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Finding sensible responses to the economic crisis
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We are going through a difficult time in Europe. Two years since the beginning of the economic crisis, we are hitting unprecedented negative records, and there are no signs of recovery on the horizon.
Unemployment in the eurozone is currently 11.7%, according to a recent news release from Eurostat, the statistical office of the European Union. An estimated 25.9 million people were unemployed in October 2012, which accounts for an increase of 204,000 compared with the previous year. The countries that are suffering the most are Spain and Greece, where unemployment rates are up to 26.2% and 25.4%, respectively. Health spending has fallen across the EU, reversing a growth trend that began in 1975. According to the 2012 report of the Organisation for Economic Co-operation and Development, health spending per capita increased by 4.6% per year from 2000 to 2009 but fell by 0.6% in 2010.
In ophthalmology, as in many other branches of medicine, we are confronted with a dilemma. Budget restrictions in public hospitals and diminished patient volume in private practices call for a reduction of costs. On the other hand, today’s well-informed, Internet-savvy patients have high expectations. They know as well as we do that the latest technological advances can provide substantially better results and better quality, and they are not prepared to be offered lower standards. But high-tech, premium procedures require higher investments and greater costs for consumers.
Traditionally, public hospitals all over Europe have been able to offer free or near-free high-quality care and have been equipped with the latest technology. In recent years, however, the cost of keeping up with advances has increased to the point of being unaffordable. In ophthalmology, public health care has failed in updating budgets to the cost of premium IOLs and encountered huge problems in meeting the increasing demand for anti-VEGF injections for age-related macular degeneration. The cost of being equipped with the latest diagnostic and monitoring technologies is too high in the current situation, and femtosecond lasers for cataract are, in most cases, a dream that is far from coming true. And yet there will be pressure from the public, which expects to have access to the gold standard of care and is not prepared to accept the second choice when health is involved. Although cuts have been made on investments, reimbursements, staff and salaries, the quality of services in most European hospitals remains high. But overcrowding and longer waiting times for patients are an issue. We are now talking about months, while in past years we had been able to provide most surgical procedures within weeks.
Lucio Buratto
Private practices are suffering a decrease in the demand for surgery, especially for elective procedures such as refractive and cosmetic surgery. Refractive surgery had its first downfall about 7 years ago. Too many cases had been treated without the proper selection criteria, leading to poor results and complications. The media were, at the time, very influential in propagating a negative image of refractive surgery, discouraging potential patients from undertaking it. Since then, refractive surgery has made giant steps in both safety and efficacy, with the introduction of customized treatments, wavefront technology, new eye tracking and iris recognition systems, new lasers with flying spots and microspots, and the femtosecond laser. Procedures have been standardized, and patient selection has become more accurate thanks to the advancements in diagnostic testing and criteria. In expert hands, results are now excellent and highly predictable, and complications are extremely rare. We have been able to progressively rebuild the good reputation of refractive surgery, but the economic crisis has put a stop to the positive trend. Numbers are still relatively stable where high professional skills and high technological solutions are offered and prices are within the range of affordability. Certainly, city practices enjoy privileges that small-town practices do not share. At this stage, smaller and more decentered practices suffer the most because they are less well known, less publicized and, in many cases, less technologically equipped.
However, the low-price policy is wrong and unnecessary, in my opinion. As ophthalmologists, we need high investments in technology, constant updates, continuing education and travel to meetings. Depreciating ourselves would inevitably lead to killing private medicine. I hope the practices that have lowered their prices will use it as only a temporary measure. It might be a strategy to survive, but in the long run, with the high costs involved in running a surgical practice, it could have a boomerang effect, leading to huge deficits.
To face the crisis, we need to be active, think positive and invest in new options for our patients. Nowadays we have a wide range of solutions we can offer at different prices, meeting all needs. We can certainly reduce the expenses that are not necessary for the good management of our practice and choose low-cost options for information and marketing, such as the Internet and social media. Another possibility we have is to extend practice hours to allow patients to come at the end of their working day.
The crisis may also speed the ongoing trend toward group practices, allowing a more cost-effective management of time and the sharing of costs related to premises, personnel and equipment, including high-cost technology that would not be affordable for a single surgeon. Working in a team will also encourage the free flow of ideas and initiatives, promoting individual and team development and improvement.
The feeling of uncertainty that we are experiencing today in Europe highlights the weaknesses of a political, economic and monetary union that coexists with structural and cultural differences and unequal levels of wealth and development. The need to overcome fragmentation in health care policies has become, at this time, even more self-evident and relevant.