20 June 2018
They will significantly improve healthcare throughout the world, although speed of implementation will vary from country to country
Ezekiel Emanuel, North American oncologist and specialist in bioethics, was the guest speaker at the 11th edition of the Josep Egozcue Lectures, held in Barcelona on 13 and 14 April. In the first of his two lectures, Emanuel identified six trends that will influence health and clinical research over the next 10 years. In his opinion, these trends will significantly improve healthcare throughout the world, although speed of implementation will vary from country to country.
Emanuel, chair of clinical bioethics at the University of Pennsylvania, believes that over the coming decade more efforts will be focused on chronic diseases. The progressive ageing of the population will require changes in our approach to a category of diseases which, in the USA, already account for the majority of health spending. This will require us to identify people at risk of suffering from chronic diseases, and will mean that doctors have to give managers responsibility for monitoring patients, to identify their needs and to control the treatments prescribed. It is therefore very important to educate people about their illness and what they can expect of it.
Another issue that Emanuel believes will grow in importance in the future concerns our approach to mental illness. Currently, almost all countries treat such conditions separately, often in facilities that are completely independent of those where physical diseases are treated. Over the next 10 years, this separation will have to be reduced so that patients can receive combined care. Many patients affected by other diseases also suffer from mental conditions caused by their physical illness (for example, depression in cancer patients). It is essential for doctors to work in coordination with psychiatric specialists and for there to be closer coordination between them to improve the health system.
Outpatient care will become more common. The trend is towards reducing interventions at medical centres, providing them in patients' homes, instead. Emanuel noted that, in the field of oncology, many treatments are now available in this way. This is a slow process, as politicians are reluctant to close hospitals, but the shift from hospital- to home-based treatment will save money and improve care. In addition to improvements in quality and comfort, according to the statistics, home-based care also reduces mortality and increases patient satisfaction.
At the same time, there will be greater measurement of the performance of hospitals and doctors, comparing their activities and practices. This will generate competitiveness, which will bring benefits in mutual learning and the sharing of best practice. There will also be changes in payment systems. At present, treatments are paid for on a fragmented basis: initial visit, analysis, pre-surgery, etc. The trend will be towards block pricing with adjusted fixed amounts. This will save money and increase the efficiency of treatment.
Finally, with respect to drug costs, Ezekiel Emanuel is not optimistic. Forecasts suggest that these will continue to rise. This is because in countries such as the USA monopolies continue to be granted for certain drugs and competition is not allowed. Research is not as expensive as final drug prices imply, but the greatest research effort is concentrated in areas where a lot of money can be made. In the USA, work is currently in progress on 631 cancer drugs, but there are very few projects in the development of antibiotics. This is because, although antibiotics are absolutely vital for people's health, they are not as profitable as cancer drugs.