Sunday, September 21, 2008

8-10th June, 2008 Washington DC
This year’s
AcademyHealth conference was held in the sweltering heat of Washington in June, a city where summer is always hot and sticky but which this year was experiencing what was, for it, a heatwave. A strong disincentive to leave the conference venue! With my colleague Bernd Rechel, we had organised a session based on our forthcoming book on hospital. This is the product of a collaboration between the European Observatory and the European Health Property Network.. After introducing the scope of the study, which draws on the most innovative ideas in hospital configuration and design from across Europe, we looked in detail at some of the most interesting examples. One was Northern Ireland’s regional hospital plan, which will create a network of hospitals offering different levels of care, primary care and rehabilitation facilities, and care in patients’ homes. Another was the Orbis Medical Park, near to Maastricht, in The Netherlands, where a new hospital is being designed to support clinical pathways and processes rather than, as is more usual, ignoring them. The third was the Alzira Hospital in Valencia, Spain, which has implemented a new financing model that was initially quite problematic but is now working well, in contrast to the UK’s Private Finance Initiative, which is now suffering what seem to be terminal death throes.
As always, many of the presentations at the conference focused on the problems that arise when you fail to provide universal health coverage. A growing number of states are now taking initiatives themselves, typically by requiring people (and their employers) to purchase insurance schemes. However, for a European the overwhelming impression is of just how complex these schemes are, and also how many holes there seem to be in them. It is difficult to see how any of them will ever really work without addressing some of the reasons why health care is so expensive in the USA, in particular the high cost of pharmaceuticals and the huge administrative costs of maintaining a multi-payer system.
There is, of course, an election coming up but it is not obvious that either candidate has a solution. What’s more, we heard that health reform is not high on the concerns of ordinary Americans, and is training far below where it was when Hilary Clinton attempted to do something in the early 1990s. Instead they are concerned about the economy and the wars in Iraq and Afghanistan. Yet this may change, as manifest by the growing evidence that people are having to cut back on expenditure to meet health care costs. Something must be done sometime, but I suspect things will have to get a lot worse before they get better.

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