The quality of spending on healthcare and long term care be improved in virtually every EU country

The Sustainability Index as A Benchmark Indicator of Health System Vitality

Each countryโ€™s health system is different, and various subjective articles have been written on this topic. Many have merit, however, they do not always provide the holistic measures required to provide to a comparative, and practical, analysis. The Sustainability Index, however, accomplishes exactly this in an engaging and quantitative format.

Setting the scene

The key to the Sustainability Index is that it is based upon averages of individual measures within five โ€˜Vital Signsโ€™ - Access, Health Status, Resilience, Innovation and Quality.

This aligns with the European Commissionโ€™s Joint Report on Healthcare and Long-term Care Systems & Fiscal Sustainability which presents policy challenges for healthcare and fiscal sustainability in similarly categorised areas.

The โ€˜Accessโ€™ pillar, for instance, addresses this by incorporating data points from out of pocket expenditure for healthcare, geographical coverage, access to screenings, psychiatrists, nurses, hospitals and physicians. When coupled with the โ€˜Health Statusโ€™ pillar, which includes disease death rates, it gives a picture of the effectiveness of health systems based upon the causal nexus of availability and effect.

Healthcare and long-term care are integral to all European countriesโ€™ social protection programmes, as they contribute to about 10% of EU GDP - sustained productivity of this sector is essential to ensure healthy and happy populations.

In addition, the Index considers both demographic and non-demographic factors, which affect the fiscal sustainability of healthcare expenditures.

Considering the policy challenges of ageing populations, there is a need to apply objective benchmarking criteria to not only incorporate varied parameters but also present them in an objective and easily usable format.

The Sustainability Index succeeds in representing and quantifying this challenge by adding another dimension - โ€˜Resilienceโ€™. This measure considers factors such as age of physicians, old-age dependency ratio, working hours, tobacco consumption, alcohol consumption, obesity and graduate nurses and doctors.

As we talk about the healthcare expenditures, it has been shown that โ€˜Innovationโ€™ in medical technology is a major driver of such expenses*. A countryโ€™s ability to foster innovation is an important measure of success in its healthcare provision. Again, this is addressed by assigning scores to R&D spending, research publications and patents. Generating breakthrough treatments is important, but greater focus must be on translating it into usable and cost-effective technologies available to the public en-masse.

The final pillar, โ€˜Qualityโ€™, considers the three most important indicators of healthcare delivery effectiveness - happiness, health literacy and life satisfaction.

These speak to the quality of life as affected by health and form the ultimate yardstick of healthcare system outcomes. A World Happiness Report, 2018, found that the health and perceived health affects the happiness score more than income and age for certain populations. A health system which scores high on the innovation and access pillars but scores low on the satisfaction index still contributes to unhappiness due to unplanned out of pocket expenses.

While health illiteracy does not plague the European nations to the extent it does African or Asian regions, it does significantly impact the exercise of choice and informed decisions which impact every vital indicator in this index.

Final word

I would like to echo the conclusion of the European Commissionโ€™s Joint Report on Heath Care and Long term Care Systems & Fiscal Sustainability which mentions that the quality of spending on healthcare and long term care be improved in virtually every EU country.

A sustainable improvement relies on accurate methods to record baseline performance and performance improvement while relying on practical and trend-able metrics. Coherent governmental framework and public spending on healthcare must be coupled with fiscal responsibility, which should be measured through metrics of effectiveness on a regular basis.

The Sustainability Index has the potential to become one such metric, which is applicable on both a local and global scale.

* Sorenson, C., Drummond, M., & Bhuiyan Khan, B. (2013). Medical technology as a key driver of rising health expenditure: disentangling the relationship. ClinicoEconomics and outcomes research : CEOR, 5, 223โ€“234. doi:10.2147/CEOR.S39634

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