Speaker 1: So how was it booking your last doctor's appointment?
Speaker 2: If I'm honest, here in London, getting a doctor's appointment
Speaker 2: can be impossible, sometimes being sold I've got a wait
Speaker 2: months just to see a doctor. It can be able
Speaker 2: an nine.
Speaker 3: Yeah, I don't book any doctor's appointments.
Speaker 2: I tried to actively avoid it because it's so hard
Speaker 2: to book.
Speaker 3: It took me almost well more than a year and.
Speaker 4: A half booking my last doctor's appointment. It was a
Speaker 4: bit of a difficulty considering the way in time when
Speaker 4: you're booking it over the phone.
Speaker 5: From Bloomberg News and iHeartRadio it's the big tag. I'm Westcasova. Today,
Speaker 5: healthcare systems across Europe are starting to crack. For decades,
Speaker 5: the UK's National Health Service and public healthcare systems in Sweden,
Speaker 5: France and other European nations were held up as a
Speaker 5: model to the world. Unlike in the US, where a
Speaker 5: simple doctor's visit can mean a staggering bill, the European
Speaker 5: systems provide cradle to grave care for everyone at low
Speaker 5: cost to patients. But in recent years some of those
Speaker 5: systems have come under extreme financial strain, and they're now
Speaker 5: struggling to keep up with the needs of the people
Speaker 5: they serve.
Speaker 3: I think we need to be flexible, be open, and
Speaker 3: bring innovations so that we can adapt to the changing
Speaker 3: needs of the population.
Speaker 5: That's doctor Thomas Zapata of the World Health Organization. He's
Speaker 5: here to talk about how governments are trying to prevent
Speaker 5: these systems from collapsing. It's a problem one who official
Speaker 5: liken to a ticking time bomb. But first Bloomberg's Naomi
Speaker 5: Kresky and Jonas Ekblom on why this is happening now
Speaker 5: in so many countries at the same time.
Speaker 1: In one third of countries in Europe, more than forty
Speaker 1: percent of doctors are more than fifty five years old.
Speaker 1: And if you do the math on that, you can
Speaker 1: see that there's a big problem ahead. The workforce of
Speaker 1: medical workers is older in the EU than it is
Speaker 1: in the US. I crunched these numbers myself, and every
Speaker 1: time I hear them it just shocks me again. In Italy,
Speaker 1: fifty six percent of doctors are over the age of
Speaker 1: fifty five. In France it's about forty four percent. In
Speaker 1: Germany almost forty five percent of doctors are over the
Speaker 1: age of fifty five. They don't have enough young doctors
Speaker 1: to replace the doctors who are getting older and other
Speaker 1: types of medical workers as well. So the ticking time
Speaker 1: bomb issue is really this age issue, but that's just
Speaker 1: a piece of a broader problem.
Speaker 5: And Jonas, what are some of those other problems.
Speaker 4: You're talking about, like the huge demographic changes, an aging
Speaker 4: population that requires not only more advanced care but also
Speaker 4: more like prolonged care. Medical care and medical treatment is
Speaker 4: becoming increasingly advanced and increasingly expensive as well, Like we're
Speaker 4: not talking about necessarily simple drugs, we're talking about very
Speaker 4: expensive drugs, which like way on like healthcare budget even more,
Speaker 4: and machines and other treatments are also getting more expensive.
Speaker 4: So healthcare systems are really stuck between like a rock
Speaker 4: and a hard place when it comes to European healthcare,
Speaker 4: and obviously in a lot of other developed countries around
Speaker 4: the world as well, So but it's very pronounced in Europe.
Speaker 1: It's sort of a dual demographic challenge where demographics are
Speaker 1: driving an increase in the need for healthcare at the
Speaker 1: same time that demographics are reducing the ability of hospitals
Speaker 1: and healthcare systems to provide healthcare. I was talking recently
Speaker 1: with a European politician who said that the cost of
Speaker 1: medicines issue alone is like a giant Iceberg that European
Speaker 1: healthcare systems are sort of driving toward as if they
Speaker 1: were the Titanic because all of this is so expensive.
Speaker 4: The situation is quite similar Europe. Just take for example,
Speaker 4: the UK and their National Health Service, where doctors and
Speaker 4: nurses are striking and talk about increasingly poor working conditions
Speaker 4: like long hours and not being able to provide sufficient
Speaker 4: care for their patients and also working with extremely low
Speaker 4: pay on the same isstry for like a lot of
Speaker 4: other places in Europe.
Speaker 5: So here we are, we're talking about the health system.
Speaker 5: We started out talking about a taking time bomb. Then Naomi,
Speaker 5: you compared it to the Titanic hitting in Iceberg. So
Speaker 5: pretty dramatic situation For those of us who aren't as
Speaker 5: familiar with the European healthcare systems. What's the sort of
Speaker 5: broad differences between the European style model of healthcare and
Speaker 5: the US healthcare model.
Speaker 1: There's sometimes a sort of a mistake and equation of
Speaker 1: all European health systems being the same as the National
Speaker 1: Health Service in England, like a single payer system where
Speaker 1: the government is organizing everything and paying things, and that's
Speaker 1: not necessarily the care. There are many different ways that
Speaker 1: healthcare is provided in Europe, but the overarching difference, I
Speaker 1: think is that you don't have to be worried in
Speaker 1: Europe as a consumer of healthcare about whether your healthcare
Speaker 1: is going to bankrupt you. If you walk into a
Speaker 1: hospital in France or in Germany and you need health care,
Speaker 1: in some cases, you might not even see the bill.
Speaker 1: It doesn't mean that your healthcare is free, but the
Speaker 1: overarching idea is that there will be fair and equitable
Speaker 1: care available for everybody who needs it.
Speaker 5: And Jonas, I guess the other big difference between the
Speaker 5: US and all the various European models is that healthcare
Speaker 5: isn't tied to your job. That you don't feel like
Speaker 5: you have to stay in a job for fear of
Speaker 5: not being able to pay for your medication or your
Speaker 5: health needs exactly.
Speaker 4: And I feel like that comes back to what Naomi
Speaker 4: was saying. It's like fair and equitable to everyone because
Speaker 4: even if it might be paid from for example, like
Speaker 4: you know, deduction from your pay or your wages or whatnot,
Speaker 4: it's still funded in a fashion that it doesn't rely
Speaker 4: on you holding down a job or something like that.
Speaker 5: You're in Stockholm, and Sweden is often held up as
Speaker 5: a real example of a healthcare system that treats people. Well,
Speaker 5: how does it work there? When you go to the
Speaker 5: doctor in Sweden, so.
Speaker 4: You pay actually your own contribution, We're talking about the
Speaker 4: range of like thirty forty dollars. You only do that
Speaker 4: up to like two hundred dollars per year. After that
Speaker 4: everything is completely free. The same goes for like for
Speaker 4: a time, like drugs and medicine like up into an
Speaker 4: amount of about like you know, two hundred dollars. You
Speaker 4: pay the cost yourself. Otherwise you just stroll up to
Speaker 4: your be it like a primary care facility or the hospital,
Speaker 4: and most is taken care of you. But like every
Speaker 4: single visit, be it an emergency room or like in
Speaker 4: a multi day hospital stay or whatever, it's still only
Speaker 4: that thirty dollars cost for you as a private individual.
Speaker 5: And Yaomi, you're based in Berlin, you go see your
Speaker 5: doc in Berlin. How does it work?
Speaker 1: In Germany? There's a network of nonprofit public insurers that
Speaker 1: actually compete with one another. They offer maybe slightly different things,
Speaker 1: and some are seen as better and more desirable than others.
Speaker 1: There are a lot of them. The last time I looked,
Speaker 1: I think they were about three hundred of these, So
Speaker 1: about nine tenths of people have this public insurance and
Speaker 1: about one tenth have private insurance, which is slightly cheaper
Speaker 1: when you're younger, more expensive when you're older. And when
Speaker 1: you go to the doctor. If you're publicly insured, you
Speaker 1: have an insurance card that you present whether you receive
Speaker 1: a bill or not. It's not going to make you
Speaker 1: worry about bankrupting yourself for your healthcare. Personal example, my
Speaker 1: mom was visiting last summer. We wound up having to
Speaker 1: make an emergency room visit because she fell down so
Speaker 1: short outpatient visit, rode in in an ambulance to the hospital.
Speaker 1: Got the bill for the ambulance. I think it was
Speaker 1: one hundred and sixty dollars. The outpatient visit for the
Speaker 1: hospital was like about a hunt Red Books. I think,
Speaker 1: if I'm recalling correctly, we're talking about like very low
Speaker 1: three digit numbers. And this is without insurance at all.
Speaker 1: We just paid it. The cost structure is just a
Speaker 1: completely different one.
Speaker 5: Jonas both you and Naomi are in big European cities,
Speaker 5: but you're right that the situation is much different in
Speaker 5: rural areas, and that's kind of part of the big
Speaker 5: tension here.
Speaker 4: As healthcare grows increasingly complex when it comes to forzon
Speaker 4: be it fairly simple conditions to like cancer or like
Speaker 4: cardiac care or whatever, there's been a trend to centralize
Speaker 4: and specialize in the bigger cities, which goes hand in
Speaker 4: hand with like decreasing costs too. But that obviously creates
Speaker 4: a bit of a dilemma because care again might be
Speaker 4: a bit more limited to the bigger cities, like a
Speaker 4: big problem in Sweden of for example, which it's as
Speaker 4: big as California as it comes to like the size
Speaker 4: of the country, a lot of empty space like rural
Speaker 4: areas too, and a fairly specialized emergency care for like
Speaker 4: pregnancy care and like delivery rooms. And there's been like
Speaker 4: a lot of places where like pregnant women like about
Speaker 4: to give birth, like needs to try for like you know,
Speaker 4: several hours to actually get into a deliver room that
Speaker 4: can actually accept them.
Speaker 1: There's this idea of the medical desert, and in France,
Speaker 1: a very large portion of the area of the country
Speaker 1: actually is medical desert like places where people can't get
Speaker 1: to a doctor quickly, and it's a big political problem.
Speaker 1: In France, they don't have enough general practitioners in small
Speaker 1: towns or rural places, or in some cases in poor
Speaker 1: neighborhoods of big cities, like sort of the poor suburbs
Speaker 1: surrounding Paris might also be medical desert where people are
Speaker 1: not able to get quick access to a general practitioner
Speaker 1: who's close by. They might wind up in the emergency
Speaker 1: room because they did not get that care from their
Speaker 1: primary care.
Speaker 5: Doctor after the break. Health systems compete to lure doctors
Speaker 5: away from neighboring countries.
Speaker 2: Junior doctors in the UK have begun a four day walkout.
Speaker 2: Unions have made a final plea for the Prime Minister
Speaker 2: Whisunak to discuss higher pay settlements for workers in the NHS.
Speaker 5: The largest nursing strike in NHS history is underway.
Speaker 3: Thousands of junior doctors are striking today and they'll be
Speaker 3: on strike until seven o'clock on Saturday morning.
Speaker 5: What you heard there is just what's going on in
Speaker 5: the UK, and medical professionals have been striking across Europe Naomi.
Speaker 5: What are some of the problems that doctors and nurses
Speaker 5: are facing right now that has them so upset.
Speaker 1: There's a pay issue, certainly, and we see that in
Speaker 1: France with healthcare workers striking, marching in the streets. There's
Speaker 1: a big debate over the amount of money that doctors
Speaker 1: get per visit. There is a push to double it
Speaker 1: to fifty euros per visit, which when you think about it,
Speaker 1: is actually still a very small number. It's also important
Speaker 1: to put all of us into context of the COVID
Speaker 1: nineteen pandemic. Spending on healthcare in Europe had risen for
Speaker 1: decades and then at around the time of the financial
Speaker 1: crisis in two thousand and eight, it kind of went
Speaker 1: flat as a percentage of GDP and stopped rising. Then
Speaker 1: tensions were building in the systems. There wasn't as much
Speaker 1: increase in money as there used to be, plus demographic
Speaker 1: issues that we've discussed, and then COVID happens and the
Speaker 1: healthcare systems are under extreme strain. Also, a lot of
Speaker 1: money is pouring into the systems all of a sudden,
Speaker 1: but a lot of it is for things like COVID
Speaker 1: vaccines and short term solutions for beds and clinics. There's
Speaker 1: not a whole lot of money coming into structure reform.
Speaker 1: It's more like putting a lot of band aids on
Speaker 1: some very big problems. And now for a few years,
Speaker 1: workers have been super stressed, they're super burnt out, nurses
Speaker 1: are leaving coming out of COVID. We just had a
Speaker 1: horrible winter in Europe for as I'm sure in the
Speaker 1: US as well, for respiratory diseases pneumonia RSV, really stressed
Speaker 1: emergency rooms. And then add of course in cost of
Speaker 1: living crisis, which healthcare workers also feel, and you've got
Speaker 1: this bubbling pot of resentment, I would say in hospitals
Speaker 1: in many different European countries.
Speaker 4: A lot of these issues free date the COVID pandemic
Speaker 4: by years or even decades like sometimes, and the healthcare
Speaker 4: professionals and the healthcare staff is really being pinched in
Speaker 4: like every direction here, like Naomi was saying, and a
Speaker 4: big thing too, like talking to healthcare professionals, you hear
Speaker 4: they want to work in this field, they want to
Speaker 4: provide care, and they do very often put their heart
Speaker 4: into their jobs.
Speaker 5: And that's of course something that healthcare workers in the
Speaker 5: US and everywhere else seem to be experiencing too these
Speaker 5: incredible strains that wind up affecting their own lives. And
Speaker 5: you spoke to a number of healthcare workers in different
Speaker 5: European cities, what do they have to say about what
Speaker 5: it's been like for them?
Speaker 1: We and our colleagues in Paris and Rome, who also
Speaker 1: worked on this story, spoke to a number of doctors
Speaker 1: in different countries and nurses as well, and they all
Speaker 1: kind of had similar things to say that they feel
Speaker 1: like they're not serving their patients as they could because
Speaker 1: they're spread tooth thin. And I talked to one orthopedic
Speaker 1: surgeon in Madrid who talked about how when she has
Speaker 1: her mourning shift, like morning shift in this Madrid hospital
Speaker 1: is sort of I think from eight am to like
Speaker 1: three pm or two pm, so it's a pretty long shift.
Speaker 1: She has to get through forty patients. She would normally
Speaker 1: have twenty patients, that's the number of appointments she has,
Speaker 1: but the administrative staff at her hospital double books each
Speaker 1: single appointment, and so she'll have forty people there. So
Speaker 1: she has like five minutes per patient, and she doesn't
Speaker 1: really have time to do much more than speak in
Speaker 1: a really superficial way with them. She said, a lot
Speaker 1: of them are older people who have you know, arthritis,
Speaker 1: degenerative disease, joint problems, and she can't fix their issues
Speaker 1: in five minutes. She doesn't even really have time to
Speaker 1: explain to them that this is an issue of aging
Speaker 1: and that they might actually not feel better. And I
Speaker 1: think what she said to me is they might have
Speaker 1: an incurable disease, but you can't tell them that in
Speaker 1: three minutes. And so what she winds up doing is
Speaker 1: maybe giving a few bits of advice and then booking
Speaker 1: them in for another consold six months down the line.
Speaker 1: And it just creates the snowball effect of people just
Speaker 1: coming back in order to make them feel like she's
Speaker 1: giving something to them, She'll give them these repeat appointments,
Speaker 1: but it doesn't solve anything. It's not the way that
Speaker 1: she would prefer to be giving care to these people.
Speaker 4: Yeah, I can only agree, Like, I feel like the
Speaker 4: most heartbreaking thing talking to healthcare staff is this fact
Speaker 4: like they want to provide a more holistic, long term
Speaker 4: type of care which allows them to care for the
Speaker 4: whole human and not just like the most urgent symptom
Speaker 4: or illness they might be suffering from. Like right, there, and.
Speaker 5: Then Jonas, let's hear what one doctor in Stockholm you
Speaker 5: spoke to had to say about what it's like to
Speaker 5: practice medicine there.
Speaker 6: Right now, our hospitals are getting full almost every day,
Speaker 6: and it leads to one in one out situation where
Speaker 6: we have to choose between different patients that all need
Speaker 6: hospital care. We're constantly forced to break rule routines and
Speaker 6: are moral compass. When I come as an I see
Speaker 6: a consultant to the emergency room, and perhaps there are
Speaker 6: free patients that need intensive care and we just have
Speaker 6: one last intensive care of bad left. Then I have
Speaker 6: to choose which patient that gets that spot and which
Speaker 6: two patients that don't. So I have to choose which
Speaker 6: patients will get the greatest chance to survive. That's not
Speaker 6: how it should be.
Speaker 5: And here's a nurse in France who's talking about what
Speaker 5: work these days is like for her.
Speaker 7: In France, nobody applies to hospital jobs anymore because those
Speaker 7: jobs aren't attractive at all. Salaries are low compared to
Speaker 7: other places, and working conditions are deteriorating a lot. So
Speaker 7: these days, to provide our care services, we're always in
Speaker 7: a rush. It's care that we do back to back
Speaker 7: and not well. We don't have time to drink or eat.
Speaker 7: We don't have time to go to the bathroom. We
Speaker 7: barely have time to sit down. We don't have time
Speaker 7: to talk to patients, to families, to communicate with them.
Speaker 5: What's going on, Naomi. One of the things you write
Speaker 5: in the story is that lower income countries in the
Speaker 5: EU have become what you call feeder nations for their
Speaker 5: wealthier neighbors. What does that mean?
Speaker 1: That was something that somebody at the World Health Organization
Speaker 1: pointed out to me. He cited the example of Romania,
Speaker 1: which produces the most medical school graduates per capita in
Speaker 1: the European Union, but at the same time has a
Speaker 1: below average density of healthcare workers. And that's because the
Speaker 1: doctors are migrating in Germany, where I think more than
Speaker 1: one in ten doctors were educated elsewhere. Romanian doctors are
Speaker 1: the biggest immigrant group.
Speaker 5: Because they can make more money practicing in Berlin than
Speaker 5: they can at home.
Speaker 1: Correct the average annual pay for a specialist doctor in
Speaker 1: Germany is about one hundred and sixty six thousand euros
Speaker 1: a year. That's depending on exchange rate, about one hundred
Speaker 1: and seventy six thousand dollars and that's at least three
Speaker 1: times more than what doctors would get in Romania, so
Speaker 1: they are clear economic incentives. And then at the same time,
Speaker 1: German doctors moved to Switzerland, which pays even better, and
Speaker 1: doctors from Eastern Europe will also wind up in Sweden.
Speaker 1: With a single market comes in ability for high skill
Speaker 1: workers to go elsewhere, and they do.
Speaker 5: We started this conversation with this idea of a social
Speaker 5: contract in Europe that people feel that they have cradled
Speaker 5: to grave healthcare coverage. How is this crisis affecting the
Speaker 5: kind of public trust in the healthcare systems?
Speaker 1: It harms the trust in healthcare systems, and that in
Speaker 1: turn is a political liability for politicians in Europe because
Speaker 1: how people I view healthcare is really linked to their
Speaker 1: trust in government as well. And we've seen, you know,
Speaker 1: European countries and politicians acknowledging and responding to the problem.
Speaker 1: In January, the French President Emmanuel Macrong acknowledged what he
Speaker 1: called the personal and collective exhaustion that healthcare workers have
Speaker 1: had to deal with, and he pledged to spend more
Speaker 1: money and to do some reforms. In Germany, health Minister
Speaker 1: Karl Lauterbach is working to overhaul the hospital system. I
Speaker 1: guess we'll have to see how effective those reforms are.
Speaker 5: Naomi Jonas, thanks so much for speaking with me today.
Speaker 1: Thanks it was a pleasure.
Speaker 4: Thanks for having.
Speaker 5: Us when we come back. What can be done to
Speaker 5: turn these ailing health systems around? So where do things
Speaker 5: go from here? Our producer Frederica Romaniello spoke to someone
Speaker 5: who thinks about this question all the time, doctor Thomas Zapata.
Speaker 5: He heads the World Health Organization's Office of Health, Workforce
Speaker 5: and Service Delivery in Europe.
Speaker 2: At the end of March, the World Health Organization held
Speaker 2: the High Level of Regional Meeting to discuss just how
Speaker 2: serious the situation in Europe is and offer actions for
Speaker 2: governments to take. What are the recommendations that the who
Speaker 2: came up with.
Speaker 3: We need to better retain health workers. That means that
Speaker 3: those health workers that are already in the health systems
Speaker 3: all over Europe. We need to improve the working conditions,
Speaker 3: so they want to stain the system. That includes a
Speaker 3: fat muneration that depends on the country. That include increased
Speaker 3: flexibility in working arrangements. We need, for example, zero tolerance
Speaker 3: to viole against health workers. That's something that is coming
Speaker 3: up in some countries as well. Is important also as
Speaker 3: part of improving working conditions. One of the main areas
Speaker 3: that we have is that in rural areas in many
Speaker 3: countries in the region, is difficult to recruit and retain
Speaker 3: health workers in rural areas. So for that we need
Speaker 3: to bring a combination of incentives, not only financial, to
Speaker 3: make it more attractive for health workers to work in
Speaker 3: rural areas. Then we have measures in order to improve
Speaker 3: education in terms of not only improving numbers, but I
Speaker 3: think we need to improve the quality and what we teach,
Speaker 3: which competencies are we teaching to our health workers and
Speaker 3: the future generations of health workers. Then a third element
Speaker 3: is optimizing the performance. So we have limited health workers,
Speaker 3: so we need to make the best use of the
Speaker 3: time that they have, and for that we need to
Speaker 3: reduce all the bureaucracy attached to clinical practice. We need
Speaker 3: to optimize and reorganize the organ nice health services so
Speaker 3: that we can maximize that time, that clinical time of
Speaker 3: the physician, of the nurse and other types of health
Speaker 3: professionals with the patient. And in order to do all
Speaker 3: this we need to enablers. One of them is improved
Speaker 3: planning of the health work force and the second enabler
Speaker 3: is investing. We need to invest more and also more
Speaker 3: smartly in those areas that really add value.
Speaker 2: Where do you see the state of the healthcare workforce
Speaker 2: in Europe head in the years to come.
Speaker 3: We have a window of opportunity at the moment and
Speaker 3: countries are taking seriously this. So if they take the
Speaker 3: actions in terms of all the actions that we have mentioned,
Speaker 3: we should be able to go in a future direction
Speaker 3: when we have a sufficient health work force in terms
Speaker 3: of numbers, also in terms of skills of competencies, in
Speaker 3: order to deliver services that is adequately distributed in rural,
Speaker 3: remote and underserved area. Yes, and also with a healthwalk
Speaker 3: force that is performing adequately, that is motivated and with
Speaker 3: higher standards of performance and quality. Of course, I think
Speaker 3: we need to be flexible, be open and bring innovations
Speaker 3: so that we can adapt to the new changing needs
Speaker 3: of the population. We know that population is aging, more
Speaker 3: chronic diseases, more the morbidity. There are also increased expectations
Speaker 3: by the patients. We also have backlocks from the COVID pandemic,
Speaker 3: so all these things are making that the demand for
Speaker 3: services are increasing, so we need to factor all these
Speaker 3: things in the future so that we can start preparing
Speaker 3: the health workforce now to be able to cope with
Speaker 3: that increased demand in the future.
Speaker 2: Doctor Tomasa Pata, thank you so much for joining me.
Speaker 3: Thank you so much for the Erica.
Speaker 5: Thanks for listening to us here at the Big Tach.
Speaker 5: It's a daily podcast from Bloomberg and iHeartRadio. From more
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Speaker 5: Take is Vicky Virgalina. Our senior producer is Katherine Fink.
Speaker 5: Federica Romanello is our producer. Our associate producer is Zennab Sidiki.
Speaker 5: Hilde Garcia is our engineer. Our original music was composed
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Speaker 5: another Big Take.