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Speaker 1: So how was it booking your last doctor's appointment?

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Speaker 2: If I'm honest, here in London, getting a doctor's appointment

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Speaker 2: can be impossible, sometimes being sold I've got a wait

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Speaker 2: months just to see a doctor. It can be able

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Speaker 2: an nine.

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Speaker 3: Yeah, I don't book any doctor's appointments.

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Speaker 2: I tried to actively avoid it because it's so hard

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Speaker 2: to book.

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Speaker 3: It took me almost well more than a year and.

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Speaker 4: A half booking my last doctor's appointment. It was a

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Speaker 4: bit of a difficulty considering the way in time when

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Speaker 4: you're booking it over the phone.

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Speaker 5: From Bloomberg News and iHeartRadio it's the big tag. I'm Westcasova. Today,

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Speaker 5: healthcare systems across Europe are starting to crack. For decades,

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Speaker 5: the UK's National Health Service and public healthcare systems in Sweden,

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Speaker 5: France and other European nations were held up as a

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Speaker 5: model to the world. Unlike in the US, where a

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Speaker 5: simple doctor's visit can mean a staggering bill, the European

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Speaker 5: systems provide cradle to grave care for everyone at low

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Speaker 5: cost to patients. But in recent years some of those

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Speaker 5: systems have come under extreme financial strain, and they're now

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Speaker 5: struggling to keep up with the needs of the people

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Speaker 5: they serve.

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Speaker 3: I think we need to be flexible, be open, and

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Speaker 3: bring innovations so that we can adapt to the changing

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Speaker 3: needs of the population.

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Speaker 5: That's doctor Thomas Zapata of the World Health Organization. He's

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Speaker 5: here to talk about how governments are trying to prevent

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Speaker 5: these systems from collapsing. It's a problem one who official

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Speaker 5: liken to a ticking time bomb. But first Bloomberg's Naomi

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Speaker 5: Kresky and Jonas Ekblom on why this is happening now

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Speaker 5: in so many countries at the same time.

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Speaker 1: In one third of countries in Europe, more than forty

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Speaker 1: percent of doctors are more than fifty five years old.

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Speaker 1: And if you do the math on that, you can

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Speaker 1: see that there's a big problem ahead. The workforce of

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Speaker 1: medical workers is older in the EU than it is

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Speaker 1: in the US. I crunched these numbers myself, and every

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Speaker 1: time I hear them it just shocks me again. In Italy,

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Speaker 1: fifty six percent of doctors are over the age of

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Speaker 1: fifty five. In France it's about forty four percent. In

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Speaker 1: Germany almost forty five percent of doctors are over the

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Speaker 1: age of fifty five. They don't have enough young doctors

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Speaker 1: to replace the doctors who are getting older and other

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Speaker 1: types of medical workers as well. So the ticking time

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Speaker 1: bomb issue is really this age issue, but that's just

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Speaker 1: a piece of a broader problem.

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Speaker 5: And Jonas, what are some of those other problems.

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Speaker 4: You're talking about, like the huge demographic changes, an aging

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Speaker 4: population that requires not only more advanced care but also

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Speaker 4: more like prolonged care. Medical care and medical treatment is

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Speaker 4: becoming increasingly advanced and increasingly expensive as well, Like we're

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Speaker 4: not talking about necessarily simple drugs, we're talking about very

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Speaker 4: expensive drugs, which like way on like healthcare budget even more,

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Speaker 4: and machines and other treatments are also getting more expensive.

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Speaker 4: So healthcare systems are really stuck between like a rock

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Speaker 4: and a hard place when it comes to European healthcare,

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Speaker 4: and obviously in a lot of other developed countries around

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Speaker 4: the world as well, So but it's very pronounced in Europe.

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Speaker 1: It's sort of a dual demographic challenge where demographics are

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Speaker 1: driving an increase in the need for healthcare at the

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Speaker 1: same time that demographics are reducing the ability of hospitals

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Speaker 1: and healthcare systems to provide healthcare. I was talking recently

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Speaker 1: with a European politician who said that the cost of

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Speaker 1: medicines issue alone is like a giant Iceberg that European

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Speaker 1: healthcare systems are sort of driving toward as if they

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Speaker 1: were the Titanic because all of this is so expensive.

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Speaker 4: The situation is quite similar Europe. Just take for example,

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Speaker 4: the UK and their National Health Service, where doctors and

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Speaker 4: nurses are striking and talk about increasingly poor working conditions

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Speaker 4: like long hours and not being able to provide sufficient

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Speaker 4: care for their patients and also working with extremely low

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Speaker 4: pay on the same isstry for like a lot of

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Speaker 4: other places in Europe.

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Speaker 5: So here we are, we're talking about the health system.

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Speaker 5: We started out talking about a taking time bomb. Then Naomi,

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Speaker 5: you compared it to the Titanic hitting in Iceberg. So

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Speaker 5: pretty dramatic situation For those of us who aren't as

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Speaker 5: familiar with the European healthcare systems. What's the sort of

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Speaker 5: broad differences between the European style model of healthcare and

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Speaker 5: the US healthcare model.

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Speaker 1: There's sometimes a sort of a mistake and equation of

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Speaker 1: all European health systems being the same as the National

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Speaker 1: Health Service in England, like a single payer system where

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Speaker 1: the government is organizing everything and paying things, and that's

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Speaker 1: not necessarily the care. There are many different ways that

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Speaker 1: healthcare is provided in Europe, but the overarching difference, I

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Speaker 1: think is that you don't have to be worried in

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Speaker 1: Europe as a consumer of healthcare about whether your healthcare

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Speaker 1: is going to bankrupt you. If you walk into a

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Speaker 1: hospital in France or in Germany and you need health care,

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Speaker 1: in some cases, you might not even see the bill.

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Speaker 1: It doesn't mean that your healthcare is free, but the

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Speaker 1: overarching idea is that there will be fair and equitable

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Speaker 1: care available for everybody who needs it.

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Speaker 5: And Jonas, I guess the other big difference between the

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Speaker 5: US and all the various European models is that healthcare

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Speaker 5: isn't tied to your job. That you don't feel like

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Speaker 5: you have to stay in a job for fear of

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Speaker 5: not being able to pay for your medication or your

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Speaker 5: health needs exactly.

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Speaker 4: And I feel like that comes back to what Naomi

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Speaker 4: was saying. It's like fair and equitable to everyone because

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Speaker 4: even if it might be paid from for example, like

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Speaker 4: you know, deduction from your pay or your wages or whatnot,

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Speaker 4: it's still funded in a fashion that it doesn't rely

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Speaker 4: on you holding down a job or something like that.

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Speaker 5: You're in Stockholm, and Sweden is often held up as

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Speaker 5: a real example of a healthcare system that treats people. Well,

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Speaker 5: how does it work there? When you go to the

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Speaker 5: doctor in Sweden, so.

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Speaker 4: You pay actually your own contribution, We're talking about the

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Speaker 4: range of like thirty forty dollars. You only do that

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Speaker 4: up to like two hundred dollars per year. After that

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Speaker 4: everything is completely free. The same goes for like for

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Speaker 4: a time, like drugs and medicine like up into an

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Speaker 4: amount of about like you know, two hundred dollars. You

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Speaker 4: pay the cost yourself. Otherwise you just stroll up to

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Speaker 4: your be it like a primary care facility or the hospital,

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Speaker 4: and most is taken care of you. But like every

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Speaker 4: single visit, be it an emergency room or like in

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Speaker 4: a multi day hospital stay or whatever, it's still only

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Speaker 4: that thirty dollars cost for you as a private individual.

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Speaker 5: And Yaomi, you're based in Berlin, you go see your

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Speaker 5: doc in Berlin. How does it work?

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Speaker 1: In Germany? There's a network of nonprofit public insurers that

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Speaker 1: actually compete with one another. They offer maybe slightly different things,

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Speaker 1: and some are seen as better and more desirable than others.

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Speaker 1: There are a lot of them. The last time I looked,

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Speaker 1: I think they were about three hundred of these, So

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Speaker 1: about nine tenths of people have this public insurance and

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Speaker 1: about one tenth have private insurance, which is slightly cheaper

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Speaker 1: when you're younger, more expensive when you're older. And when

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Speaker 1: you go to the doctor. If you're publicly insured, you

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Speaker 1: have an insurance card that you present whether you receive

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Speaker 1: a bill or not. It's not going to make you

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Speaker 1: worry about bankrupting yourself for your healthcare. Personal example, my

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Speaker 1: mom was visiting last summer. We wound up having to

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Speaker 1: make an emergency room visit because she fell down so

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Speaker 1: short outpatient visit, rode in in an ambulance to the hospital.

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Speaker 1: Got the bill for the ambulance. I think it was

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Speaker 1: one hundred and sixty dollars. The outpatient visit for the

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Speaker 1: hospital was like about a hunt Red Books. I think,

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Speaker 1: if I'm recalling correctly, we're talking about like very low

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Speaker 1: three digit numbers. And this is without insurance at all.

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Speaker 1: We just paid it. The cost structure is just a

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Speaker 1: completely different one.

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Speaker 5: Jonas both you and Naomi are in big European cities,

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Speaker 5: but you're right that the situation is much different in

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Speaker 5: rural areas, and that's kind of part of the big

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Speaker 5: tension here.

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Speaker 4: As healthcare grows increasingly complex when it comes to forzon

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Speaker 4: be it fairly simple conditions to like cancer or like

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Speaker 4: cardiac care or whatever, there's been a trend to centralize

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Speaker 4: and specialize in the bigger cities, which goes hand in

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Speaker 4: hand with like decreasing costs too. But that obviously creates

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Speaker 4: a bit of a dilemma because care again might be

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Speaker 4: a bit more limited to the bigger cities, like a

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Speaker 4: big problem in Sweden of for example, which it's as

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Speaker 4: big as California as it comes to like the size

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Speaker 4: of the country, a lot of empty space like rural

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Speaker 4: areas too, and a fairly specialized emergency care for like

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Speaker 4: pregnancy care and like delivery rooms. And there's been like

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Speaker 4: a lot of places where like pregnant women like about

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Speaker 4: to give birth, like needs to try for like you know,

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Speaker 4: several hours to actually get into a deliver room that

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Speaker 4: can actually accept them.

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Speaker 1: There's this idea of the medical desert, and in France,

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Speaker 1: a very large portion of the area of the country

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Speaker 1: actually is medical desert like places where people can't get

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Speaker 1: to a doctor quickly, and it's a big political problem.

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Speaker 1: In France, they don't have enough general practitioners in small

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Speaker 1: towns or rural places, or in some cases in poor

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Speaker 1: neighborhoods of big cities, like sort of the poor suburbs

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Speaker 1: surrounding Paris might also be medical desert where people are

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Speaker 1: not able to get quick access to a general practitioner

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Speaker 1: who's close by. They might wind up in the emergency

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Speaker 1: room because they did not get that care from their

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Speaker 1: primary care.

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Speaker 5: Doctor after the break. Health systems compete to lure doctors

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Speaker 5: away from neighboring countries.

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Speaker 2: Junior doctors in the UK have begun a four day walkout.

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Speaker 2: Unions have made a final plea for the Prime Minister

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Speaker 2: Whisunak to discuss higher pay settlements for workers in the NHS.

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Speaker 5: The largest nursing strike in NHS history is underway.

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Speaker 3: Thousands of junior doctors are striking today and they'll be

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Speaker 3: on strike until seven o'clock on Saturday morning.

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Speaker 5: What you heard there is just what's going on in

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Speaker 5: the UK, and medical professionals have been striking across Europe Naomi.

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Speaker 5: What are some of the problems that doctors and nurses

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Speaker 5: are facing right now that has them so upset.

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Speaker 1: There's a pay issue, certainly, and we see that in

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Speaker 1: France with healthcare workers striking, marching in the streets. There's

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Speaker 1: a big debate over the amount of money that doctors

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Speaker 1: get per visit. There is a push to double it

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Speaker 1: to fifty euros per visit, which when you think about it,

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Speaker 1: is actually still a very small number. It's also important

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Speaker 1: to put all of us into context of the COVID

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Speaker 1: nineteen pandemic. Spending on healthcare in Europe had risen for

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Speaker 1: decades and then at around the time of the financial

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Speaker 1: crisis in two thousand and eight, it kind of went

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Speaker 1: flat as a percentage of GDP and stopped rising. Then

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Speaker 1: tensions were building in the systems. There wasn't as much

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Speaker 1: increase in money as there used to be, plus demographic

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Speaker 1: issues that we've discussed, and then COVID happens and the

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Speaker 1: healthcare systems are under extreme strain. Also, a lot of

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Speaker 1: money is pouring into the systems all of a sudden,

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Speaker 1: but a lot of it is for things like COVID

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Speaker 1: vaccines and short term solutions for beds and clinics. There's

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Speaker 1: not a whole lot of money coming into structure reform.

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Speaker 1: It's more like putting a lot of band aids on

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Speaker 1: some very big problems. And now for a few years,

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Speaker 1: workers have been super stressed, they're super burnt out, nurses

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Speaker 1: are leaving coming out of COVID. We just had a

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Speaker 1: horrible winter in Europe for as I'm sure in the

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Speaker 1: US as well, for respiratory diseases pneumonia RSV, really stressed

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Speaker 1: emergency rooms. And then add of course in cost of

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Speaker 1: living crisis, which healthcare workers also feel, and you've got

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Speaker 1: this bubbling pot of resentment, I would say in hospitals

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Speaker 1: in many different European countries.

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Speaker 4: A lot of these issues free date the COVID pandemic

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Speaker 4: by years or even decades like sometimes, and the healthcare

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Speaker 4: professionals and the healthcare staff is really being pinched in

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Speaker 4: like every direction here, like Naomi was saying, and a

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Speaker 4: big thing too, like talking to healthcare professionals, you hear

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Speaker 4: they want to work in this field, they want to

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Speaker 4: provide care, and they do very often put their heart

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Speaker 4: into their jobs.

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Speaker 5: And that's of course something that healthcare workers in the

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Speaker 5: US and everywhere else seem to be experiencing too these

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Speaker 5: incredible strains that wind up affecting their own lives. And

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Speaker 5: you spoke to a number of healthcare workers in different

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Speaker 5: European cities, what do they have to say about what

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Speaker 5: it's been like for them?

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Speaker 1: We and our colleagues in Paris and Rome, who also

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Speaker 1: worked on this story, spoke to a number of doctors

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Speaker 1: in different countries and nurses as well, and they all

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Speaker 1: kind of had similar things to say that they feel

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Speaker 1: like they're not serving their patients as they could because

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Speaker 1: they're spread tooth thin. And I talked to one orthopedic

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Speaker 1: surgeon in Madrid who talked about how when she has

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Speaker 1: her mourning shift, like morning shift in this Madrid hospital

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Speaker 1: is sort of I think from eight am to like

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Speaker 1: three pm or two pm, so it's a pretty long shift.

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Speaker 1: She has to get through forty patients. She would normally

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Speaker 1: have twenty patients, that's the number of appointments she has,

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Speaker 1: but the administrative staff at her hospital double books each

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Speaker 1: single appointment, and so she'll have forty people there. So

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Speaker 1: she has like five minutes per patient, and she doesn't

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Speaker 1: really have time to do much more than speak in

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Speaker 1: a really superficial way with them. She said, a lot

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Speaker 1: of them are older people who have you know, arthritis,

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Speaker 1: degenerative disease, joint problems, and she can't fix their issues

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Speaker 1: in five minutes. She doesn't even really have time to

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Speaker 1: explain to them that this is an issue of aging

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Speaker 1: and that they might actually not feel better. And I

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Speaker 1: think what she said to me is they might have

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Speaker 1: an incurable disease, but you can't tell them that in

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Speaker 1: three minutes. And so what she winds up doing is

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Speaker 1: maybe giving a few bits of advice and then booking

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Speaker 1: them in for another consold six months down the line.

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Speaker 1: And it just creates the snowball effect of people just

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Speaker 1: coming back in order to make them feel like she's

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Speaker 1: giving something to them, She'll give them these repeat appointments,

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Speaker 1: but it doesn't solve anything. It's not the way that

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Speaker 1: she would prefer to be giving care to these people.

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Speaker 4: Yeah, I can only agree, Like, I feel like the

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Speaker 4: most heartbreaking thing talking to healthcare staff is this fact

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Speaker 4: like they want to provide a more holistic, long term

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Speaker 4: type of care which allows them to care for the

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Speaker 4: whole human and not just like the most urgent symptom

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Speaker 4: or illness they might be suffering from. Like right, there, and.

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Speaker 5: Then Jonas, let's hear what one doctor in Stockholm you

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Speaker 5: spoke to had to say about what it's like to

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Speaker 5: practice medicine there.

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Speaker 6: Right now, our hospitals are getting full almost every day,

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Speaker 6: and it leads to one in one out situation where

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Speaker 6: we have to choose between different patients that all need

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Speaker 6: hospital care. We're constantly forced to break rule routines and

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Speaker 6: are moral compass. When I come as an I see

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Speaker 6: a consultant to the emergency room, and perhaps there are

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Speaker 6: free patients that need intensive care and we just have

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Speaker 6: one last intensive care of bad left. Then I have

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Speaker 6: to choose which patient that gets that spot and which

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Speaker 6: two patients that don't. So I have to choose which

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Speaker 6: patients will get the greatest chance to survive. That's not

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Speaker 6: how it should be.

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Speaker 5: And here's a nurse in France who's talking about what

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Speaker 5: work these days is like for her.

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Speaker 7: In France, nobody applies to hospital jobs anymore because those

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Speaker 7: jobs aren't attractive at all. Salaries are low compared to

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Speaker 7: other places, and working conditions are deteriorating a lot. So

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Speaker 7: these days, to provide our care services, we're always in

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Speaker 7: a rush. It's care that we do back to back

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Speaker 7: and not well. We don't have time to drink or eat.

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Speaker 7: We don't have time to go to the bathroom. We

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Speaker 7: barely have time to sit down. We don't have time

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Speaker 7: to talk to patients, to families, to communicate with them.

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Speaker 5: What's going on, Naomi. One of the things you write

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Speaker 5: in the story is that lower income countries in the

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Speaker 5: EU have become what you call feeder nations for their

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Speaker 5: wealthier neighbors. What does that mean?

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Speaker 1: That was something that somebody at the World Health Organization

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Speaker 1: pointed out to me. He cited the example of Romania,

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Speaker 1: which produces the most medical school graduates per capita in

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Speaker 1: the European Union, but at the same time has a

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Speaker 1: below average density of healthcare workers. And that's because the

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Speaker 1: doctors are migrating in Germany, where I think more than

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Speaker 1: one in ten doctors were educated elsewhere. Romanian doctors are

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Speaker 1: the biggest immigrant group.

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Speaker 5: Because they can make more money practicing in Berlin than

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Speaker 5: they can at home.

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Speaker 1: Correct the average annual pay for a specialist doctor in

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Speaker 1: Germany is about one hundred and sixty six thousand euros

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Speaker 1: a year. That's depending on exchange rate, about one hundred

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Speaker 1: and seventy six thousand dollars and that's at least three

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Speaker 1: times more than what doctors would get in Romania, so

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Speaker 1: they are clear economic incentives. And then at the same time,

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Speaker 1: German doctors moved to Switzerland, which pays even better, and

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Speaker 1: doctors from Eastern Europe will also wind up in Sweden.

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Speaker 1: With a single market comes in ability for high skill

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Speaker 1: workers to go elsewhere, and they do.

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Speaker 5: We started this conversation with this idea of a social

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Speaker 5: contract in Europe that people feel that they have cradled

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Speaker 5: to grave healthcare coverage. How is this crisis affecting the

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Speaker 5: kind of public trust in the healthcare systems?

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Speaker 1: It harms the trust in healthcare systems, and that in

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Speaker 1: turn is a political liability for politicians in Europe because

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Speaker 1: how people I view healthcare is really linked to their

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Speaker 1: trust in government as well. And we've seen, you know,

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Speaker 1: European countries and politicians acknowledging and responding to the problem.

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Speaker 1: In January, the French President Emmanuel Macrong acknowledged what he

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Speaker 1: called the personal and collective exhaustion that healthcare workers have

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Speaker 1: had to deal with, and he pledged to spend more

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Speaker 1: money and to do some reforms. In Germany, health Minister

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Speaker 1: Karl Lauterbach is working to overhaul the hospital system. I

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Speaker 1: guess we'll have to see how effective those reforms are.

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Speaker 5: Naomi Jonas, thanks so much for speaking with me today.

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Speaker 1: Thanks it was a pleasure.

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Speaker 4: Thanks for having.

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Speaker 5: Us when we come back. What can be done to

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Speaker 5: turn these ailing health systems around? So where do things

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Speaker 5: go from here? Our producer Frederica Romaniello spoke to someone

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Speaker 5: who thinks about this question all the time, doctor Thomas Zapata.

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Speaker 5: He heads the World Health Organization's Office of Health, Workforce

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Speaker 5: and Service Delivery in Europe.

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Speaker 2: At the end of March, the World Health Organization held

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Speaker 2: the High Level of Regional Meeting to discuss just how

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Speaker 2: serious the situation in Europe is and offer actions for

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Speaker 2: governments to take. What are the recommendations that the who

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Speaker 2: came up with.

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Speaker 3: We need to better retain health workers. That means that

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Speaker 3: those health workers that are already in the health systems

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Speaker 3: all over Europe. We need to improve the working conditions,

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Speaker 3: so they want to stain the system. That includes a

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Speaker 3: fat muneration that depends on the country. That include increased

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Speaker 3: flexibility in working arrangements. We need, for example, zero tolerance

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Speaker 3: to viole against health workers. That's something that is coming

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Speaker 3: up in some countries as well. Is important also as

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Speaker 3: part of improving working conditions. One of the main areas

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Speaker 3: that we have is that in rural areas in many

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Speaker 3: countries in the region, is difficult to recruit and retain

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Speaker 3: health workers in rural areas. So for that we need

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Speaker 3: to bring a combination of incentives, not only financial, to

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Speaker 3: make it more attractive for health workers to work in

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Speaker 3: rural areas. Then we have measures in order to improve

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Speaker 3: education in terms of not only improving numbers, but I

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Speaker 3: think we need to improve the quality and what we teach,

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Speaker 3: which competencies are we teaching to our health workers and

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Speaker 3: the future generations of health workers. Then a third element

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Speaker 3: is optimizing the performance. So we have limited health workers,

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Speaker 3: so we need to make the best use of the

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Speaker 3: time that they have, and for that we need to

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Speaker 3: reduce all the bureaucracy attached to clinical practice. We need

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Speaker 3: to optimize and reorganize the organ nice health services so

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Speaker 3: that we can maximize that time, that clinical time of

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Speaker 3: the physician, of the nurse and other types of health

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Speaker 3: professionals with the patient. And in order to do all

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Speaker 3: this we need to enablers. One of them is improved

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Speaker 3: planning of the health work force and the second enabler

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Speaker 3: is investing. We need to invest more and also more

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Speaker 3: smartly in those areas that really add value.

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Speaker 2: Where do you see the state of the healthcare workforce

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Speaker 2: in Europe head in the years to come.

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Speaker 3: We have a window of opportunity at the moment and

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Speaker 3: countries are taking seriously this. So if they take the

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Speaker 3: actions in terms of all the actions that we have mentioned,

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Speaker 3: we should be able to go in a future direction

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Speaker 3: when we have a sufficient health work force in terms

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Speaker 3: of numbers, also in terms of skills of competencies, in

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Speaker 3: order to deliver services that is adequately distributed in rural,

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Speaker 3: remote and underserved area. Yes, and also with a healthwalk

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Speaker 3: force that is performing adequately, that is motivated and with

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Speaker 3: higher standards of performance and quality. Of course, I think

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Speaker 3: we need to be flexible, be open and bring innovations

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Speaker 3: so that we can adapt to the new changing needs

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Speaker 3: of the population. We know that population is aging, more

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Speaker 3: chronic diseases, more the morbidity. There are also increased expectations

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Speaker 3: by the patients. We also have backlocks from the COVID pandemic,

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Speaker 3: so all these things are making that the demand for

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Speaker 3: services are increasing, so we need to factor all these

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Speaker 3: things in the future so that we can start preparing

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Speaker 3: the health workforce now to be able to cope with

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Speaker 3: that increased demand in the future.

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Speaker 2: Doctor Tomasa Pata, thank you so much for joining me.

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Speaker 3: Thank you so much for the Erica.

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Speaker 5: Thanks for listening to us here at the Big Tach.

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Speaker 5: at Bloomberg dot net. The supervising producer of The Big

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Speaker 5: Take is Vicky Virgalina. Our senior producer is Katherine Fink.

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Speaker 5: Federica Romanello is our producer. Our associate producer is Zennab Sidiki.

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Speaker 5: by Leo Sidrin. I'm Westkasova. We'll be back tomorrow with

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Speaker 5: another Big Take.