By European Alliance for Personalised Medicine Executive Director Denis Horgan

American healthcare has been in the news of late, with President Donald Trump’s attempts to take apart so-called Obamacare.

Obamacare or not, healthcare costs in the US are by far the most expensive on the planet.

In some parts of the country the health insurer Medicare spends more per capita than people actually earn on average per year.

This is sometimes up to three thousand dollars more per person per year than the median wage.

Bringing costs under control is a critical aim, and has been for successive presidents.

Indeed, former president Barack Obama is on record as saying that: “The greatest threat to America’s fiscal health is not Social Security. It’s not the investments that we’ve made to rescue our economy… By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

Granted, there is a lot of obesity in the US, with many Americans also having a family history of heart disease. That drives up costs.

Also, in certain geographical areas, few patients take preventive measures, which, according to studies, would wipe out the need for surgery in around 50% of cases.

This is also clearly a contributory factor when it comes to costs.

On the other hand, America has among the lowest rates of smoking and alcoholism when it comes to developed and industrialised countries, and ranks roughly in the mid-range for cardiovascular disease and diabetes.

So why the high costs in some areas? And does this relate to better health? And can Europe learn anything from what is happening across ‘The Pond’?

It seems that richer cities, regions or even countries don’t necessarily produce the best healthcare - often they do, but not always - and, if it’s anything like certain parts of the US, this is in no small part down to doctors ordering what many may call unnecessary tests.

Call it ‘over-treatment’, call it ‘safety first,’ you can even call it ‘over-utilisation’ if you wish.

But it is sometimes the case that money is being spent on extra tests, services, and procedures.

These are often in excess to actual requirements and the cash, of course, disappears into a black hole.

Some patients in certain areas get more of virtually everything health related, and a lot of it is wasteful.

Think more diagnostic testing, more hospital treatment, more surgery and more home care.

This is essentially overuse of medicine and treatments on a large, and hugely expensive, scale.

When it comes to keeping healthcare costs down in a 28-Member State and 500 million-strong society that is ageing - and will inevitably have to deal with a large upturn in co-morbidities - it is not difficult to see that sustainable healthcare poses a significant challenge for Europe, America and the world in general.

It’s understandable that people tend to think that ‘more is better’.

Well, in many arenas it certainly is, but not necessarily in healthcare.

Personalised medicine, with its more targeted approaches, often involving fast-moving sciences such as genetics, can help in this regard, of course.

But over-treatment can, for example, lead to complications arising through hospital stays, side-effects of medicines, radiation illnesses, and even fairly simple tests.

Research in America has revealed that patients in some medically high-cost areas are less likely to receive low-cost preventive services, for example flu and pneumonia vaccines.

It was also found that they face longer waits at visits to their GP and are less likely to have a primary-care physician.

In the end, they are getting plenty of expensive treatment, regardless of whether it is suitable. We must guard against this in Europe.

The stunning news from the US is that almost 30% of Medicare’s costs “could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level in low-cost areas”, according to Atul Gawande who was writing in The New Yorker.

Gawande added: “Healthcare costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen.”

But it is unfair to place the burden squarely on the shoulders of front-line healthcare professionals.

The simple facts are that with our ageing population, leading to more co-morbidities and sickness, and tighter-and-tighter budgets, doctors are under immense pressure to deal with a greater number of patients with more illnesses and with less time and money to do it, per patient.

It is interesting to note that, in the American research alluded to above, in well-established medical situations the doctors in high- and low-cost cities tended to make the same decisions.

However, when the science was unclear, some physicians pursued the maximum possible amount of testing and procedures while some pursued the least possible.

This calls to mind EAPM’s drive towards ongoing and up-to-the-minute training for healthcare professionals in this era of personalised medicine.

Not only that, but in situations where communication and collaboration between healthcare professionals and those in assorted, connected fields is good, the patient tends to benefit.

And, of course, at the heart personalised medicine is the fact that the patient comes first and, also, that we should all strive to make sure that the right patient gets the right treatment at the right time.

We need to start thinking in a more ‘smart’ way in healthcare, in order to counter the problems and face up to the challenges that we face already, as well as the ones that will abound down the line.

Source: European Alliance for Personalised Medicine