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Health Congress: “Patients experience innovation in different ways“
Wolfgang Schuldzinski, attorney, health expert; © Ver-
What does innovation mean to patients and are medical innovations actually well received by patients? At the trade show Gesundheitskongress des Westens (The Western Health Congress) on March 15, 2011 in Essen Germany, MEDICA.de spoke with consumerist Wolfgang Schuldzinski.
MEDICA.de: Mr. Schuldzinski, the discussion about the topic “Evaluation, Innovation, Health Care Processes – Who or what guarantees high quality? “ also raises the question: is innovation actually well received by patients?
Wolfgang Schuldzinski: Patients experience innovation in different ways. On the one hand, there is the case where the physician says: there is a new drug or procedure, but your health insurance does not prescribe and pay for it. In this case, the patient experiences that he/she won’t have a part in innovation and views this as a problem. On the other hand, however, there are innovations where a physician at the hospital or at his practice says: This is what we are going to do. We have researched a new procedure and you can be part of it if you want. In this instance, the patient experiences innovation as a part of research.
However, if processes are newly and innovatively being considered, like for example family doctor focused health care or the so-called disease management program (DMP), which is also called program for the chronically ill, the patient will then be asked to conduct himself differently in the future. For instance, he needs to visit the doctor more often or he is only allowed to see certain physicians anymore – then he is a part of the new health care procedure. So the patient experiences innovation in many different ways, but very often he does not even experience innovation, because he simply is not aware of it.
MEDICA.de: Can patients actually still find their way? Some process innovations, like the new health practitioner regulation or the introduction of discount contracts in part actually lead to uncertainty. For a patient to also keep an eye on quality appears to be almost impossible.
Schuldzinski: It is very difficult for patients to get their bearings in the health care system and in many cases they are overwhelmed by it. And that is why it is so important that we start with the quality of physicians and the medical health care, because it is a bit of a stretch to ask of patients to take care of everything, to constantly read up on everything and to keep tabs on the physicians. This doesn’t mean that you should not be critical as a patient and ask every time you don’t understand something. Yet to ask the patient to be responsible for the quality and to decide on his own what drug he should take or not, is simply too much.
MEDICA.de: However, during the discussion you also talked about the fact that patients should put some pressure on physicians and their health insurance to protect their rights. Yet this presumes that patients have to acquire a lot of knowledge about the health care system.
Schuldzinski: Patients should have a healthy dose of self-confidence and shouldn’t accept everything the doctor suggests or how he treats them without criticism. Patients cannot have expert knowledge about their illness – aside from chronically ill people who often have a lot of knowledge about their disease. Imparting knowledge is the job of the physician. It’s the patient’s duty to critically analyze what was said. This simple rule of thumb applies: if you don’t understand something, ask until you understand. It is the physician’s duty to explain the disease to the patient. But simply a behavior modification in the patient could cause people to notice: not all is well in health care and the German health care system, respectively. This way there could and should be more pressure placed by the patient.
MEDICA.de: People also visit consumer protection agencies to complain. Do you also receive comments like for example: I asked my doctor, but that wasn’t wanted and welcome. And for patients to reach a barrier?
Schuldzinski: Yes this happens, but patients usually change physicians if they are not able to reasonably explain something to them.
MEDICA.de: In a lecture on the subject we heard, that although guidelines for different diseases are available, they unfortunately often are not being used. Is that the physician’s fault who consciously doesn’t adhere to them? After all, patients cannot ask to be treated according to the guidelines, if they don’t even know that they exist.
Schuldzinski: As a matter of fact many patients don’t know that there are guidelines for many diseases. Guidelines are treatment standards that were developed by scientific professional associations. That is to say, this is not just about drugs, but also about how to treat – for example how to treat prostate cancer. It is exactly defined how diagnosis and therapy should take place and when which decision should be made – for surgery, against surgery, for drugs and against them. A guideline is always scientifically documented. This is to say, there are International or German studies that document that a specific treatment makes sense for certain patients and leads to greater success. Such guidelines are published by these associations for physicians. Yet unfortunately they are oftentimes not translated for patients, so they are very difficult to understand, even though there are definitely also patient-oriented guidelines – for example by IQWiG, the Institute for Quality and Efficiency in Healthcare.
Then again, physicians often are not familiar with these guidelines or they don’t use them. There are only a few physicians who strictly work by these guidelines. This has many reasons. Even a physician has a very tight schedule during the day and is therefore sometimes too overwhelmed to be able to look into them. Some of them also feel too restricted in their treatment decisions by the guidelines. But this doesn’t need to be the case. A good approach actually would be to talk the guideline over with the patient and then to say: ”But in your case we should deviate from the guidelines for the following reasons.“Then it should actually be comprehensible for both sides.
Innovations can be confusing for the patients; © panthermedia.net/Jiri Moucka
MEDICA.de: Normally one expects an improvement from an innovation, for example if it pertains to a new drug. With new instruments like for instance a CT or a MRT this is similar. Do you also get critical inquiries from patients, who don’t want to accept everything without asking questions?
Schuldzinski: Not directly. At best we get this through patients, for example those with private health insurance, who wonder why they receive more and more imaging procedures for supposedly trivial things they then have to pay for themselves. And indeed analysis shows that privately insured patients receive more of these types of exams, even though it is scientifically not really necessary. So some patients in essence receive overtreatment. And this results in the patient wondering whether this particular innovation really makes sense for him.
MEDICA.de: Would it therefore be preferable for patients with statutory health insurance to also receive a doctor’s bill?
Schuldzinski: In this case it could have benefits, as long as they receive the bill as a means for checking and if it was prepared in a way that patients can actually read them. This is actually usually not the case with the classic bills.
MEDICA.de: During the panel discussion it was implied that although everybody is very much in favor of innovations, however these “take time“. Isn’t this actually a contradiction, since innovations actually suggest“ something new“?
Schuldzinski: Innovations don’t necessarily need time, innovations need evidence that they are not just new, but also useful. For example, there are pharmaceutical companies and they produce products. And new products always count as innovations. Yet these products are not necessarily better for the patient! And this is precisely what this issue is about. Patients want better treatment, but health insurance carriers only want to pay for what’s necessary. There is no money available for something that might be nice, but that you don’t necessarily need. And that’s why not every innovation is a real improvement for the patient – but it is always viewed as such by the industry that manufactures and offers the products.
On the other hand there might be innovations that are being researched at a hospital or university and for which a professor then for instance churns out a scientific article – then he turns to something else and nobody sees to it that the potentially groundbreaking work that was done here, is also put into practice. That’s an innovation that gets lost.
MEDICA.de: Would you then agree that in Germany there is too much product innovation and not enough process innovation and that the ratio isn’t right?
Schuldzinski: You can definitely say this. In Germany compared to other countries for instance we have the most drugs available. Overall, that’s far more than over 50,000 approved drugs. Other countries, like Sweden for instance, make due with “just“ 5000 drugs. There is an ancient request for a so-called white list, this being a list that specifies which drugs were scientifically tested and make sense for what type of treatment. Each new drug should then first provide evidence, that it makes sense to be included in this list.
MEDICA.de: You talked about Sweden. Do you believe in general that we should look to other countries to learn something? After all, in this case it’s legitimate to copy something from others.
Schuldzinski: You can always learn something from others, just like others also learn things from us. The German health care system still is the world leader in terms of quality. But we are also quite expensive. And if you take a look at other parameters, like for instance life expectancy, in many countries it is higher than in Germany – so it doesn’t just depend on medical health care, but also for example on the diet or getting enough exercise. And if the population lives healthier overall, with better working- or environmental conditions, then you could achieve far more in terms of quality of life than if you always just work on the medical system. Yet it is true that we can learn from other countries. That’s how the new hospital compensation system, which allots specific daily rates for diagnoses, was assumed from Australia and the US.
The Interview was conducted by Simone Ernst
(Translated by Elena O'Meara)