Three countries, three systems, many lessons to learn

Sciana brings together health leaders from three different countries: Germany, Switzerland and the UK. Each country has well-developed and deeply entrenched health care systems, each with their own strengths and weaknesses, successes and failures. On the second day of the inaugural Sciana meeting, members opened their discussions by sharing insights from their own countries’ health care systems, considering how the system was established, its current state, and expected future trajectory and reforms. Members were surprised by some of their peers’ comments. An exasperated Swiss remark that their country has too much money (a fact that hinders significant reforms of the health care system as many Swiss assume they can simply pay for a better service if they require it) received astonished laughs from their British counterparts, whose publicly-funded National Health Service (an institution “so ingrained in the national psyche” that some refer to it as the country’s religion) is facing funding and staffing crises.  German admissions that their country does not have electronic patient records, significantly hindering information sharing between its decentralised and somewhat disconnected systems of in-patient, out-patient and at-home care, drew raised eyebrows for a country often lauded for its efficiency. An electronic records system was supposed to be implemented by 2006, “but it’s 2017, and here we are,” remarked one German member, grimly.  For the Swiss, the high level of politicisation of the UK system was unfamiliar and unwelcome (indeed the future of the NHS is a key issue in the upcoming general election in June). The Swiss prefer a more democratic system (with citizens voting in referenda on various measures) that is also also grassroots-led and decentralised. “We have a lot of innovation on a small scale, at hospital level,” explained one Swiss member but attempts to scale up or centralise these reforms have mostly failed. But despite these distinct differences, the three countries also face many of the same challenges within their health care systems. All are facing the same macro challenges such as ageing populations and shifting demographics. Switzerland, Germany and the UK all rely heavily on foreign workers in their health care systems. This is an acute issue for the UK at the moment following the Brexit referendum, and while the Swiss system lures German health care professionals with its higher salaries, Germany in turn is reliant on Italian and Eastern European labor to fill in the gap. All the countries’ health systems are not only well-developed but also deeply entrenched, making wholesale reform difficult, regardless of the country’s political or public appetite for such reform. And each country team talked about the difficulties of integrating services vertically between sectors, such as acute, primary and social care systems, and sharing best practices horizontally across different cantons, Länder or devolved nations.  Through the Sciana network, it is hoped that these dedicated health leaders will uncover best practices in other countries that they can the adapt to their home contexts.  Such solutions do not need to be complex. After unpacking the high-level differences and similarities of their systems, the Sciana members shared detailed case studies, ranging from “hackathons” in Germany to “vanguard” clinical leaders programs in England. Many of these initiatives have not sought widespread reform from the offset, but instead seek to trial ideas before expanding. As one member pointed out, “We’re not trying to build a 747 here, we’re building a paper aeroplane to prove the idea can fly.” While much of the day’s conversation focussed on the health care systems of each of the three countries, it was also highlighted that general health and wellbeing needs to be promoted, not just access to quality health care when a person is sick. With governments so focussed on economic growth as a measure of a country’s success, one member urged his peers that as members of the health sector, they should advocate for a measure beyond GDP and consumption, and instead focus on human happiness and progress. Read more in the daily Sciana newsletter (PDF)