Country Correspondent: Sonĵ Hall

In December 2018, the Australian Commission on Safety and Quality in Health Care launched the User Guide for Health Services Providing Care for People with Mental Health Issues, part of the second edition of the National Safety and Quality Health Service Standards. The guide provides an overview of approaches to providing optimal health care for people with comorbid mental and physical health issues.

Around the same time, the Australian Institute of Health and Welfare published data from a patient satisfaction survey from two of Australia’s largest states, Queensland and New South Wales. This survey of more than 24,000 respondents found that in 2016–17, a larger share of patients receiving ambulatory mental health services reported their overall care experience as ”good,” “very good,” or ”excellent” (92% in QLD, 91% in NSW), compared to those receiving inpatient services (73% in QLD, 86% in NSW).

• Australian Commission on Safety and Quality in Health Care: Mental Health
• Mental health services in Australia

Country Correspondent: Roosa Tikkanen

In Montreal, primary care physicians can prescribe a free trip to the Montreal Museum of Fine Arts to help alleviate patients’ and family members’ symptoms and anxiety, as part of a new partnership between the museum and Médecins francophones du Canada, which represents French-speaking physicians in Canada. The museum houses the largest art therapy center in North America. Ontario has also announced plans to launch a one-year pilot funded by the provincial health ministry to allow social prescriptions for a wider set of benefits, from cooking classes to practical needs such as help with tax returns. The concept of “social prescriptions” was first introduced in the United Kingdom, where they are part of a national strategy to combat loneliness.

• Primary care providers exploring value of "social prescriptions" for patients

Country Correspondent: Roosa Tikkanen

For Canadian provinces and territories to receive federal matching dollars, they are required by law to administer medically necessary services to residents without user fees. However, in Quebec, patients are able to pay for quicker access to medical exams at private clinics. Last year, the federal health minister issued a warning to the province, stating that “all of the fees imposed on patients for these services contravene the Canada Health Act,” and that access shouldn’t be faster for those with more money. The minister warned that if Quebec fails to ban access to private diagnostic services, the federal government will cut health transfers to the province starting in 2023. Thus far, the provincial health premier has ignored these warnings, stating that “some people like to have access rapidly to some services. I don’t like to see the federal government telling us how to manage the health-care network.”

• Quebec supports cue-jumping for medical exams, despite warning from federal government

Country Correspondent: Roosa Tikkanen

Antimicrobial resistance (AMR) is a top health policy priority for countries around the world. In some nations, 40 percent to 60 percent of the most common bacterial organisms do not respond to antibiotic treatment, putting children, the elderly, and others at risk of contracting resistant infections. In a November 2018 report, the Organisation for Economic Co-operation and Development (OECD) estimated the costs of combating AMR globally, using advanced techniques such as machine learning. The report finds that most AMR deaths could be prevented by spending just $2 per person per year on simple measures, including promoting better hygiene such as hand-washing, curbing inappropriate antibiotic prescribing, and rapidly testing patients to determine whether they have viral or bacterial infections.

• Stemming the Superbug Tide
• Stopping antimicrobial resistance would cost just USD 2 per person a year
• Stemming the Superbug Tide: Just a Few Dollars More

Country Correspondent: Roosa Tikkanen

In 2017, health ministers from 35 high-income countries asked the Organisation for Economic Co-operation and Development (OECD) to investigate the performance of the pharmaceutical industry in terms of enhancing value for money for health systems. Its November 2018 analysis found the industry directly employs more than 1.2 million people, including nearly half a million in the U.S. Countries vary in terms of the proportion of their gross value added invested back into research and development (R&D), ranging from about 40 percent in Japan and the U.S. to one-quarter in Denmark. Over time, the productivity of R&D expenditures — measured as the amount spent per approved medicine — has declined internationally. The investigation also showed that new medicines are increasingly being developed for small patient populations, yet innovation is lacking in certain areas, including development of new antimicrobials and drugs for some rare diseases. The report also included several recommendations for how countries can work together to increase the value of pharmaceutical spending.

• Pharmaceutical Innovation and Access to Medicines

Country Correspondents: Roosa Tikkanen and Angèle Malâtre-Lansac

In November 2018, the French national health authority took a bold move ahead of World AIDS Day, announcing that it will partially reimburse the cost of male condoms obtained through prescription from a doctor or midwife. The aim is to combat the spread of HIV and other sexually transmitted diseases. A report last year showed that cases of chlamydia and gonorrhea tripled in France between 2012 and 2016, with young people ages 15 to 24 most affected. At the moment, coverage extends only to two brands of condoms, including the French-made Eden, which costs far less than leading brands. France joins a handful of European countries that cover the cost of condoms through their national health insurance system.

• France's health system to reimburse cost of condoms in fight against STDs

Country Correspondent: Michael Laxy

The German state of Hesse has approached the shortage of general practitioners (GPs) in rural areas with an innovative pilot. Around 170 GP positions are currently unfilled in Hesse; in some areas, just three GPs are responsible for more than 8,000 patients. In this pilot, initiated by the Association of Statutory Health Insurance Physicians, patients are served in a mobile GP center known as a “medibus.” The bus is equipped with a driver, a GP, and two nurses and visits six rural villages, four days a week. As other measures such as financial incentives have thus far had little effect in attracting GPs to practice in rural areas, the medibus model could be a potential solution to shortages.

• MEDIBUS: DIE MOBILE HAUSARZTPRAXIS (in German)
• Germans turn to 'medibus' as doctors desert villages

Country Correspondent: Margje Haverkamp

Holland’s Maastricht University Medical Center is collaborating with international partners in developing an artificial intelligence–based virtual system, known as Molly, to help patients with heart failure. Molly version 1.0, a virtual nurse, is already being used under supervision among a small group of patients with cardiomyopathy, a form of heart muscle disease. Molly measures their blood pressure and advises them when to contact their physicians. With EUR 4.5 million (USD 5.1 million) in funding, the group is now developing Molly 2.0, with the aim for Molly 2.0 to be able to independently diagnose diseases, recognize warning symptoms, prescribe medications, and request blood tests. Developers believe that Molly will be able to reduce unnecessary hospital admissions and thereby health care costs. Molly 2.0 is expected to be tested in a clinical environment in two years’ time.

• Nieuwe robot Molly is een halve arts (en nu al controversieel) (in Dutch)
• MAASTRICHT UMC+ VIRTUAL NURSE TO DIAGNOSE, PRESCRIBE MEDICINE FOR HEART PATIENTS

Country Correspondent: Margje Haverkamp

In December, Bruno Bruins, the Dutch Minister of Health, wrote a letter to the Dutch parliament announcing stronger incentives to encourage health care providers to share their patients’ data electronically and uniformly. Currently, there is no legal requirement for hospitals, physicians, and other health care providers to exchange information. Bruins wants to legally enforce data-sharing in situations where the responsibility for patients moves from one provider to another, for example after discharge from the hospital. The Dutch government has announced plans to allocate EUR 400 million (USD 452 million) for this project. Earlier and more sweeping attempts by the Dutch parliament to enforce the exchange of medical information failed because of privacy concerns.

• Minister Bruno Bruins: “Wettelijke basis voor digitale gegevensuitwisseling verbetert patiëntveiligheid” (in Dutch)
• Health minister wants to speed up digital transfer of patient files

Country Correspondent: Marianne Storm

Tale Maria Krohn Engvik worked as a health nurse at upper secondary schools in Oslo but felt that she was not available enough to her students. To better connect with them, she created the @Helsesista (health sister) user profile on Snapchat. Her profile quickly became popular across the country, and her daily Snapchat stories now reach some 130,000 youths. Her followers send questions about sexuality, mental health concerns, or family issues. Engvik says she aims to communicate with youth in their own language and give hope to those experiencing mental health crises. Helsesista is now colloquially known as ”Norway’s school health nurse” and Engvik has received several national awards. Recently, Engvik landed a book deal and was given her own television show.

• Jeg redder liv med Snapchat (in Norwegian)
• The Årets Ladejarl award 2018
   

Country Correspondent: Jennifer Moore

The latest Learning from Adverse Events report shows that health care providers in New Zealand are continuing to develop and improve their systems for reporting, reviewing, and learning from adverse events. Each year, adverse events are reported to the Health Quality & Safety Commission by district health boards and other health care providers. The commission works with these providers to encourage an open culture of reporting so they can learn from what happened and put in place systems to reduce the risk of recurrence.

• Adverse events increase reflects improved reporting systems
• Learning from adverse events: Adverse events reported to the Health Quality & Safety Commission

Country Correspondent: Jennifer Moore

A campaign encouraging New Zealanders to start thinking about developing an advance care plan was launched in February. The campaign is designed to inspire people to have a conversation with their whānau (Maori for “family”) and health professionals about what matters to them if they become unwell, to discuss what kind of care they would or wouldn’t want, and to write down what is important to them. It features voices of people at different stages of life and culminated in Advance Care Planning Day on April 5. The campaign will be promoted primarily through social media, but with a strong focus on Māori and Pacific Islander media outlets.

• Te whakamahere tiaki i mua i te wā taumaha (in English)

Country Correspondent: Ulrika Winblad

Because of the overuse of antibiotics, antimicrobial resistance is increasing around the world. In Sweden, however, antibiotic prescribing decreased by 23 percent between 2007 and 2017 in terms of daily doses per inhabitant. The decrease among children, 43 percent, was particularly large. Changes to physician behavior, in response to national and regional policies, have been credited with this reduction. Changing public perceptions of antibiotics also may have made it easier for physicians not to prescribe them when they are not indicated.

• Antibiotikaanvändningen minskar i Sverige (in Swedish)

Country Correspondent: Lars Hemkens

The Swiss government has launched the “Strategy eHealth Switzerland 2.0,” which aims to promote digitization of health care information. Its focus is on the establishment and implementation of the electronic patient dossier, or medical record, to improve the quality and efficiency of care, patient safety, coordination of care, and health literacy. The dossier will allow patients, health professionals, and health care facilities to share information electronically and make the most important health documents accessible. The initiative runs until 2022.

• Die Digitalisierung im Gesundheitswesen fördern (in German)
• Strategie eHealth Schweiz (in German)
   

Country Correspondents: Partha Das and Roosa Tikkanen

In 2013, six of the nine leading supermarket chains in the U.K. removed unhealthy items such as sweets, chocolate, and potato chips from their checkout aisles. The move was a response to public concerns about unhealthy foods being the only options available at checkout, potentially contributing to rising levels of obesity. A new study published in the PLOS Medicine journal showed that shoppers at stores that made this change purchased 20 percent fewer unhealthy products than shoppers at other stores. A deeper dive into their habits showed that shoppers purchased less food to eat on the go than before. The government has announced that ending the promotion of unhealthy foods at checkouts is part of its strategy to halve childhood obesity in England over the next 12 years.

• Supermarket policies on less-healthy food at checkouts: Natural experimental evaluation using interrupted time series analyses of purchases
• Banning sweets at supermarket checkouts 'works'

Country Correspondents: Partha Das and Roosa Tikkanen

In November, the U.K.’s Secretary of Health and Social Care Matt Hancock released a new plan for the National Health Service that focuses on prevention at the Annual Meeting of the International Association of National Public Health Institutes, held in London. The overarching goal is to improve life expectancy by at least five years over the next 15 years and to close the life expectancy gap between the richest and poorest Britons. The plan includes a number of other bold targets, including halving childhood obesity by 2030, diagnosing 75 percent of cancers at stages 1 or 2 by 2028, sequencing 5 million genomes in five years, and offering whole-genome sequencing to all children and adults with cancer or other serious illnesses in 2019. To support ongoing efforts to tackle social isolation, the government also aims to make social prescribing available in every locality by 2023. In addition, Hancock wants to increase specialist maternity mental health services and find ways to encourage employers to support employment of individuals living with disabilities.

• Health Secretary launches 'Prevention is better than cure' vision

Country Correspondents: Partha Das and Roosa Tikkanen

The National Health Service (NHS) and the Association of the British Pharmaceutical Industry have reached a five-year deal regarding branded medicines. With the goal of keeping brand-name prescription drug costs predictable and affordable for the NHS, the industry agreed to a 2 percent cap on the growth in sales of branded medicines to the NHS. Pharmaceutical companies must repay the NHS for any spending over the cap. In turn, the NHS agreed to speed patients’ access to the latest medicines by having earlier discussions with industry representatives as well as faster health technology assessments. The NHS is expected to save nearly GBP 1 billion (USD 1.31 billion) in 2019 alone as a result of the agreement. The deal started on January 1.

• NHS to save £1 billion on its medicines bill in 2019

Country Correspondents: Partha Das and Roosa Tikkanen

British Prime Minister Theresa May has announced a GBP 3.5 billion (USD 4.6 billion) funding boost for primary and community health care by 2023–24. To reduce avoidable hospital admissions, some of these funds will be channeled toward rapid-response teams made up of doctors, nurses, and physiotherapists. These teams, available 24/7, provide urgent care and support in the community as an alternative to hospital care. Further initiatives include measures to help hospitalized patients return home sooner and a national rollout of a successful pilot in which health care teams were assigned to care home residents. The announcement was made as part of the Long Term Plan for the National Health Service, touted as the largest-ever funding boost for the British health system.

• Record NHS funding to give patients a better alternative to hospital

Editorial Team

Editor: Roosa Tikkanen

Co-editor: Molly Fitzgerald

Project manager: Aisha Gomez

Country Correspondents

Australia — Sonĵ Hall

Canada — Roosa Tikkanen

Europe/International — Roosa Tikkanen

France — Roosa Tikkanen and Angèle Malâtre-Lansac

Germany — Michael Laxy

Netherlands — Marthe Haverkamp

New Zealand — Jennifer Moore

Norway — Marianne Storm

Sweden — Ulrika Winblad

Switzerland — Lars Hemkens

United Kingdom — Partha Das and Roosa Tikkanen