European countries need to work togetherBMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5395 (Published 29 September 2010) Cite this as: BMJ 2010;341:c5395
- Fiona Godlee, editor, BMJ
This week (6-9 October) health policy makers and academics will converge on the Austrian mountain resort of Gastein for the 13th annual European Health Forum. Discussions will focus on whether health care in Europe is ready for the future. On the agenda are healthy ageing, health literacy, the workforce, and inevitably finance. Underlying these issues is a growing push to harmonise and consolidate policies across Europe.
In their editorial, Martin McKee and colleagues describe varying approaches to the economic crisis (doi:10.1136/bmj.c5308). While most European Union member states face serious budget cuts, some have increased funding for health as well as investing to limit the health effects of unemployment. At a recent meeting in Moscow where health ministers emphasised the need to recognise how health and health services contribute to economic growth and how developments in other sectors contribute to health.
Ministers also compared ways of reducing cost, including reference based pricing and generic substitution of drugs. Smaller countries reported difficulties in negotiating with the drug industry. Others considered shifting cost from individual preventive measures to population based health protection and encouraging healthy choices. In her column Tessa Richards suggests that richer countries in the EU could learn from poorer countries that have had to find low cost methods of delivering care (doi:10.1136/bmj.c5341).
The challenges of achieving financially sustainable health care are clearly enormous. McKee and colleagues conclude that these will only be met if European countries work together. Horsley and colleagues take the same view about continuing professional development and accreditation (doi:10.1136/bmj.c4687). European countries have widely diverse approaches, creating huge problems for employers tasked with ensuring that doctors coming from any EU country are fit to practise. Seventeen of the EU’s 26 member states have compulsory CPD but only eight have consequences for non-compliance, and the focus is on process measures (did the doctor participate?) rather than outcome (was learning achieved?).
Could we move to a system of mutual recognition? The United States and Canada already have this in hand, and a group of several EU countries is working on it. They aim to agree on a set of core principles, values, and measures around which countries could adapt their own systems.
Horsley and colleagues point out that one barrier to harmonisation is the lack of good evidence that CPD improves practice. Alice Miller and Julian Archer partly confirm this (doi:10.1136/bmj.c5064). Their systematic review found little evidence that workplace based assessment is an effective educational tool, although there was some conflicting evidence that multisource feedback improves performance and practice. The studies they looked at were mostly non-comparative or observational and were of mixed quality.
But John Sandars says that the literature can guide those designing CPD systems(doi:10.1136/bmj.c5214). The message is that the learner must actively participate in the educational process and needs the support of a facilitator. Of course this is expensive, which brings us back to money. As Horsley and colleagues ask, who should pay for a doctor’s professional obligation to engage in continuous lifelong learning?
Cite this as: BMJ 2010;341:c5395