The health system constitutes a vector of social cohesion and economic growth that is going through a critical moment in a context in which important challenges come together. To those that have existed for decades, new ones have been added: the aging of the population and the increase in chronic diseases, the impact of environmental risks on health, the lack of health professionals, the incorporation of new drugs and new advanced therapies and the emergence of new technologies, among others. Innovation plays a fundamental role in facing these challenges that lead to a new healthcare paradigm.
Dialogues La Vanguardia, in collaboration with EY, brought together a group of experts to analyze these challenges that, if not addressed correctly, can undermine the sustainability of the system. Jaime del Barrio, senior advisor of Healthcare & Life Sciences at EY, participated in the round table; Hugo Dosil, partner in Business Consulting and Lifesciences at EY; Andrés Morales La Madrid, clinical director of the Pediatric Cancer Center Barcelona, of the Sant Joan de Déu Hospital; Adriana Rubio, President and CEO of Roche Diagnostic; José María Giménez Arnau, Chief Scientific & Medical Officer of Esteve; Fina Lladós, general director of Amgen Iberia; and Josep Maria Guiu, director of the Pharmacy and Medicine Area of the Catalan Health and Social Consortium.
It is not about adding technology to inefficiency, because it will be technologically endowed inefficiency, but about changing the forms of solutions.”
Jaime del BarrioHealthcare & Life Sciences Senior Advisor at EY
Longevity and the chronification of diseases, “an unmitigated success of our health system,” in the words of Hugo Dosil, is a major challenge. The forecast is that Spain will be the country in the world with the highest life expectancy in 2040; It is estimated that he will be around 93 years old a decade later. And even more of a challenge in a scenario of growing lack of professionals.
The WHO estimates that in 2030 there will be a shortage of 18 million health professionals in the world, “practically impossible to cover in a realistic way,” said Dosil, who, however, assured that what can be done is “make more efficient.” the system.” The WHO, he highlighted, estimates that between 20 and 40% of the health system worldwide is inefficient, in terms of organization, redundancy of processes or fragmentation of the offer. “This inefficiency is an opportunity for improvement,” he stressed. Following this reflection, Jaime del Barrio warned of the risk of trusting the solution only to technology. “It is not a question of putting technology to inefficiency, because it will be technologically endowed inefficiency; “This is about changing the way we approach problems and think about solutions.” Of course, he stressed that, thanks to technology, what is happening can be made transparent in real time, who is doing what and with what results, not only economic, but also in health.
We have been talking about advanced precision medicine for 20 years, but it is not yet a reality. With data, we can change the patient’s care cycle”
Hugo DosilBusiness Consulting and Lifesciences Partner at EY
Regarding how to face the challenge of longevity, Josep Maria Guiu stated that it is not just about living longer, but about living them with quality. Age, he recalled, is normally associated with suffering more multimorbidity and, therefore, polypharmacy, which has an impact on problems associated with medication. “We have never had so many patients with so many treatments at the same time,” he noted. A situation that contributes to high spending, and that can put the sustainability of the system at risk. Therefore, in addition to betting on innovation and technology to gain efficiency, he prescribed prevention: “We have to bet on prevention. Society must be clear about what healthy habits are to enjoy aging with quality of life.” The prescription was shared by all the speakers. “We have to reduce the pressure on a system that is increasingly worn out and less efficient. To achieve this, the empowerment of people, facilitating the acquisition and maintenance of healthy habits, is essential,” declared Andrés Morales La Madrid.
We need social awareness, greater collaboration with clear leadership and data integration. And that requires, yes or yes, a transformation of the system.”
Fina LladósGeneral Director of Amgen Iberia
The clinical director of the Pediatric Cancer Center Barcelona warned that the challenge is not only in older people, but also in diseases at the beginning of life, such as pediatric cancer, considered no longer a rare disease, but a group of rare diseases. Although much has been learned and the great contribution of innovation and technology, pediatric cancer, with 1,200 new cases annually in boys and girls under 14 years of age in Spain, continues to be eradicated in four out of every five diagnoses with a combination of surgery, radiotherapy and chemotherapy. The toxicity of the treatment continues to be a problem and causes a significant percentage of survivors to have to face health problems that lead them to be linked to a health system for life and can even shorten their life expectancy. “Chronicity does not begin in these cases at age 40 or 50, but at five or ten,” he noted.
We have to focus on prevention. “Society must be clear about what healthy habits are to enjoy aging with quality of life.”
Josep Maria GuieuDirector of the Pharmacy and Medicine Area of the Health and Social Consortium of Catalonia
Precision medicine, Morales La Madrid continued, is “still the anecdote in pediatric oncology.” And advanced medicine is precisely another of the system’s great challenges. “We have been talking about it for 20 years, but it is not yet a reality,” added Dosil, for whom, “thanks to the data, the patient’s care cycle can be changed.” In Del Barrio’s opinion, one of the reasons why personalized medicine is not reaching patients is “resistance to change.” Dosil and Del Barrio valued data to achieve individual and collective health. In this sense, the partner in Business Consulting and Lifesciences at EY highlighted the initiative of the Ministry of Health to develop the Healthcare Data Lake, a data repository that will allow the massive processing and analysis of existing information in regional health systems, improving diagnoses. and treatments. This data unification is a fantastic step in the right direction, he highlighted.
“We must reduce the pressure on the system, which has been at increasing risk for years, and this is achieved through the empowerment of people.”
Andrés Morales La MadridClinical Director of the Pediatric Cancer Center Barcelona. Sant Joan de Déu Hospital
At this point, José María Giménez Arnau said that one of the great challenges is “the ability to digest” the large amount of data available “asking the right questions” and helped by technology to make the right decisions. “The challenge, especially in the scientific community, is knowledge management,” Del Barrio said.
Adriana Rubio lamented that, despite the large amount of data generated by a diagnostic site, it is still not possible to use this “very valuable information” to benefit the health of the population and the efficiency of the system. Roche Diagnostics management also called for “more speed to incorporate innovation in a systematic and harmonized way.” “It is not only about how innovation is incorporated, but also how obsolete practices that no longer add value are stopped,” he emphasized.
Speed is needed to incorporate innovation. And it is not only how it is incorporated, but also how obsolete practices that no longer add value are stopped.”
Adriana RubioPresident and CEO of Roche Diagnostic
He gave the Pap test as an example. “We all know that it does not detect 50% of cervical cancers and we still have discussions about the purchasing method to incorporate population screening for the detection of alternative cervical cancer for women between 18 and 60 years old,” he shared.
Fina Lladós spoke about the role of drugs in this new paradigm. “There has been a revolution and we have gone from chemically synthesized drugs, which continue to have a lot of value, to biotechnological drugs that require significant knowledge of pathologies and genetics,” said the general director of Amgen Iberia, who reported that the 36% of the drugs approved by the European Medicines Agency (EMA) in 2023 were biological. These drugs, he added, are a great opportunity “to live longer and live better,” because they will allow us to address diseases that cannot be treated now, but he warned that it is necessary to achieve an efficient system. He defended that health sector agents must work together to understand what levers must be activated to achieve this efficiency. “We need social awareness, greater collaboration with clear leadership and data integration. And that requires, yes or yes, a transformation of the system,” he highlighted. In his opinion, it is a mistake to work today thinking that the system will continue to be sustainable by doing the same.
The sick person is not the disease; It is the person who gets sick and the situation that surrounds them. “This is a revolution in medicine that we have not yet fully embraced.”
José María Gimenez ArnauChief Scientific and Medical Officer of Esteve
As an example of this transversal collaboration, “and not in silos”, to which Lladós alluded, Giménez Arnau cited the PRECISEU platform (Personalised medicine Empowerment Connecting Innovation ecoSystems across Europe), promoted by Biocat, which aims to accelerate the adoption of personalized medicine in Europe, facilitate the digital and sustainable transformation of health systems and support the development of highly innovative products. Co-financed by the EU, the project involves 25 partners from 12 European regions in 10 member states, as well as Ukraine.
Regarding the authorization of new medications, Lladós explained that in the European Union it is the EMA that is responsible for evaluating their effectiveness and safety, but that this process in our country is repeated not only at the national level but also in some autonomous communities, ” I wish we did not duplicate efforts in things that others have already done so as not to delay the adoption of innovation, but that requires trust, leadership and changing governance,” he added. An idea shared by Giménez Arnau, who added the importance of will and vocation. to change also in the long term.
Spain will be the country in the world with the highest life expectancy in the year 2040
36% of the drugs approved by the EMA in 2023 were biological
After highlighting the scientific method and the standards of good clinical practice in the research of new therapies, the Esteve manager assured that a revolution is taking place at the healthcare level. In medical books, he said, he himself learned symptoms and diseases, etiology and differential diagnosis. “We were not taught to approach the patient in a comprehensive way. The sick person is not the disease, it is the person who gets sick and the situation that surrounds them. “This is a revolution in medicine that we have not yet fully embraced,” he highlighted. In this same sense, he added that “we must change our approach: stop focusing solely on costs and short-term productive efficiency. Instead, it is essential to adopt processes that promote long-term efficiency and truly impact people’s lives.
The system needs to gain efficiency to not put its sustainability at risk
Although the challenges are many, as a finishing touch to the debate, Rubio wanted to put a positive note by stating that technology has already allowed us to reach important fields, such as digital pathology, or the use of algorithms to improve diagnoses, and that, without a doubt, it will continue. allowing progress.
