In Europe, financially constrained healthcare systems need to cope with an ageing population, rising chronic diseases, epidemics such as Covid-19, increasing costs, new technologies, exploding data and a lack of healthcare workers. How can In Vitro Diagnostics (IVD) help in such a context? That is what we asked Lucy Nugent, President of the European Association of Hospital Managers (EAHM) and CEO of Tallaght University Hospital in Dublin, and Antoine Bloch, Vice President France, Clinical Operations, bioMérieux.

Lucy Nugent: We have come through the post-Covid-19 recovery and are now trying to establish a restorative phase in hospitals. But we are subject to increasing financial pressures. When 75% of a hospital’s budget is primarily pay, this means that we are looking at staff cuts although we know that by 2030 there will be an 18 million global shortage of healthcare workers. That is a major dichotomy that we face.

In addition, healthcare is no longer attractive from a wage point of view. A graduate in computer science earns more than twice as much as a graduate nurse, although they have both spent four years in university. We are clearly suffering from this lack of competitiveness.

And another huge challenge for us is climate change. If healthcare was a country, it would be the fifth largest contributor to greenhouse emissions. So urgent progress needs to be made on how hospitals operate, for example 85% of hospital waste is non-hazardous but how are we managing that.

Antoine Bloch: For me, another big challenge is to give access to healthcare and diagnostics 24/7, everywhere, to all patients who need it. In many places, people don’t get access to the same level of diagnostics during the night or the weekend because associated costs are higher. And when we talk about profit and loss, bad decisions can be made. If on top of that we send too many people into hospital for the wrong reason, or without knowing what they are suffering from, we are saturating the system. That means that it is getting difficult to get access even to basic treatment. 

A.B.: IVD is all about information. Finding, or not finding, at a very early stage is key for the patient. Take the example of sepsis. Every hour you lose on sepsis is an additional 10% risk of fatality, so the earlier you know what you need to know, the better it is. Earlier information also allows to make the right choice about using or not an expensive antibiotic or expensive technology, and to better manage all types of resources.

We need to focus more on diagnostics and everything that can be put in place before a patient gets sent into hospital to only give access to hospitals to patients who really need emergency care. In addition to medical value and saving lives, it is also a matter of cost avoidance and making better use of resources. This is exactly what we went through with Covid-19. It was as simple as knowing whether you had to go to the emergency department or not.

L.N.: I agree that if we can keep the hospitals free for people who need acute care, that is a positive thing. By having earlier access to diagnostics you get an earlier diagnosis, you get the right treatment, and you can monitor the treatment. That leads to better outcomes and increased patient satisfaction. We talk about reducing the length of stay of a patient, which makes economic sense for the hospital, but we are in fact reducing the days away from home, and that is a true value to the patient.

From a prevention point of view, diagnostics are also valuable as an indicator for health. People over a certain age should be getting their blood checked every year. If you see a negative trend in blood results you can make lifestyle changes so that in some cases you never end up in a hospital. Patients should know their numbers; cholesterol and haemoglobin levels, for instance, are indicators of their health. Empowering patients, getting them involved in understanding the numbers is very important. We know earlier intervention can delay the progression of the most serious outcomes of chronic diseases. So it’s all about getting answers and improving outcomes.

A.B.: We are talking here about awareness. We have to make people aware of the value diagnostics can generate. It’s about knowing, knowing as fast as possible, as accurately as possible.

Something we don’t talk so often about is antibiotic use. Today half of the antibiotics taken by patients are prescribed without knowing exactly the root cause of the problem. This will have a huge impact in the near future. All clinicians should be aware that there are diagnostic tools that can provide quick, accurate answers to support them in choosing the right antibiotic at the right time.

Patients should also be aware that tools are available to provide useful information. During Covid-19 they fully understood the importance of diagnostics and the value of PCR testing. This was a significant leap forward, but we need to go further.

L.N.: We need to look at what IVD can contribute to the integrated patient journey. That story has probably not been articulated well enough. It is something that everyone on an intellectual level knows and understands, but how for example do we encourage people to get their blood checked proactively? I think there is nothing like the power of a story. I recently heard that it is projected that more people will die from antimicrobial resistance (AMR) than the 1.2 million people who died of Covid-19. By 2050 it is projected to be 10 million people. When I heard that, I thought: «That is something we can actually prevent, so how do we do that?»

We also need to get clinicians to order the right tests, at the lowest level of complexity. One of the ways of ensuring that is by using more systematically standardized care pathways. 

L.N.: In principle, value-based healthcare drives efficiencies, but it has to be within a level playing field, using the right data, with realistic benchmarks and transparency.

Most of the time procurements and contracts are very driven by price. I think it’s really important that industry and healthcare providers who are truly committed to try to improve healthcare for all have opportunities to dialogue and understand each other’s viewpoints.

A.B.: I fully agree: let’s open an objective and transparent dialogue about value-based models for In Vitro Diagnostics.