Innovation in Czech Healthcare Not a Black-and-White Situation
Technological innovations and their introduction into the Czech healthcare sector are among the key issues that will determine not only the future quality of services for Czech patients, but also, to some extent, the financial sustainability of the Czech healthcare system. Except for the general rise in prices caused by the growth of the national economy, innovation is the single most important factor for the increase in costs. The OECD study The Future of Health and Long-Term Care Spending shows that the introduction of new technologies, along with institutional innovations (and relative price levels in the healthcare sector), had a markedly greater impact over the last 20 years on the increase in healthcare costs than, for example, the frequently mentioned aging population. Yet the differences in the impact of innovations between particular countries are striking. While the innovation is the most important factor contributing to the rising healthcare-related spending for most countries, there are countries that have been able to actually save on adoption of innovation (e.g., Israel).
Nevertheless, innovations are in the context of the discourse on Czech healthcare; that is, viewed through a relatively simple but misleading black-and-white perspective. Innovation brings great benefits for patients, prolongs life expectancy in the event of serious illness, and can improve quality of life; at the same time, innovation poses a challenge because it makes Czech healthcare financially unsustainable. But there are reasons why this black-and-white view is often espoused. Looking at the spending data — for example, on medical devices — we must note that the average annual growth of about 6% is far above the rate of growth that would be accounted for solely due to inflationary pressure and the aging of the population. The best argument for this black-and-white view on innovation is provided by drugs for cancer and certain other high-cost diseases available in the specialized centers of care. Year-on-year increases in expenditure for these drugs averaged 15% over the last five years. At this rate of growth, it would take 20.2 years for these drugs to "swallow up" all of the current Czech healthcare budget. It is no wonder that the health insurers are raising the alarm and innovations are seen as a burden for the system.
By international standards, Czech healthcare services are currently doing very well in terms of quality and availability of treatment, faring very well in the Euro Health Consumer Index, in a comparison of international results. Taking into account overall expenditure, Czech healthcare takes third place in Europe in terms of cost-effectiveness. Nevertheless, the future does not look so rosy. Innovations such as biological treatment, personalization of treatment based on genetic profile, modern prosthetics, or / and predictive analytics in diagnostics can fundamentally change the results — as well as the costs — of healthcare. Increasingly, the ability to finance treatment will depend on how the healthcare system can optimize the use of innovations in general, and adopt those that have the potential to save money.
Saving money through innovation means primarily focusing on systemic innovation, based on health informatics, greater involvement of patients through modern self-diagnosis, and data-based treatment that reveals potential inefficiencies in the organization of care. These inefficiencies may take simple forms such as a discoverable duplicate examination, or they could be more difficult to discover, like late transition to palliative care. Unfortunately, given the past record of ICT projects within the Czech healthcare system, there is a high degree of skepticism surrounding big IT systems of innovation. This skepticism resulted in a very down-to-earth, unimaginative approach that focuses only on basics and ignores greater opportunities. Czech healthcare managers, in addition to the legitimate questions regarding costs, focus on partial technology solutions and make themselves busy by procurement management, as they are primarily interested in what server or software solution is needed or which vendor to choose. Paradoxically, ICT is often reduced to a "maintenance issue", and the potential transformative impact on the whole healthcare system is not sufficiently studied.
Healthcare policy makers should be asking different questions. Not what server or what specific ICT architecture does the hospital need, but what skills and achievements in terms of care do we actually want hospitals and other healthcare providers to offer? What communication channels are they able to use with the patient and with each other? What degree of sophistication in predictive diagnostics can we expect from them?
Even in the case of health insurers, the specific architecture of their ICT system is not important from the perspective of the patient/taxpayer. What is important is how they contribute to the quality and availability of healthcare. Can they distinguish the quality of care among individual providers? Do they use their data to direct patients to where they are likely to get the best care? Can they motivate providers to improve the quality of their services (within the boundaries imposed by reimbursement rules set by the government)?
The healthcare system the Czech Republic, and also in the greater CEE region overall, is currently at a crossroads. Citizens continue to receive high-quality services relative to international standards, especially given the limited amount of financing that they are responsible for (taxes, marginal co-payments). New innovations, which, in many cases, will mean the difference between life and death for a patient, will require an increasing amount of available funding. Similarly, the demographic situation of the Czech healthcare labor pool is not a reason for optimism. Czech physicians are getting older, and every chance to alleviate the pressure on them and increase automation should be welcomed. The ability to use innovations not only as a direct means of treatment, but also as a means for systemic change that can support financial sustainability, will determine the future ability of the Czech (and other CEE) healthcare services to keep pace with global advancements.
As either current or future patients, we should hope that the systemic approach to innovation and evidence-based health policies will prevail, and that CEE healthcare systems will fully exploit the potential of all innovations: Not just those that save lives directly, but also those that can save the money needed to buy the life-saving ones.