Professor of Healthcare
University of Sheffield
Across the world, governments continue to experiment with ways of empowering patients. While altruism is no doubt one of the reasons, there is another, perhaps even more powerful reason. When patients with chronic illnesses are given control over health expenditure, they usually stay within budget and shift the pattern of expenditure away from professional services to those that provide more personal support. The Dutch tried it for a selection of patients with chronic diseases some years ago, with apparent success. In the UK, citizens can fashion their own package of community care, but not as yet their healthcare. Patients will, however, shortly have their choice of surgeon and hospital as part of their NHS care.
In the USA, a number of states are giving patients with disabilities greater control over their Medicaid services to make it easier for them to continue living in their homes. In the latest development in South Carolina, eligible Medicaid patients will not only plan the services they need but also hire the service providers. Some European citizens are exercising personal choice in circumstances where local waiting lists are unreasonably long, by having their surgery in another country and sending their government or insurer the bill. This trend towards patient empowerment seems set to continue. Patients are learning how to make the system work for them, and they are, it seems, better at keeping within budget than health professionals.
On another front, citizens of Australia who live in Tasmania have for some time been able to access their personal clinical records online, which enables them to participate more actively in their healthcare delivery. The Healthconnect system operates from a secure online site, and within an agreed consent framework, to provide summary health information generated from general practice and hospital records. In a related development, Mediconnect will provide doctors and pharmacists with access to more complete information about consumers’ medicines. Consumers who join Mediconnect will be able to have their prescription, over-thecounter and complementary medicines information added to their record. Their allergies to medicines will also be recorded.
In contrast to this open approach, the European Commission is, it seems, still determined to block direct-toconsumer advertising by the pharmaceutical industry, despite the fact that almost every European citizen can access this information on the internet. The resistance to move with the technological tide may reflect a paternalistic approach to the protection of patients from inappropriate selling. But it may also have something to do with the fact that the advertisements may stimulate medicine uptake and governments, rather than patients, will end up paying. The Commission is, however, working hard to replace the current social security paper forms, including the E111 form, with a European health insurance card, which should make it easier for citizens to get healthcare during a temporary stay in another EU country. The new card should be available by June 2004.
The Commission continues to struggle with health issues, mainly because they come at them from a market or economic perspective. Maybe in the future health will become a matter of major policy concern in its own right. But first national governments will have to cede some ground. It is time they did. Health is beginning to transcend national boundaries.