Interview with Vilius Grabauskas: Rooting out inequality is the key to balancing the books

9th June 2015

Rising demand might be seen as a threat to sustainability, but the two can be reconciled through universal coverage. This will reduce inequalities whilst increasing the efficiency of health care systems. Recent reforms in Lithuania demonstrate this, says Professor Vilius Grabauskas

Since it was established in December 2011, the Lithuanian Health Forum has made the case for, and promoted, a whole of society and whole of government approach to tackle the social determinants of health inequality, and the need to restructure health services to address the disparity in provision of health care services between rural and urban populations.

In particular, the spotlight has fallen on heart disease and stroke, where there is both a disparity in access to treatment within the country, and where Lithuania has a greater incidence of premature death (below the age of 65) than elsewhere in the EU.

The logic is that reconciling the inequality in access to specialist services between Lithuania’s rural and urban populations will improve the performance of the health care system vis-a-vis fellow member states, says Professor Vilius Grabauskas, President of the Health Forum and Chancellor of the Medical Academy of the Lithuanian Academy of Health Sciences.

Putting this into practice, Lithuania has adopted integrated models of health care, setting up specialised clusters focusing on specific diseases, with the aim of addressing the variation in access between rural and urban populations.

As Professor Grabauskas notes, time is of the essence with heart attacks. People can be treated effectively if they can get to a specialist centre, with skilled physicians and high tech diagnostic tools. “The time in bringing people to a place where you can do angiography and carry out stenting, coronary bypass, or other procedures, is a matter of life and death,” he says.

At a conference in March this year, the cardio- and cerebrovascular disease cluster reviewed progress made in its first two years in operation. “It really has delivered remarkable results. The time lapse from first signs of an attack to getting people to a specialist centre where there is proper treatment has been cut,” notes Professor Grabauskas.

This is providing an exemplar for regional and local healthcare bodies, which now have real world evidence of how integrated models can improve efficiency. “It needed a little initial effort in reorganising and reallocating budgets, but the costs as a whole are not going up,” Professor Grabauskas says.

However, more people are getting treated and inequalities have been reduced. “Costs are controlled because people survive; they return to work; they contribute to economic growth. And there are no ongoing care costs,” says Professor Grabauskas.

Where is the innovation?

Innovation, in the shape of new therapies, personalised medicine and digital health, has a role to play in improving health care systems and this is factored into Lithuania’s national health plan. However, it should not be innovation for innovation’s sake. “Innovation is definitely important, but you have got to keep in mind cost containment of health systems – if we neglect that, resilience is undermined, contributing to greater inequality,” Professor Grabauskas says.

The critical factor is to find ways of implementing innovation so that it increases effectiveness and not the costs of health care systems, Professor Grabauskas believes. “Given the evidence, it is very logical to expect that additional resources will be made available to implement new treatment options, because this will also contribute to the social and economic advancement of the country.”

It is important not to fall for the hype: It will not be the case that every innovation turns out to be an important advance, in the sense that it improves outcomes and contributes to sustainability. But it is also the case that there will be embedded technologies and established drug regimens that are using up budget currently, which are not as cost effective as potential successor innovations.

“For me it is obvious that there is a need for careful monitoring and continuing evaluation,” Professor Grabauskas says. Ongoing reform and change are needed to ensure that both existing and potential new treatment options promote equity and sustainability.