Gain from quality health care
A major problem in the overall design of today’s health systems is that far too little systematic effort is made to measure accurately – and reflect on – the real value that alternative strategies and methods might have in reducing a given health problem for the population. What is the relative effectiveness and cost of the different methods to prevent, diagnose and treat, for example, allergies, heart disease and depression?
There is an urgent need to find a more unifying management concept – one that will stimulate the search for better quality and reward innovations, not stifle them.
The measurement of health outcomes – using internationally agreed indicators at the level of populations – offers such a unifying concept with which to compare the relative value of health promotion, disease prevention, treatment and rehabilitation programmes.
The European health for all indicators and database provide a unique tool for comparing the relative success of all the 51 Member States’ attempts tostrive towards the regional health for all targets. Never the less, much more should be done within countries to use this approach and refine it to suit local needs, as a tool for strategic decision-making. A crucial problem in today’s health care is that the out come of clinicalcare for similar patients often shows large variations among countries, regions, hospitals and individual providers – even when the material, financial and human resources employed are the same.
A major reason for this is that such differences are not recognized because the data are not collected. There is great hidden potential for substantially improving the quality and cost–effectiveness of patient care. So far, however, only a few systematic efforts are being made to ensure that such health out comemeasurements are part of daily practice. The systematic measurement of health outcomes in clinical care – using internationally standardized quality indicators, and with the results fed into databases where by the outcomes can be compared with those of peers – is an indispensable new tool for continuous quality development in patient care. Such health impact measurements, as a start to the process of quality of care development, together with greater emphasis on evidence-based medicine, can providenew tools for the assessment of technology and for more effective and efficient application of diagnostic and curative interventions.
They can identify what works, what is necessary and what is not. This permits a scientific approach to identifying promising new interventions and to reducing any unnecessary procedures, pharmaceuticals and equipment. It can also identify resources that can be released to help meet some of the increasing demands on the health sector arising from an aging population, and the steady introduction of more complex health care technologies.
Resources for health care
The funding of health care should ensure equity and sustainability. Whatever system is used, governments must ensure that it provides universal coverage and access to health care, as well as containing over all costs. As concluded by the 1996 Ljubljana Conference on health care reform, there is no room for unrestrained market activity in the funding or provision of a social good like health care.
More over, market mechanisms targeting the individual or funding institutions have been not ably less successful in terms of equity and efficiency than those targeting hospitals and other health care providers. Payment systems for primary health care providers that combine elements of capitation, free choice of provider and fee-for service, foster better possibilities for managing the system to achieve high quality, cost-effective use of resources, user and provider satisfaction, and a focus on health promotion and preventive services. Educational programmes for health care providers and managers should be based on the principles of the health for all policy.
Technical and managerial capacity-building will need to be enhanced at all levels and across sectors, with emphasis on health impact and action. In most Member States, public health infrastructures and functions will require strengthening and modernization in line with HEALTH21. The education and training of public health professionals needs to prepare them not only for their technical work, but also to act as enablers, mediators and advocates for health and population based action in all sectors. Educational programmes for professional groups, such as architects, engineers, economists, journalists and sociologists, need to provide the necessary knowledge, motivation and skills tosupport multisectoral action for health.
To create a broad societal movement for health through innovative partnerships, unifying policies, and management practices tailored to the new realities of Europe
The collective power of the people of the European Region to shape the future is now more compelling than ever before. Governance is the sum of the many ways individuals and institutions, public and private, collectively solve problems and meet society’s needs.
It is a process through which conflicting or diverse interests may be accommodated and cooperative action taken. It includes formal institutions empowered to enforce compliance, and informal arrangements to which people and institutions have agreed. In the European Region today, the role of central government
is changing in many countries. Governance based on health for all therefore involves not just governments but also non governmental organizations, civil society and the private sector in health development schemes.
The role of research and information
In many countries, health policies and programmes should be more clearly based on scientific evidence. Health research policies and strategies should be based on health for all principles and needs, striking a better balance between basic and applied research. Communication and cooperation between the scientific community and decision-makers for the application of newknowledge to health development needs to be strengthened in most countries.
If all existing knowledge about which health approaches work and which do not were fully applied, this would have a major impact on improving health and protecting the environment. Each coun- 29 Managing change for health try should have a mechanism for systematically identifying, each year, the evidence of new successful methodsproduced by international or nationalresearch.
A decision should then be made as to any changes that should be made in that country’s health sector as a result.
National and local health information systems are a prerequisite for the development and monitoring of effective, efficient and equitable health policy. Evaluation and monitoring systems will determine whether the targets and objectives are being met and which issues require extra attention.
Health information should be relevant for and easily accessible to politicians, managers, health and other professionals and the general public. At all levels, good governance for health requires transparency, accountability and incentives to promote participation.
Managing change for health 30Engaging the resources and expertise
of the media and communication sector, particularly the Internet and television, is a great opportunity to inform, educate and persuade all people of the individual and collective importance of health.
It is important to monitor and assess the ethical, scientific and social implications of research in medical technology, and in particular those of research in genetic technology.
Geneticknowledge can greatly improve preventive and therapeutic options, but its application should respect human dignity, autonomy and justice. Involving the public in the debate around genetics can ensure that democratic decisions form the basis for future policy choices.
Health for all policies and partners
Health for all is an integrated and forward-looking policy framework for setting priorities, choosing strategies and mobilizing resources for action for health throughout society. A national, targeted policy based on health for all values is the key to providing motivation and
setting a framework for policies and action in regions, cities and local communities, and in settings such as schools and workplaces. By establishing values, settingtargets and mapping out strategies to achieve them, a health for all policywill guide and facilitate implementation.
It is extremely important, when planning national policies and programmes, to engage those who are meant to implement the policy, that is senior leaders in, for example, health and other ministries, national associations of health professionals, universities and national associations of local municipalities. A wide process of consultation, before final adoption by parliament, is a very good way of ensuring broad support from the whole of society. Similar principles should be applied to health for all programmes atsubnational and local levels as demonstrated, for example, by members of the European Regions for Health and Healthy Cities networks.
Encouraging all partners to adopt the health values outlined in HEALTH21 will influence actions by individuals, organizations, businesses and households.
Emphasis should be placed on building networks, alliances and partnerships for health at national, regional and local levels, and on empowering people to take action. By identifying and taking into account the mutual benefits of investment for health, all sectors stand to gain.
However, integrative and participatory planning has implications for those governments that are not yet ready for such a holistic approach. Institutional reforms and mechanisms may be needed in a number of Member States to promote cooperation in implementing policies and plans, to facilitate the decentralization of structures, to involve different sectors, and to achieve better coordination within government.