctor in, say, Pennsylvania and a colleague-specialist in New York state.

With the understanding that patients want access to healthcare data, and to those expert consults between doctors working across U.S. state borders, I leave you with a link to an investigative article on NBC News last week about U.S. patients’ continued difficult access to “their” own data. This story features the profoundly personal experiences of close friends in my own healthcare community, Regina Holliday and Dave DeBronkart.

 

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