Interview with Stanimir Hasurdjiev: Remove barriers to access to improve patient outcomes and promote efficiency and sustainability

20th May 2015

Focussing on outcomes is the foundation stone for efficient, equitable and sustainable health systems. And the key to improving outcomes lies in dismantling barriers to access, says Stanimir Hasurdjiev

Despite a brighter economic outlook many austerity measures remain in place. Governments are cautious about spending and introducing innovation into health systems.

But on the positive side there has been a huge learning process and this is informing decisions on how healthcare budgets are invested. “Improving patient outcomes is now the leading imperative and this is driving reforms,” says Stanimir Hasurdjiev, board member of the European Patients’ Forum and co-founder and chair of the National Patients’ Organisation in Bulgaria.

An important motivation for reform has been the acknowledgement that health and economic growth are intertwined. “Health is not a cost; it should be considered to be a crucial investment, generating human capital, with a skilled workforce, production facilities and the growth of associated sectors,” Dr Hasurdjiev says.

There is no single, simple answer to the question of how to improve outcomes, but an important principle of the Vilnius Declaration, in calling for a collaborative approach, involving all stakeholders, on a European level, is underpinning efforts to find solutions.

“There are three things we need to do – to improve equitable access, improve outcomes and reinforce sustainability,” says Dr Hasurdjiev. “I’m very happy to say that following on from the Vilnius Declaration, there is good momentum and we are seeing further developments.”

As a board member of the European Patients’ Forum and chair of Bulgaria’s National Patients’ Organisation, Dr Hasurdjiev has been instrumental in the formation of the Patient Access Partnership. This is a European-level collaboration dedicated to scoping barriers to access, in order to dismantle them. “We are not talking about access for its own sake, but as part of systematic moves to improve health systems and patient outcomes,” Dr Hasurdjiev notes.

Bringing stakeholders together

While it was not straightforward pulling stakeholders including the European Parliament and European institutions on board, the Vilnius Declaration provided the context to frame the discussion.

“The process of setting up the Patient Access Partnership may have been complicated, but it shows everyone sees the problem and the need for action,” says Dr Hasurdjiev. “It’s not the sole problem of any single government, industry, doctors’ group or patients’ group, but a common problem, requiring common solutions. That’s what the Patient Access Partnership is about.”

Since getting off the ground at the turn of the year, the Patient Access Partnership has made headway, most notably in its objective of putting access high on the political agenda. In January the European Parliament Interest Group on Patient Access was launched, with the Health Commissioner Vytenis Andriukaitis speaking at its inaugural meeting. “The group has 30 MEPs representing all colours of the political spectrum and more than 15 member states, so there is high political commitment,” Dr Hasurdjiev observed.

The aim of the group is to ensure that access and sustainability of health systems is addressed in all EU policies and to show how the EU can help member states make efficient investments in health.

“This is not about the EU seeking to take influence over health systems, which are of course, a national responsibility, but of knowing what are the challenges, where are the gaps, and having collaborative and EU actions to support member states,” says Dr Hasurdjiev.

Mapping patient experiences

To promote this objective, the Patient Access Partnership has set out on a project to map patient experiences of access across Europe. “We want to look at access in the 28 member states and show how different stakeholders define access, see if there are differences in perception between patients, industry, governments, doctors and other health professionals, and hospital managers,” Dr Hasurdjiev says.

“Based on this we will have a better idea about the overall situation and expectations, and give institutions and politicians a view of what the needs are and what action is needed on an EU level.”

Following on from the mapping exercise, the Patient Access Partnership has a longer term aim of providing a tool for measuring access. “There are some indicators already, for example, waiting times. But these are just numbers; they don’t give any idea of the effect on the patient, or insights into the reason for the waiting time,” Dr Hasurdjiev noted.

It also transpired that there is no consistent definition of access, a gap that prompted the Patient Access Partnership to formulate the 5A Access Principles:

  • Availability: are services in place?
  • Adequacy: is there enough resource to go round and to ensure continued supply?
  • Accessibility: are services optimised for use, are facilities physically accessible; how long does it take to access care; are the services those that people need?
  • Affordability: can people pay without suffering financial hardship?
  • Appropriateness: are the services culturally attuned; do they meet the needs of different sections of the population?

The first task in devising the tool will be to call on experts to say what elements, for example, access to information, to innovation, outpatient services, generic drugs, and so on, should be in the ‘access basket’.

“This is a really crucial piece of work to identify the barriers and provide the information needed to shape reforms. I believe that in the next months and years we have to find the answers,” Dr Hasurdjiev concluded.