Periodic Reporting for period 1 - FLASH (Flexible Approaches to Support Health through financing)
Berichtszeitraum: 2023-01-01 bis 2024-06-30
The FLASH project (Flexible Approaches to Support Health through Financing - https://flash-project.com/(öffnet in neuem Fenster)) aims to analyze the European financing of health systems and their adaptability. In response to evolving health challenges, including those highlighted by the COVID-19 pandemic, FLASH seeks to enhance the sustainability and resilience of healthcare systems. The project explores new financing models, evaluates their impact on health system performance, and develops policy recommendations to help EU member states improve their financial management and resource allocation in healthcare.
FLASH addresses the gap between dynamic health challenges (such as population aging, technological advancements, and varying health needs) and the often static financing mechanisms adopted by member states. By focusing on flexible approaches, the project aims to equip health systems with the tools to efficiently and equitably tackle current and future health challenges. This includes improving care quality, ensuring equitable access to services, and strengthening financial protection for citizens across the European Union.
FLASH addresses the gap between dynamic health challenges (such as population aging, technological advancements, and varying health needs) and the often static financing mechanisms adopted by member states. By focusing on flexible approaches, the project aims to equip health systems with the tools to efficiently and equitably tackle current and future health challenges. This includes improving care quality, ensuring equitable access to services, and strengthening financial protection for citizens across the European Union.
Most of the activities carried out during the first 18 (of 48) months were fundamental steps towards achieving the final results expected mainly in the second half of the project.
Regarding the resilience of health systems to sudden shocks such as a pandemic, extensive work has been done to define quantitative indicators of health system resilience, to collect data to operationalise such indicators, and to identify factors that can contribute to improving the resilience of the system. With regard to efficient and equitable ways of dealing with population ageing and the increasing prevalence of chronic diseases, the focus was on the role of better integration between primary and hospital care, especially for the elderly. The theoretical analysis focused on how different payment rules for primary care can contribute to better integration with hospital care under different assumptions about doctors' preferences. In addition, the impact of collecting and using information on a range of quality indicators for both primary and hospital care was studied empirically in different settings.
New technologies with significant potential benefits are constantly becoming available to patients. However, innovation tends to be very costly, putting increasing pressure on healthcare budgets. We have studied the complex process that leads from the development of a new health technology to its adoption at two critical stages: before it reaches the market, and at the time when payers have to decide whether or not to reimburse it after it has reached the market. For the early phase, a novel participatory approach has been developed for the early evaluation of new technologies. For the adoption phase, a tool is being developed that will enable payers to predict the financial impact of the innovation more efficiently and accurately.
Digital health is one of the innovations that is likely to affect large numbers of patients in the near future. However, much remains to be learned about the efficiency and equity implications of widespread use of digital technologies. The work done so far has allowed us to collect original and relevant data to analyse an existing tool (an app) and to understand citizens' perspectives on the transition to digital health services.
Contributing to defining policies to improve equity in healthcare is an essential goal of the FLASH project. An original dataset combining information from several sources for the comparative analysis of the relationship between health needs and health expenditure is currently under construction. This will enable policymakers to identify financing solutions that are more likely to ensure that the amount of funding is adequate for health needs. Another equity related topic concerns the role of out-of-pocket payments, including a better understanding of their redistributive impact and the relationship with unmet medical needs.
One way to improve equity of access is to allow patients to seek care where they can get the best service for their health needs. In some cases, this may involve cross-border patient mobility. An analysis of the legal and economic barriers to international patient mobility has been completed, providing the basis for identifying appropriate solutions to reduce these barriers.
Regarding the resilience of health systems to sudden shocks such as a pandemic, extensive work has been done to define quantitative indicators of health system resilience, to collect data to operationalise such indicators, and to identify factors that can contribute to improving the resilience of the system. With regard to efficient and equitable ways of dealing with population ageing and the increasing prevalence of chronic diseases, the focus was on the role of better integration between primary and hospital care, especially for the elderly. The theoretical analysis focused on how different payment rules for primary care can contribute to better integration with hospital care under different assumptions about doctors' preferences. In addition, the impact of collecting and using information on a range of quality indicators for both primary and hospital care was studied empirically in different settings.
New technologies with significant potential benefits are constantly becoming available to patients. However, innovation tends to be very costly, putting increasing pressure on healthcare budgets. We have studied the complex process that leads from the development of a new health technology to its adoption at two critical stages: before it reaches the market, and at the time when payers have to decide whether or not to reimburse it after it has reached the market. For the early phase, a novel participatory approach has been developed for the early evaluation of new technologies. For the adoption phase, a tool is being developed that will enable payers to predict the financial impact of the innovation more efficiently and accurately.
Digital health is one of the innovations that is likely to affect large numbers of patients in the near future. However, much remains to be learned about the efficiency and equity implications of widespread use of digital technologies. The work done so far has allowed us to collect original and relevant data to analyse an existing tool (an app) and to understand citizens' perspectives on the transition to digital health services.
Contributing to defining policies to improve equity in healthcare is an essential goal of the FLASH project. An original dataset combining information from several sources for the comparative analysis of the relationship between health needs and health expenditure is currently under construction. This will enable policymakers to identify financing solutions that are more likely to ensure that the amount of funding is adequate for health needs. Another equity related topic concerns the role of out-of-pocket payments, including a better understanding of their redistributive impact and the relationship with unmet medical needs.
One way to improve equity of access is to allow patients to seek care where they can get the best service for their health needs. In some cases, this may involve cross-border patient mobility. An analysis of the legal and economic barriers to international patient mobility has been completed, providing the basis for identifying appropriate solutions to reduce these barriers.
Among the results contained in deliverables submitted and articles published during the first 18 months are:
• The development of a novel methodology for the early assessment of new technologies, i.e. before they reach the market. Early assessment allows stakeholders to prepare for the organizational changes implied by the future adoption of the new technology and, to some extent, also to adapt some of its technological characteristics to the needs of end-users and patients, as expressed through the assessment process. The methodology is based on the definition of several indicators, measuring the performance of new technologies along several dimensions, which, combined with a set of weights for each indicator, allow the construction of a score for the early assessment of the technology and the identification of challenges and opportunities related to its future development.
• A theoretical model has been developed for the exploration of the dynamics of primary care physicians' (PCPs) treatment decisions for chronically ill patients, focusing on prevention efforts, under three types of payment systems: capitation, fee-for-service, and pay-for-performance. We show that capitation leads to inefficient referrals, while moderate fees align incentives for efficient referrals and encourage higher levels of effort. Our theoretical predictions also show that pay-for-performance effectively increases effort without negatively affecting referrals, while hospital capacity constraints increase effort.
• The development of a novel methodology for the early assessment of new technologies, i.e. before they reach the market. Early assessment allows stakeholders to prepare for the organizational changes implied by the future adoption of the new technology and, to some extent, also to adapt some of its technological characteristics to the needs of end-users and patients, as expressed through the assessment process. The methodology is based on the definition of several indicators, measuring the performance of new technologies along several dimensions, which, combined with a set of weights for each indicator, allow the construction of a score for the early assessment of the technology and the identification of challenges and opportunities related to its future development.
• A theoretical model has been developed for the exploration of the dynamics of primary care physicians' (PCPs) treatment decisions for chronically ill patients, focusing on prevention efforts, under three types of payment systems: capitation, fee-for-service, and pay-for-performance. We show that capitation leads to inefficient referrals, while moderate fees align incentives for efficient referrals and encourage higher levels of effort. Our theoretical predictions also show that pay-for-performance effectively increases effort without negatively affecting referrals, while hospital capacity constraints increase effort.