Day One Afternoon: Monday, 4 April 2005

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Plenary session: How is the global healthcare economy evolving?

One of the favorite new words that has found its way into common English usage is «prioritization», or, put simply, a ranking of the urgency of solutions. As is often the case, the usage of such a word can be a way of avoiding the tackling of an unpleasant task; in other words, a form of political correctness.

The further the distance from the patient and the reality of disease and human suffering, the easier it is to believe in these euphemisms. And yet, if indeed resources are limited, it would seem fair to abandon the Utopian notion that the treatment agenda should be all encompassing and to adopt a more practical cost/benefit analysis in deciding where scarce resources should be directed; in other words to distance oneself from the reality of the patient (for surely no individual, no matter his views on rationing, would choose a less than best course of treatment for a sick loved one). That is, assuming that the resources are really in short supply. Facile notions are therefore in this case the enemy of solutions.

To avoid euphemisms and make a wise choice requires a great deal of knowledge about what consequences will tumble out of the various alternative decisions. If there are no options, then the mind is brilliantly clear. Under those circumstances, one may seize the following advice: When you come to a fork in the road, take it.

This Plenary Session will attempt to discover if there is indeed a clarity to be achieved, if proximity to the patient is in fact reconcilable with the assumption of an in principle limit to resources for healthcare.

Round Table 1: How to improve the global regulatory environment for healthcare

The evolution of the global healthcare economy will be influenced by and will itself influence the regulatory environment of medicine. It will also be profoundly affected by the changing demography in the developed and developing world.

Innovative and complex therapies will require a global regulatory structure that is designed to enhance patient safety to expedite the introduction of new therapies and technologies, and to diminish the cost of discovery.

In ever increasing numbers everywhere, citizens will expect medicine to extend longevity and enhance the quality of life. Thus the demands upon healthcare systems will grow exponentially in the coming decade. If resources are indeed limited, the question must be asked whether or not a structure exists which can maximize this panoply of diverse goals.

Furthermore, is the current system for the ongoing evaluation of the therapeutic efficacy of drugs adequate? Do the various agencies involved in this process need to be interconnected in new ways and at the same time independent? Can generalizations be made about how to adjust the regulatory environment worldwide?

Round Table 2: Does the Swiss model translate? Strengths and weaknesses

In many respects, Switzerland’s consumer-driven healthcare system would seem to be a model towards which other industrialized countries should strive in the pursuit of high quality care and equity. Why then, do the Swiss complain? And do the Swiss fully understand the insurance plans to which they subscribe. Does this reflect the possibility that the gains from consumer-driven healthcare may be evanescent or will the market forces of quality and efficiency lead to increasing consumer satisfaction?