Chronic diseases: forcing change in EU healthcare management

Over one third of the European population above the age of 15 have a chronic disease and two out of three people reaching retirement age will have at least two chronic conditions, according to the World Health Organisation (WHO).

The number is expected to grow, leading to rising health care costs, lost productivity, and lower quality of life for the patients.

Between 70 to 80 percent of healthcare budgets across the EU are currently spent on treating chronic diseases, according to the European Commission.

And of healthcare budgets in general, 97 percent are spent on treating patients both with acute and chronic conditions.

Only 3 percent is spent on prevention, with chronic diseases being among the most preventable illnesses.

Chronic Disease Management

Traditionally, primary care has been provided by doctors, usually in small practices with few support staff focussing more on acute episodes of care rather than on recurrent cases of chronic conditions.

But chronic disease management is a way of coordinating care that focuses on the entire clinical course of a disease - across care networks and with the patient more actively involved.

The patient is the day-to-day manager of disease. But to support patients in controlling their disease, a better environment needs to be created where citizens have more ‘health literacy’.

While most European countries have already implemented some sort of strategy to control the burden of chronic disease, their approaches vary greatly.

Most chronic disease plans show that a successful management plan can benefit the care progress, increase patients’ well-being, and lower healthcare costs.

Fragmentation - a major obstacle

A report by the World Health Organisation says that Disease Management Programmes focussing on a single disease have “increasingly come under pressure”.

“Doctors and researchers admit they have focused on a straightforward disease management approach because it was relatively simple.”

The European Patients’ Forum (EPF) says that chronic-disease sufferers regularly say that a fragmented health and social care system are a “major obstacle” to quality of care.

Problems include internal resistance to change, as well as a fixed way of spending budgets.

“The result of this organisational and financial fragmentation is that patients often need to actively “fight the system” just to get the services they need”, says EPF.

While Scandinavian countries are generally considered much more advanced in dealing with chronic diseases, there has been no large-scale evaluation of the situation across Europe.

One EU project (CHRODIS) looks at chronic care plans across Europe but is focused mainly on cardiovascular diseases, strokes and type-2 diabetes.

“It is really very important to extract the best knowledge that has been developed in the past few years of experience in managing chronic diseases in order to know what we are doing in Europe,” says Juan E. Riese, director of the CHRODIS project.

“Europe is a very complicated picture - it is a sum of countries, regions, culture and traditions,” he adds.

“The aim of the whole project is really to identify what is going on in the area of chronic disease management.”

Prevention and communication

There are also differences in how EU member states fund their healthcare model.

Some are funded by taxes while others are funded through a social health insurance. The revenue source can have an impact on the integration of care models.

Another step towards improving European healthcare and chronic care management is eHealth - healthcare practice supported by electronic processes and communication - to better facilitate care to patients.

The incoming EU health commissioner Vytenis Andriukaitis has already pledged support for improving healthcare systems, although the commission has limited power in this area.

“I will support efforts to make health systems more efficient and innovative; so that they can provide equitable healthcare to all citizens,” he said.

Andriukaitis also said he will focus on “prevention” over the coming five years.

“I intend to put much focus on enhancing prevention. I believe that the more health systems invest in prevention now, the less they will pay in treatment in the future,” he added.