EH 5_2015

Copyright:Shutterstock/Zerbor EUROPEAN HOSPITAL  Vol 24 Issue 5/15 4 NEWS & MANAGEMENT Death risk rises over weekendsNew studies reveal the heightened risk of death that patients face if admitted to hospital over a weekend, Mark Nicholls reports Researchers have studied what effect the day of hospital admission has on death rates across England in 2013- 2014, as well as on hospitals in other countries, such as Australia, the USA and The Netherlands. Professor Paul Aylin and team at Imperial College London found that the heightened risk of death after weekend hospital admission – the so-called ‘weekend effect’– is a fea- ture of several developed countries’ healthcare systems, i.e. not just a problem in England. Drawing on international data from the Global Comparators pro- ject - a database to which more than 50 hospitals in the UK, USA, Australia, The Netherlands, Italy, Spain, Belgium, Finland, Norway and Denmark contribute – the research- ers looked at data on almost three million admissions between 2009 and 2012 from 28 metropolitan teaching hospitals. They focused on deaths occurring in hospital within 30 days of an emergency admission or elective surgery and found that, after taking account of influential factors, the risk of dying within 30 days for emergency admissions at weekends was 8% higher in 11 hos- pitals in England, 13% higher in five of the US hospitals, and 20% higher in six Dutch hospitals, though there was no significant daily variation in the heightened risk of death in Australia. ‘Although these results are limited to the small number of participating hospitals, the international nature of our database suggest that this is a systematic phenomenon affecting healthcare providers across borders,’ the researchers conclude. ‘Further investigation is needed to under- stand the factors that give rise to the weekend effect.’ Focusing on the UK – examining data for 2013-2014 – the team said their findings suggest a generalised ‘weekend effect’ which can be partly explained by the reduced support services from late Friday through the weekend, leading to disruption on Monday morning. The analysis, carried out by University Hospital Birmingham NHS Foundation Trusts and University College London, stressed the need to ‘determine exactly which services need to be improved at the week- end to tackle the increased risk of mortality’. In the UK an average of 2.7 million patients were admitted to hospital on each weekday, while an aver- age of 1.2 million were admitted on a Saturday and one million on a Sunday. Saturday and Sunday admis- sions were more likely to be emer- gencies, 50% and 65% respectively, than on weekdays (29%) and length of stay was also higher for patients admitted at the weekend. Patients admitted to hospital at the weekend were more likely to be sicker and have a higher risk of death, compared to those admitted during the week. Researchers discovered that around 11,000 more people die each year within 30 days of admission to UK hospitals on Friday, Saturday, Sunday, or Monday compared with other days of the week. The findings from both studies – published in The British Medical Journal - come amid proposals for seven-day working week within the NHS and follow health secretary Jeremy Hunt’s recent call for hospi- tal doctors to work at weekends to improve quality of care and reduce deaths. Professor Aylin suggests more research is needed to determine the ‘complex’ relationship between staff- Dr Stanimir Hasurdjiev (also Hasardzhiev) is a board member of the European Patients’ Forum as well as a member of several other regional and international organisations and networks. He is among the initiators and found- ing members of the joint initiative of the European Patients’ Forum and the Bulgarian National Patients’ Organisation – the Patient Access Partnership – a multi- stakeholder platform for finding innovative solutions to reduce inequities in access to healthcare in Europe ing levels and services, and patient safety and that changes to how the NHS provides weekend and out of hours care ‘will be an ideal opportu- nity to evaluate their impact on the weekend effect’. The UK government has confirmed that plans for seven-day services will focus on the delivery of urgent and emergency care, rather than seven- day elective care. Dr Mark Porter, the BMA (British Medical Association) council chair, said: ‘The BMA agrees that seven-day urgent and emergency care should be the priority for investment. This will ensure the sickest patients have access to excellent care, around the clock. The focus should be on bring- ing this up to the same high stand- ard across the week before looking at whether the NHS can afford to expand routine, elective care. ‘More detail is now needed on how seven- day services will be provided at a time when existing staff and ser- A road to purchasing equality must be built Dying for equal access to drugsNew drugs – especially for cancer care – are increasingly expensive. How, in times of austerity, can patients’ access to new medicines be ensured? EH reporter Michael Krassnitzer sought answers from Dr Stanimir Hasurdjiev, Board Member of the European Patients’ Forum ‘Today, we see innovative new treat- ments for diseases that had once been untreatable; there is also per- sonalised medicine that seeks indi- vidual approaches for each patient. Such advances come with a price tag,’ Dr Hasurdjiev underlined. ‘Even wealthier countries struggle to meet the costs. Therefore, the time has come in Europe to act and to estab- lish a pricing system that is really fair, based on solidarity and on the fact that all European citizens have the right to innovation.’ Where is access to new medicines good and where is access to new drugs limited? ‘Traditionally, there are some coun- tries in Europe where patients and citizens have very early access to medicines, for example in Germany, the United Kingdom or France. However, in others, mainly in Central and Eastern Europe, the time span between approval of a new drug and accessibility for patients is far longer – it can take two years, or even more, before the patients and citizens can benefit from an innovation. For example, in Bulgaria, where I live, the law says that the costs for a new medicine will only be reimbursed when five other countries already do that. Then the local reimbursement process starts, but it can take months before a decision is made. Moreover, new medicines are reimbursed only from 1 January of the year following the year of the positive decision for reimbursement. You can imagine that it can take really long before patients can benefit from the innovation.’ Is that for monetary reasons? ‘It’s a complex problem, but money is definitely a big obstacle – especial- ly for countries with a lower gross domestic product (GDP), where the pressure on the healthcare budget is really high. The European pricing system keeps the prices more or less at the same level for all European countries – which is not always fair because of the substantial differences in GDP between the wealthier and the poorer countries – but the peo- ple in poorer countries have to pay similar prices because of the external reference price system.’ How does this external reference price system work? ‘An external reference pricing sys- tem means that each county can compare prices in other countries. In Bulgaria, for example, each pro- ducer or importer of pharmaceuti- cals has to offer the lowest possible price of all EU-countries. However, Bulgaria is a reference country for Spain. Thus, even if a pharmaceuti- cal company acknowledged the eco- nomic situation and the constraints and offered Bulgaria a lower price, it would immediately influence the bigger and more profitable market in Spain; and, from Spain, this price could spread to any other European country. ‘This was a very good mechanism to reduce prices as long as there were fewer members of the European Union and the Member States were similar in economic development. Today, there are so many Member States that are economically not as highly developed – and that creates definitely problems.’ Could this system change? ‘This debate is on-going in Europe. I can see a shift to more openness to discuss the issue. One option to con- sider is the so-called differential pric- ing system. In other words: tailored pricing depending on a country’s ability to pay – based on GDP – and its willingness to invest in healthcare. But it’s tough because it would need a fundamental change in European legislation.’ What kind of change do you mean? ‘First, the wealthier countries have to agree that poorer countries have the right to pay less. Secondly, and that’s a bit more difficult, there has to be a guarantee that cheaper medicines from a poorer country won’t appear in more wealthy markets. In Europe, we have the fundamental rule of free movements of goods: Everyone can buy cheap medicines in Bulgaria and sell them on wealthier markets, such as Germany or France. This is one of the reasons why most of the companies keep similar prices for the whole European market.’ What should be done concretely? ‘Probably we should think of ways to restrict parallel trade – at least within a cluster of countries with similar economic development. The most important objective is to ensure that every European patient has simi- lar access to innovation in his own country. Poor access to new drugs in a Member State creates not only problems for this state, but also for other states. The lack of adequate healthcare in your country, that can save your life, or the life of your child, is a very good reason to migrate and to find a country where you have better chances for survival. (c)Nacionalnapacientskaorganizacia(NPO) The EU Today we search in vain f Report: Mark Nicholls Two of the core tenets underpin- ning the European vision - the euro and the Schengen agreement – are coming under unprecedented threat through financial challenges and the impact of the refugee crisis across the continent. It is these critical issues that keynote speaker Professor Martin McKee tackled during the open- ing plenary session at the recent European Health Forum in Gastein in Austria. Within the main theme of this year’s Conference, ‘Securing health in Europe - Balancing priorities, sharing responsibilities’, the intri- cacy posed to the capacities of European Health Systems by those fleeing conflict-torn home countries will be high on the agenda. Professor McKee said the global financial crisis had ‘exposed the fault lines in the design of the European stability mechanism’. In addition, he feared the refu- gee crisis has placed the Schengen agreement - among the 26 European countries that had abolished pass- port and other border controls - under extreme pressure with exam- ples of some governments taking actions to reduce free movement. As Professor of European Public Health at the London School of Hygiene and Tropical Medicine, he continued: ‘In both these cases, the measures that must be taken are obvious, except, it seems, to European governments. ‘It is also clear that we need a fair system to distribute refugees across the European Union, regard- less of race or religion, yet we have the remarkable situation, in the 21st century, of one member state refusing to take Moslems and others refusing to participate at all. ‘This is happening at a time when the ordinary people of Europe are opening their arms to welcome those who are fleeing conflict and persecution, adding a new word – Wilkommenkultur - to our vocabu- lary.’ Professor McKee, who established the European Centre on Health of Societies in Transition (ECOHOST)

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