According to VZP (General Health Insurance Company) director Zdeněk Kabátek, health insurance companies are supposed to shape, change and innovate the healthcare system and be responsible for ensuring that it is sustainable in the long term. The head of the largest domestic health insurer said this at the second annual Technology and Innovation in Healthcare Summit organised by the Healthcare Daily. Kabátek considers innovation in the field of pharmaceuticals to be already mastered. According to him, central care is no longer a bogeyman after 11 years. „The problem of healthcare is an across-the-board increase in wages and reimbursements, but certainly not central care,“ said the director of the largest health insurer in the Czech Republic. The situation is more complicated for medical devices, but even there VZP is coming up with an initiative in the form of a new methodology.
„As health insurance companies we see our role as an important carrier of influence in the Czech healthcare system, not as an office or a redistributor of money. The insurance company is the entity that is supposed to shape, change and innovate the healthcare system and be responsible for ensuring that it is sustainable in the long term,“ Kabátek said.
This, he said, is also the basis for how health insurers should operate. „I reject the idea that an insurance company should be a mere payer, that it should just redistribute the collected health insurance funds without expecting anything back from the system. That is why I think the verb ‘invest’ should be used in relation to insurance companies rather than ‘reimburse’. Because everyone who invests expects that it will bring them some financial or qualitative benefit,“ said the director of VZP.
According to him, domestic insurance companies are ready to help change the healthcare system: „We do not want to change it in a revolutionary way, but gradually and with the aim of achieving better access to healthcare services, increasing their quality, investing in such a direction as to ensure high availability of medicines, medical devices and new technologies.“
The director of VZP also spoke about personalized medicine, which, according to him, is a double-edged sword. „It presents a challenge in terms of cost, but also an opportunity in that after a significant investment at the beginning, it can reduce our costs in the future.“ Insurance companies are also investing in improving the organization of care, according to the VZP chief. „So that the patient is informed and educated about prevention options in a timely manner, but also so that he or she is diagnosed early, treated early and successfully, and eventually transferred to the follow-up care system in a timely manner. This leads to a system that saves resources and gives us the space to focus on innovation,“ Kabátek said.
Innovation in four areas
According to him, investment in the network of health services is also necessary. „A great deal of work remains to be done towards primary care, which is the basis of any health care system. We need to clearly define what the competencies and role of primary care should be and also identify the problems that have arisen in primary care generationally because of the education system and also because the debate on this issue has only started intensively in the last few years.“ This is what Prime Minister Petr Fiala also spoke about in his speech at the summit before Zdeněk Kabátek.
According to Kabátek, innovations in healthcare should take place in four areas, which are pharmaceuticals, medical devices, electronization and telemedicine, and innovative reimbursement models. „We have mastered the area of pharmaceuticals, we have set processes in it, we are successful in it. And this success is measurable and can be justified at least by the fact that we are at the top of the European Union in the availability of highly innovative medicines,“ Kabátek said. According to the director of VZP, the proof that we are successful in the field of medicines is the fact that around 2012, the „big scare“ was centre-based care. „There were analyses based on which it was said that centre-based care would destroy the healthcare system and would be absolutely fatal for cost growth. And today, eleven years later, we see that there is no bogeyman, that we have it perfectly managed. The problem with health care is across-the-board wage and reimbursement increases, but certainly not center-based care,“ he said.
Kabátek said the situation is different in the area of medical devices. „In recent years, the discussion about how innovation should enter into reimbursement has been very complicated. But the medical device area is also characterised by the fact that a lot of work has been done in the last few years. And in addition to the new legislation that has been created to address medical devices on voucher, we have set up methodologies and processes that are clear, understandable, fast and predictable, and we are getting to some conclusion where the work in the medical device area should be similar to that in the pharmaceutical area,“ the VZP chief said.
No risk of hitting the wall
Another area is electronization and telemedicine. „This is an eternal topic in Czech healthcare. However, when I observe the actions of the Ministry of Health, I begin to believe that we will actually succeed in starting the process of electronization and digitalization of healthcare. And that thanks to this we will be able to achieve significant savings in the area of redundant care, duplicated procedures and other ills of the Czech healthcare system,“ said Kabátek, according to whom the shift in this area will bring benefits not only to payers, but to all entities in the Czech healthcare system.
According to the VZP director, the last area that is still in its infancy in the Czech Republic is the use of innovative reimbursement models. „For years we have been talking about the fact that quality, success and necessity should be part of the health service, but we have never translated this into practice – there are more and less successful attempts,“ said the VZP chief, mentioning the activities of the Health Insurance Office, but adding that „it is a tool for benchmarking, but not for reimbursement“. „Our ambition is to bring something to the system that really fulfills our ambition to pay for the outcome – for the patient effectively treated and cured, not for their stay in the system and treatment, but for the outcome. At the moment we want to start a discussion with providers, especially in acute inpatient care, in terms of validating such care in practice – this is the innovation we are coming up with and which we would like to push in the upcoming years,“ Kabátek said.
„Health insurers in the Czech Republic are ready for the challenges ahead. We have the ambition to be truly insurance companies, i.e. those who shape the system, achieve greater efficiency, manage the system and ensure the patient receives the right course of treatment,“ said the director of VZP. „And I can – a little grandly – declare that I am not afraid of the future. That if we do as well as in the past, there is no danger of hitting the wall here and that we are able to keep the system financially stable on a permanent basis,“ concluded Zdeněk Kabátek.
Foto: Radek Čepelák
Healthcare Daily would like to thank Roche, Zentiva, ORCZ, Medtronic, Medicalc, Novartis, Alk, Akeso, EUC, MyCom, Satum and the health insurance companies VZP, ZP MV and RBP for their support of the summit.