What a remarkable time to have traveled to Switzerland and the United Kingdom. After a series of meetings with healthcare industry leaders in Switzerland and England last week, the trip put some of the raging healthcare policy debates into better context. Unfortunately, the current U.S. political situation was at times quite distracting with revelation upon revelation unfolding throughout the trip; but no less so than the debates raging around Brexit, bickering over tariffs, Europe’s own version of Russian meddling, and the “baby Trump balloon.” What a surprise to learn that the State Department had issued a travel advisory warning for Americans traveling in London of all places.
Often U.S. politicians opposed to the Affordable Care Act point to the “single payor system” in Europe which unfortunately ignores the fact that there is not one system in Europe and that while countries like Switzerland achieve universal coverage, they do so through a mosaic of private, non-profit and for-profit organizations. There are three principle health insurance models across Europe: (i) the government manages both the insurance and provider sectors; (ii) government provides insurance but leaves the provider sector private; or, (iii) both sectors are private yet the government mandates that all citizens must have coverage. Switzerland falls into this last category.
According to the Euro Health Consumer Index (2017), Switzerland is consistently ranked second (behind The Netherlands) for quality and cost effectiveness of its healthcare system. The study concluded that there is little correlation to quality of healthcare and money spent to deliver it, but that in fact, healthcare is a “process” industry that excels with well-managed systems. Think of Swiss watches. In 2015, Switzerland spent 11.7% of G.D.P. on healthcare, notably less than the U.S. healthcare system. Switzerland has the highest percentage of nurses per thousand citizens at 17.4 (in 2013) and has 313 hospitals, underscoring the depth of commitment to a distributed care delivery system. General life expectancy is 82.6 years, which places Switzerland near the top of all countries.
Basel is an extraordinary city with a population of only 175,000, and yet, it is home to some of the largest pharmaceutical companies in the world (Novartis, Hoffman-La Roche, Ciba Geigy, Syngenta, Actelion). Much like the Kendall Square phenomenon in Boston with Harvard and Massachusetts Institute of Technology, this cluster of leading drug development companies is anchored by the first university in Switzerland which was founded in 1460 and is particularly expert in the medical and chemical sciences. Conversations with a number of these executives revealed that talent is quite mobile from company to company, and yet there is a fierce pride associated with the role these companies play in the global pharma industry.
Despite the myriad of reasons to be troubled by the situation in the U.S., my Swiss hosts were incredibly respectful (at one company I was provided a set of guidelines with the first point being “Avoid contact with chemicals.”) Notwithstanding the current rhetoric in the U.S. concerning drug pricing, one leaves with a sense that executives view this to be temporal and will not unduly impact their core programs.
In addition to the pricing concessions offered by Novartis concurrent with my trip to Europe, there were two other “medical discoveries” announced while I was there. To screaming tabloid headlines in the U.K., researchers with the Cochrane Library on behalf of the National Health Service (NHS) announced that Omega-3 and fish oil supplements are useless. Apparently, the English spend 420 million pounds on supplements annually and the NHS is worried that much of it is wasted.
Perhaps more timely, given the proclivity of the U.S. President to tweet, the Journal of the American Medical Association released a study that confirmed heavy social media use may make one twice as likely to develop attention deficit hyperactivity disorders. I better tweet that right away.