7 days in healthcare (December 30th 2024-January 5th 2025)

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Summary

The most impactful news in health this week were:

  • Biomedicine: Cancer vaccines are promising.
  • Global health: Covid-19 after five years: an almost banal disease.
  • International health policy: The British Prime Minister is willing to promote a plan to reduce waiting lists.
  • National health policy: ASISA plans to take on MUFACE alone.
  • Companies: The Ribera group is planning a new hospital in Orihuela.

Biomedicine

  • Finally, cancer vaccines are promising. There are trials underway against skin, brain and lung cancers. The approach is a combination of immunotherapy and mRNA technology. The hope is that these treatments will advance, so that there is no need for more invasive therapies such as chemotherapy or surgery. Moderna and BioNTech, in this race.
  • Health uses artificial intelligence for medical note-taking, based on AI language recognition. Tech giants such as Microsoft, Amazon and Oracle, as well as many start-ups, are in the race.

Global Health

  • Covid-19 at five years: an almost banal disease.
  • On the death of Jimmy Carter: His quiet but monumental work for Global Health.

International health policy

  • The Surgeon General (Federal Medical Director USA) calls for cancer warnings for alcohol. Alcohol is a major cause of cancer and alcoholic beverages, like cigarette packs, should carry a warning to this effect.
  • China remains addicted to tobacco, more than 300 million smokers and sales are on the rise. This country, which does not have a national law to address the problem, is the largest consumer and producer of tobacco in the world.
  • Keir Starmer (UK Prime Minister) ready for a plan to radically reduce waiting lists in the NHS. There is great frustration among Labour at the lack of results on waiting lists, which currently reach more than 6 million waiting for care. The plan involves access to certain tests without going through the primary care physician (GP) and the increase in elective surgery. There is great skepticism among senior doctors in the United Kingdom about the plan.

National Health Policy (Spain)

  • News at MUFACE. ASISA is considering taking on MUFACE alone.
  • Use of hospital emergency rooms: Spaniards are increasingly using hospital emergency rooms to access healthcare.
  • The proliferation of medical degrees and the risk of medical unemployment.

Companies

  • International
    • Significant investments in Lilly’s production capacity. This company has announced investments worth 14.6 billion dollars in 2024 to expand its production capacity.
  • National
    • The Ribera group is planning a new hospital in Orihuela.

Biomedicine

  • Cancer vaccines are finally showing promise. Trials are underway against skin, brain and lung cancers. The approach is a combination of immunotherapy and mRNA technology. The hope is that these treatments will advance, so that there is no need for more invasive therapies such as chemotherapy or surgery. Moderna and BioNTech are in the race (https://www.economist.com/science-and-technology/2025/01/01/cancer-vaccines-are-showing-promise-at-last)
  • Healthcare is using artificial intelligence for medical note-taking, relying on AI language recognition and the creation of medical notes about patient contact. Tech giants such as Microsoft, Amazon and Oracle, as well as many start-ups, are in the race (https://www.ft.com/content/5c356658-6db4-47c1-940b-b2e3cf3a51f3)
  • New link between Alzheimer’s and the herpes virus (https://www.epe.es/es/sanidad/20250104/vinculo-alzheimer-herpes-comun-proteina-tau-tratamiento-113073882). Access to the original article: https://www.cell.com/cell-reports/fulltext/S2211-1247(24)01460-8
  • These 11 trials promise to have an impact in 2025. New treatments and technologies aimed at treating cancer, obesity, malnutrition, poor mental health and the effects of extreme heat (https://www.diariomedico.com/medicina/investigacion/11-ensayos-clinicos-prometen-impactar-medicina-2025.html)

Global Health

  • Covid-19 after five years: learning from a pandemic that many are forgetting (https://www.science.org/content/article/covid-5-years-later-learning-pandemic-many-are-forgetting)
  • Covid-19 after five years: an almost banal disease (https://www.lemonde.fr/planete/article/2024/12/31/covid-19-cinq-ans-apres-une-deflagration-mondiale-une-maladie-presque-banale_6474759_3244.html)
  • WHO implores China for clues on the origin of Covid (https://www.theguardian.com/world/2024/dec/31/who-china-covid-19-origins-data-coronavirus)
  • Medicine on the battlefield in Ukraine (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02677-1/abstract)
  • Jimmy Carter’s quiet but monumental work for Global Health (https://www.nytimes.com/2024/12/30/health/jimmy-carter-global-health.html)
  • Is it just one mutation that will cause avian flu in cows to spread between humans? The H5N1 virus is causing a historic epidemic among cattle. There is a debate about whether this could be the start of a new pandemic in humans (https://www.larazon.es/sociedad/estamos-sola-mutacion-que-gripe-aviar-vacas-transmita-humanos_202501056779e7b1bc785b000171952b.html)
  • The mysterious illness detected in the Congo is a mix of malaria, common respiratory viruses and acute malnutrition, says the WHO (https://www.elmundo.es/ciencia-y-salud/salud/2024/12/30/6772e042e9cf4a102b8b459a.html)

International health policy

  • USA
    • The Surgeon General (Federal Medical Director of the USA) calls for cancer warnings for alcohol (https://www.nytimes.com/2025/01/03/health/alcohol-surgeon-general-warning.html)
  • China
    • China remains addicted to tobacco, more than 300 million smokers and sales on the rise (https://elpais.com/sociedad/2025-01-05/china-se-mantiene-adicta-al-tabaco-mas-de-300-millones-de-fumadores-y-ventas-al-alza.html)
  • United Kingdom and the National Health Service
    • All NHS trusts are failing to meet the 18-month waiting list target (https://www.theguardian.com/society/2025/jan/04/all-nhs-acute-hospital-trusts-in-england-are-missing-labours-18-week-target)
    • Keir Starmer (UK Prime Minister) ready for a plan to radically cut waiting lists in the NHS (https://www.theguardian.com/society/2025/jan/03/keir-starmer-to-unveil-radical-nhs-changes-to-cut-waiting-times)
    • Cash incentives for GPs to radically cut waiting lists in the NHS (https://www.theguardian.com/society/2025/jan/05/cash-incentives-for-gps-under-labours-radical-plan-to-cut-nhs-waiting-lists)
    • Wes Streeting (Health Secretary) UK) announces extraordinary investments for hospitals that cut waiting lists faster (https://www.ft.com/content/fdc3c3a2-4269-4208-bb67-74d9ccb8ebe0)
    • The NHS is considering selling patient data (https://www.ft.com/content/9ec787a8-60d5-4899-8223-81335dfa919b)

National health policy

  • Central government initiatives
    • Science allocates 296 million euros in 2024 for biomedical and health R&D&i in Spain (https://www.diariomedico.com/medicina/investigacion/miciu-destino-296-millones-euros-2024-impulsar-idi-biomedica.html)
    • The Ministry publishes the “Statistics of Specialized Care Centers. Year 2022” (https://www.sanidad.gob.es/estadEstudios/estadisticas/docs/TablasSIAE2022/2022_INFORME_ANUAL_SIAE.pdf)
  • Initiatives and news from the autonomous communities
    • Navarra promotes the Horizon 2030 Health Plan and seeks solutions to the shortage of health workers (https://www.consalud.es/autonomias/navarra/navarra-impulsa-salud-horizonte-2030-soluciones-escasez-sanitarios_152554_102.html)
    • Catalonia will incorporate public dentistry benefits for the elderly and vulnerable people (https://www.elperiodico.com/es/sociedad/20241229/cataluna-prestaciones-odontologia-publica-personas-mayores-vulnerables-112987676)
  • MUFACE
    • ASISA plans to take on MUFACE alone (https://www.eldiario.es/economia/asisa-contempla-asumir-muface-solitario-garantizar-sanidad-privada-funcionarios_1_11933971.html)
  • Emergencies
    • Spaniards are increasingly using hospital emergency rooms to access healthcare (https://elpais.com/sociedad/2024-12-30/los-espanoles-usan-cada-vez-mas-las-urgencias-de-los-hospitales-para-acceder-a-la-sanidad.html)
  • Medical Degree
    • The proliferation of medical degrees and the risk of medical unemployment (https://www.larazon.es/educacion/boom-grados-medicina-duplican-20-anos-hay-riesgo-paro_20241227676e7e704f1fb70001897bbd.html)

Companies

  • International news
    • What price is society willing to pay for medicines? (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02562-5/abstract)
    • Lilly has announced investments worth 14.6 billion dollars in 2024 to expand its production capacity (https://www.elespanol.com/invertia/observatorios/sanidad/20241230/lilly-anunciado-inversiones-valor-millones-dolares-ampliar-capacidad-produccion/911659136_0.html)

7 days in healthcare (November, 18th-24th, 2024)

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Summary

The most impactful news in health this week were:

  • Biomedicine: the results of the ambitious Human Cell Atlas project appear.
  • Global health: final agreement at COP29, by which rich countries will finance those with fewer resources in the fight against climate change, but only from 2035.
  • International health policy: Trump’s appointments in health – generally anti-vaccine and anti-lockdown people during the pandemic – foreshadow great changes.
  • National health policy: the debate and the unknowns about the continuity of MUFACE continue. No less important news in Navarra: according to the draft of the new law of the Navarra Health Service, new staff additions will be based on the labor regime.

Biomedicine

  • A Human Cell Atlas appears, which is compared to Wikipedia. The project was launched in 2016 by biologists Aviv Regev, from Genentech, and Sarah Teichman, from the University of Cambridge, together with more than a hundred other scientists. They aim to catalogue every type of cell in the human body, from development to ageing. It is estimated that 37.2 “trillion” (American) cells have been catalogued. This week this initiative is presenting the first studies. This project would not have been possible without the Human Genome Project, and the NIH Brain Initiative. This is presented as a catalogue of every type of cell in our body, which will allow us to understand certain processes of inflammation or tumour development.

Global Health

  • Pact in extremis at COP29 to finance climate action in poor countries. They will allocate 300 billion dollars a year from 2035. The agreement leaves a bittersweet taste and has been received with harsh criticism by social organisations, who call it “disappointing”.

International health policy

  • Trump’s choices for Health Agencies suggest that a radical change is coming. Elections of anti-vaccines, opposed to lockdowns in the pandemic and contrary to conventional medical thinking. What a survey shows is that after the pandemic that killed more than a million Americans, many Americans have lost confidence in science and medicine.
  • President Petro’s battle against the EPSs in Colombia continues. The Health Superintendency intervenes in the EPS Coosalud, the fifth largest in Colombia. It is the eighth EPS that the government of Gustavo Petro takes control of, which has sought to eliminate this figure through a debated and so far failed legal reform. The EPS Coosalud has more than 3.2 million members. Among the entities that the State has taken possession of are large institutions such as the private Sanitas, the mixed Nueva EPS or Famisanar.

National Health Policy (Spain)

  • The disasters continue after the DANA in the Valencian Community. The struggle of the Dana peoples: 16,000 children without schooling, 2,150 uninhabitable houses; health risks; and a huge economic hole. The public health risks due to floods are still latent.
  • MUFACE’s continuity in doubt. In what appears to be a fight between the Ministry of Public Administration and the Ministry of Health, the former asks the insurers at what price they would be willing to provide the service, announcing a new tender. On the other hand, the public procurement court paralyses the awarding of the MUGEJU and ISFAS tenders, following a demand from UNIPROMEL. CSIF announces a large mobilisation on 14 December, in defence of the MUFACE model.
  • No more new statutory employees in the Navarre Health Service. According to the provisions of the Navarre Health Service Bill, which establishes that new additions would be as “permanent labour personnel”. The unions, as could not be otherwise, oppose it. Always defending the “tenured position”, one of the scourges of the system.

Companies

  • International
    • Johnson & Johnson threatened in the United Kingdom, with demands on talcum powder.
  • National
    • Biosim reminds us that future savings from biosimilars require an attractive market. Biosimilars generated savings of 1.8 billion euros in 2023 in Spain and projections estimate that this could add up to 22.295 billion by 2030. However, experts warn that the sustainability of this market requires tax incentives, simplified regulation and balanced public purchasing strategies and a reduction in price pressure that guarantee the viability of companies.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (October 21st-27th, 2024)

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Summary

Biomedicine

  • A drug that can change the world. Drugs like Ozempic will change the world. First they were for diabetes, then for obesity, now for cardiovascular and kidney diseases, and are being tested for Alzheimer’s and addictions. As they become cheaper and easier to use, they promise to change the lives of more than a billion people. These drugs can produce great social changes, improving productivity and freedom.
  • 950 AI devices approved by the FDA. The fact that 950 devices have already been approved argues for the impact of AI in health. Radiology leads the number of approved devices.
  • Potential for newborn screening. Genetic sequencing makes it possible to identify dozens of treatable diseases in newborns that escape current screening. A study of 4,000 babies found health problems in 120 ailments compared to 10 with conventional tests.
  • The promising future of vaccines for treatment. Curing Parkinson’s, Alzheimer’s or tackling pancreatic cancer. Vaccinologists gathered in Malaga analyse the paradigm shift in serums, intended to cure, not just prevent, diseases. From Alzheimer’s to Parkinson’s, including certain cancers such as pancreatic or lung cancer.

Global Health

  • Microplastic pollution. Twenty years after the introduction of the concept of microplastics, we now know better their ecological impact and risks, as well as the risks to human health.
  • Climate change, cities and health. More than ever, the climate crisis is a health crisis. It is estimated that 5 million people a year die as a result of suboptimal temperatures, the vast majority (37%) from heat, attributed to changes in temperature due to human action.
  • The loss of biodiversity: a health crisis. There are two irrefutable pieces of evidence: that there is a loss of biodiversity and that this generates problems for human health, specifically more infectious diseases.

International health policy

  • The shortage of doctors in the USA. Article in the American Journal of Medicine: Congress is called upon to intervene to prevent the US doctor shortage, estimated at 57,259, 79,080, and 81,180 doctors in 2025, 2030, and 2035, respectively.
  • Public opinion is asked on how to fix the NHS. The Health Secretary wants to start a national conversation on the issue, asking professionals, experts, and the general public for their opinions.
  • Wes Streeting (British Health Secretary) unveils plans for “patient passports” to carry NHS medical records. The idea is that all NHS patients have digital access to their clinical information. It is a step in the line from “analogue to digital”.
  • “Mon bilan prévention”, launch of an ambitious device to improve the health of the French. Announced by the President of the Republic in 2022, this would allow access to preventive care at key ages in life: between 18 and 25 years; between 45 and 50; between 60 and 65; and between 70-75. It seems like an important step towards including preventive medicine in the public health system.
  • Europe falls behind China in the recruitment of new clinical trials. Clinical trials in Europe have been reduced by half in the last decade, while laboratories seek more simplified regulation in the USA and China.

National Health Policy (Spain)

  • Health will be present at the next Conference of Presidents, as stated by the Minister of Territorial Policy and Democratic Memory. Regardless of the result, which will surely not be relevant, it is important that health is on the political agenda.
  • Catalonia promotes the joint purchase of medicines to improve the efficiency of the system. Agreement between the ICS, the Unió and the Consorció Sanitari de Catalunya. An important step, equivalent to the great step taken in the USA to allow Medicare to negotiate the price of medicines. This totally decentralised purchase of medicines in the hospital setting is something that does not make sense.
  • The new MUFACE agreement divides insurance companies. It seems that DKV is for no, ASISA for yes, and Adelas is in doubt. Among the shareholders of Adeslas, it is said that Mutua is for no, while La Caixa is for yes.
  • The POP denounces that waiting lists put lives at risk. It demands urgent solutions. The lives of the most vulnerable patients are being put at risk. In the United Kingdom, the consequences of waiting lists are well analyzed in terms of deaths. There is no reason to think that in Spain they do not have the same consequences.
  • The SEMI Congress urges the transformation of the SNS due to the chronicity of pathologies. They understand that home hospitalization must be intensively developed.
  • The Catalan EBAs want their model to expand. The president of their association, ACEBA, said that they will once again present proposals for this type of management by professionals. The halt to the expansion of the EBAs in Catalonia, during the time of Marina Gelli, was bad news for everyone. It is certainly not a model that can be generalised to the whole system, but in the face of empty proposals for reform of Primary Care, the EBAs offer a model with excellent results, both in terms of care and satisfaction of professionals. It would be good news if it expanded and not only in Catalonia. Already during the time of the councillor Lasquetty there was an attempt, with the advice of Albert Ledesma, to extend the model in Madrid, unfortunately failed due to the action of the “white tides”.

Companies

  • International
    • Competition will make anti-obesity drugs better and cheaper. Although NovoNordisk and Lilly are going to dominate the market for a while, many competitors are looming, with cheaper prices.
    • Walmart and Amazon threaten pharmacies in the USA in the distribution of drugs. CVS and Walgreens, traditional pharmaceutical chains, are under pressure.
  • National
    • HM integrates a new centre in Salamanca. With this incorporation the group will have 23 hospitals

Biomedicine

Global Health

International Health Policy

National health policy

  • Congress of the Spanish Society of Internal Medicine (SEMI)
    • he SEMI Congress urges the transformation of the SNS due to the chronicity of pathologies. They understand that home hospitalization must be intensively developed (https://www.larazon.es/salud/urge-transformar-sns-cronicidad-patologias_20241026671a4f2dd0584100016f768b.html)

Companies

7 days in healthcare (August 19th-25th, 2024)

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Summary

Biomedicine

  • Brain implants to reduce Parkinson’s symptoms. Implants reduce Parkinson’s symptoms by reading brain activity. Parkinson’s is known to affect about 10 million patients globally. This approach, called deep brain stimulation (DBS), reduces Parkinson’s motor symptoms by half.

Global Health

  • The need for international coordination on Mpox. Editorial from The Lancet. 15 months ago, the WHO concluded that the Mpox outbreak no longer represented a Public Health Emergency of International Concern (PHEIC). On August 14, the WHO declared this Emergency for Mpox, following a declaration a day earlier by the African Center for Disease Control and Prevention. The strain is called clade 1b Mpox1, which is genomically distinct and more deadly than the one in the 2022-23 outbreak. More than 16,000 infections and 500 deaths have been reported in Congo in 2024. Cases have also been reported in the Central African Republic, Rwanda, Burundi, Uganda and Kenya, while Sweden and Pakistan have reported imported cases. The hope is that PHEIC will trigger an international response.
  • Mpox vaccines are not reaching Africa. The slow WHO regulatory process is blamed for the lack of vaccines. While some developed countries have their own regulatory bodies, many African countries rely on WHO regulation, which is especially cautious and slow.
  • Covid is resurgence again, although with fewer severe cases. New variants that evade immunity are causing a massive summer wave.

International health policy

  • Abortion takes centre stage in the American elections and, in particular, at the Democratic convention. At this major event, the star was Hadley Duvall, a woman from Kentucky, who had become pregnant at the age of 12 by her stepfather and asked Trump about his description of the abortion ban as a “beautiful thing”.
  • AI and healthcare productivity. The Nuffield Trust analyses whether AI is the “silver bullet” that will improve healthcare productivity. Although high hopes have been placed on the NHS, this article sets out certain cautions: 1. Limitations of the current information infrastructure; 2. Regulatory considerations; and, 3. Ethical considerations that the application of AI minimises the core values ​​of the NHS, patient-centredness, services based on need not the ability to pay.
  • Major conflicts in India over the rape of a doctor. The rape and murder of a doctor in India is generating major conflicts. There are 32,000 reported rapes in India in 2022, the last year with official figures, although the number may be much higher. The rape and murder of a 31-year-old doctor in training in West Bengal has sparked protests by women across the country.
  • The first non-Covid mRNA vaccine is approved in Europe. The mResvia, manufactured by Moderna, is intended to protect the elderly against the respiratory syncytial virus, which causes bronchiolitis.
  • The EU does not recommend mass vaccination or border control due to Mpox. The EU Health Security Committee, which met on Monday, has noted that border control is not recommended and that the risk to the EU is still low.

National Health Policy (Spain)

  • Mpox: vaccination only for risk groups. The Ministry of Health maintains the vaccination strategy for Mpox only for risk groups.
  • The Mpox emergency catches Spain without a Public Health Agency. Despite the Ministry’s promises that the Agency would be operational in 2024, the draft bill has been sleeping for six months in the Health Commission of Congress. The photo of a minister reporting on Covid, surrounded by an improvised spokesperson and military personnel, should not be repeated.
  • Extensive surgical activity in the private sector. According to the IDIS Foundation, private healthcare carries out 32% of total surgical activity. The IDIS has done a commendable job of disseminating the activity of the private sector. On the other hand, it is well known that the private sector carries out significant surgical activity and, in many cases, of high complexity. However, this percentage requires clarification. It would be necessary to see complexity, according to some classifications: minor, moderate and major surgery; Surgical Complexity Score (SCS); the classification of the American Society of Anesthesiology; the Case Mix Index, etc. In such a complex topic, simple percentages are not enough.

Companies

  • International
    • Growing volume of AI business in healthcare. The global AI market in healthcare has reached 19.54 billion in 2023 and is expected to reach 490 billion in 2032.
    • Big business of copies of anti-obesity drugs.
  • National
    • Catalonia, leader in Spain in pharmaceutical manufacturing. Catalonia concentrates 45% of the pharmaceutical manufacturing plants. Of the 174 drug production plants in the country, 79 are located in Catalonia. They are followed by Madrid and Castilla y León, with 22% and 8% of the factories.

Biomedicine

Global Health

  • The Lancet editorial: the need for international coordination on Mpox. 15 months ago, the WHO concluded that the Mpox outbreak no longer represented a Public Health Emergency of International Concern (PHEIC). On August 14, the WHO declared this Emergency for Mpox, following a declaration a day earlier by the African Centre for Disease Control and Prevention. The strain is called clade 1b Mpox1, which is genomically distinct and more deadly than the one in the 2022-23 outbreak. More than 16,000 infections and 500 deaths have been reported in Congo in 2024. Cases have also been reported in the Central African Republic, Rwanda, Burundi, Uganda and Kenya, while Sweden and Pakistan have reported imported cases. The hope is that PHEIC will trigger an international response (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01708-2/fulltext)
  • Why Mpox vaccines are not reaching desperately needed Africa. This NYT article blames the slow WHO regulatory process for the vaccines not arriving. While some developed countries have their own regulators, many African countries rely on WHO regulation, which is particularly cautious and slow (https://www.nytimes.com/2024/08/23/health/mpox-vaccines-who-africa.html)
  • Mpox and Gavi. Declaration of this association in an article in The Lancet. Gavi is acting on four lines: 1. Purchase of vaccine doses; 2. Coordination of donations; 3. Declaration of regional emergency, activating a series of actions; and 4. Investing in the generation of adequate information (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01706-9/fulltext)
  • Article in Science: Covid is re-emerging again, although with fewer serious cases. New variants that evade immunity are causing a massive summer wave (https://www.science.org/content/article/why-covid-19-surging-again-and-do-shots-still-make-sense)
  • NEJM article: Preventing and controlling global antimicrobial resistance. Antimicrobial resistance has been identified by WHO as one of the 10 most important threats to health. An estimated 1.3 million deaths globally in 2019 were attributed to this problem. Although the basic principles of the approach to this problem have been known for decades, and scientific and technological innovations are promising, implementation has been too slow (https://www.nejm.org/doi/full/10.1056/NEJMp2401360)

International health policy

National health policy

  • Private health care

Companies

9 strategic proposals for a health system in crisis

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On the occasion of the 6th anniversary of the Health supplement of the Asturian newspaper “La Nueva España”, I published, December 15th 2023,  the following article in said supplement, whose PDF can be accessed:

 

9 strategic proposals for a health system in crisis

9 strategic proposals for a health system in crisis

Logically, both the public and private health systems have to address pressing day-to-day problems. But it is good that they also have a strategic vision of the changes to be introduced in the medium and long term, a kind of long-term vision, which we will summarize in 9 points. All of this from a broad sector perspective: not only the healthcare or public health part, but also the industrial part linked to health products.

  1. Dialogue and agreement

We consider dialogue and agreements between the actors that make up the health system – Public Administrations, various institutions, companies, professional associations, scientific societies, patient associations, etc. – a prerequisite to address the challenges it faces.

This is not a one-time agreement, but rather a permanent framework. On the other hand, we understand that not only governments and political groups must participate in this dialogue and agreement, but also the various actors in the health system must actively participate.

  1. Orientation towards health, to prevent the person from falling ill and reduce the burden of disease

Our health system – like those of practically all countries – is fundamentally oriented towards disease.

We must promote a paradigm shift that reorients it towards health (life habits, eating behavior, physical exercise, etc.). This implies changes in priorities, financing, main actors, professional profiles, etc.

The objective is to reduce the burden of disease, the only way to make systems more sustainable.

  1. However, there will still be patients and they will need care, which must be provided through the most advanced methods of precision medicine

Despite the reorientation of the health system towards maintaining health, there will continue to be diseases and patients, especially chronic ones.

Patients will require care of the highest quality, personalized and precision, compared to the traditional form of clinical intervention that lacked instruments to segment (with current precision) patients.

This medicine will provide precision diagnoses based on multiple analyzes and studies of all kinds, which will allow diseases to be redefined in a finer (more granular) way and, therefore, offer the most appropriate treatment for each pathology.

This will mean more complex and expensive healthcare, which must be addressed.

  1. Human resources policies, a central element

Healthcare professional activity is very demanding, so burnout is a problem in any healthcare system.

This, together with the shortage of certain professionals and the need to attract and retain talent, means that human resources policies (including planning) have a central role in health policies, something they have never had.

The problem, for different reasons, affects both the public and private sectors.

  1. Better financing, but with cost efficiency

Surely our health system requires greater financing, in order to be standardized with the majority of the most advanced countries in the EU and to be able to address certain pending challenges (new human resources policy, digital transformation, precision medicine, among others).

However, this request can only be made within the framework of an effort to achieve cost efficiency.

This requires several elements: first, suppressing a lot of activity that does not add value, including duplication of tests and procedures (in line with the “do not do” initiative, promoted by the Ministry of Health, in collaboration with scientific societies); secondly, facilitate a new management framework that facilitates efficiency and, finally, measure and make public efficiency, by establishing indicators at the national level to measure it.

  1. Hybrid, in-person and technology-based assistance

Although online health activity did not begin with the COVID-19 pandemic, this clearly boosted her.

Healthcare from now on will be hybrid, a percentage will be in person and another percentage, perhaps greater and growing, online. Not only for consultations, but for monitoring, early diagnoses, surgeries, tests and all types of activities.

  1. Collaborative care

We must move towards what we could call collaborative medicine.

This implies greater coordination and continuity of care between Primary Care and hospitals; greater collaboration between the health sector and the social and socio-health sectors; more multidisciplinary care, in which different professionals participate. Finally, as in all advanced societies, the public health service must be offered by a very varied set of public and private institutions and companies, both at the level of insurance and provision.

  1. A “hub” of innovation in biomedicine for Spain

Spain has become a powerhouse in clinical research, something that we have not encountered, but is the result of the effort and taking advantage of favorable conditions created by multiple agents: the health system, clinicians, the pharmaceutical company, the Administration , scientific societies and patient associations.

The aim would be to take advantage of this undoubted success to extend it to basic research and development, understanding development as the placement of products on the market.

  1. Emphasis on expanded strategic autonomy

The COVID-19 pandemic has highlighted the logistical difficulties – and also the high environmental cost – of excessive dependence on health technologies and medicines produced in distant countries, especially Asian ones.

This is why the European Union coined the term “extended strategic autonomy”, wanting to indicate the need to boost production in Europe of many health products.

Spain must join this movement, favoring the production of health products in our country (especially those that are strategic).

Only with a long-term strategic vision will we be in a position to address the problems of a health system – both public and private – in a serious crisis.

7 days in healthcare (September 11th-17th, 2023)

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Summary

From the point of view of Biomedicine, it is worth highlighting that the famous doctor and communicator Eric Topol publishes an article in the magazine Science about the multiplication of medical applications of artificial intelligence. The number of variables of each individual person (anatomical, genomic, metabolomics, epigenomics, etc.) can only be captured and used in diagnosis and treatment through the use of artificial intelligence. Clinicians must become familiar with these new tools and possibilities.

Regarding Global Health, The Lancet comments on what happened with the mpox pandemic (previously called monkeypox), which triggered a global alarm from the WHO and which today has decreased significantly. UN high-level meeting on tuberculosis, whose mortality has increased recently, after years of decline. The Gates Foundation proposes simple and cheap measures to improve the health of women who give birth, since 800 women globally die in childbirth every day.

In terms of International Health Policy, there is an emphasis on measures not learned during Covid, as global politicians seem to move away from fundamental concerns such as equitable access to vaccines and greater transparency. Alcoholism is a serious and very common disease in the USA, causing around 140,000 alcohol-related deaths each year in that country. It seems that the new medications (Ozempic, Wegovby) now used for obesity may also be useful in alcoholism, by curbing consumption. In the NHS the waiting list continues to grow, reaching historic record levels, which contrasts with Prime Minister Sunak’s promises. Serious problem for the Nigerian government to retain its doctors, since six out of ten intend to emigrate in search of better opportunities. Eurostat publishes the most frequent surgical interventions in Europe. Caesarean sections and cataracts, the most frequent interventions.

If we talk about National Health Policy (Spain), covid infections skyrocket due to the drop in immunity. Spain has 100 million vaccines not adapted to the new strains. However, the public health commission recommends the use of adapted vaccines. Problem for Spain, since these vaccines not prepared for the new strains cannot be sold or donated. Spain takes 780 days to supply the new medications. Apart from the 629 days recognized in the WAIT report, from the time the drug is approved by the EMA until the price and public financing are approved in Spain, another five months must be added for approval by the autonomous communities and it would even be necessary to add delays due to approval by hospital commissions. Cosmetic surgery operations have increased rapidly in Spain in recent years.

In the field of Companies, at the international level, the Strasbourg plenary session supports the plasma law that favors Grifols. At the national level, private hospitals (ASPE) take the Sanitas and Generali alliance to court. Ferrer and Almirall, with very good prospects.

Biomedicine

Global Health

International health policy

  • Mexico
    • Abortion, not criminalized in Mexico. The decision of the Supreme Court to reject the law that criminalized abortion opens the door to its legalization, increasing the liberalization of abortion in Latin America (https://www.bmj.com/content/382/bmj.p2060)

National health policy

Companies

 

 

 

 

Sant Joan de Déu Hospital in Barcelona: how to transform a 500-year-old “hospitality” into a global children’s hospital

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On July 12, 2022, a breakfast with Manel del Castillo, Managing Director of the Sant Joan de Déu Hospital in Barcelona, ​​took place as part of the “Breakfasts with leaders in the health sector” series, organized by Roland Berger.

The presentation used during breakfast is shown below:

sjd. madrid. iriesgo. jul2022

 

A summary of the breakfast content is as follows:

Why was it possible to promote a change of these characteristics

All the changes were possible because management tools were available: precisely what most public hospitals in Spain lack.

Many of the things that we have been able to promote (internationalization, global hospital, etc.) could have been done by other public hospitals, but it is impossible without the appropriate management tools (autonomy and legal personality, personnel regime, etc.).

Hospital Sant Joan de Déu is a public hospital, but privately managed, therefore not subject to the management restrictions of most public hospitals

About us

Basic characteristics

  • Maternal and child Hospital
  • University Center University of Barcelona
  • Private non-profit
  • Arranged with the public system

Basic data

  • 320 beds
  • 2,800 professionals
  • 289 million euros budget

 

  • 25,672 admissions
  • 245,000 visits
  • 165,039 emergencies
  • 3,381 deliveries

The strategy

The evolution

  • 1867, Charitable Hospital
  • 1973 Pediatric General Hospital
  • 2004, Referral Hospital
  • 2012, Global Hospital

Evolution 2004-2021

  • Number of professionals, x 2.3
  • Activity, stable
  • Complexity, +36%
  • Teaching, x10 in terms of number of students
  • Research, x18 in terms of impact factor (IF)
  • Economic income, x3.5

Hospital Sant Joan de Déu accounts for more than half of hospital admissions in the Barcelona metropolitan area. It is the hospital with the highest tertiary activity in Spain.

A significant percentage of patients are international, coming from the area of ​​Russia (37.3%), Europe (12%), Middle East (10%) and Latin America (20.9%).

The hospital receives 10-12 requests for assistance from international patients a day.

Regarding international activity, we believe that Spain as a country is very well positioned to compete in this field, since it offers very good technical quality (comparable to the best) at a very competitive price. As an example, for a treatment of Fallot, the Hospital Sant Joan de Déu charges 25,000 euros, while in any prestigious North American hospital the price is 250,000 dollars.

The center with the highest number of ERN accreditations (rare diseases) in Spain and the 6th in Europe.

Non-Cat-Salut healthcare billing has gone from 3.7 million in 2004 to 28.4 in 2021.

The drivers of these changes

Knowledge

  • Renewal of 80% of middle managers
  • Incorporation of therapeutic innovations: Card-T therapy Leukemia, oncolytic virus for retinoblastoma, etc.
  • Great research support

Humanism

  • A child never forgets a hospitalization
    • It can be a traumatic event
    • Or a positive experience even in difficult times
  • The keys to this humanistic approach are what are called the 4 Ps:
    • Parents
    • Play (game)
    • Pain
    • Professionals

Commitment

The bases of this commitment are:

  • Project
  • Values
  • Coherence (equity)
  • Leadership
  • Autonomy/participation
  • Support/recognition
  • Working conditions

Organizational innovation

  • Management model
    • Participatory model
    • Daily huddles
  • Digital transformation
    • Liquid hospital
    • Cortex (command center on the whole of the hospital’s activity, including follow-up of patients at home)
  • Infrastructures
    • Reform plan
  • Income Diversification
    • International activity
    • Fundraising

SJD Pediatric Cancer Center Barcelona

A new building to house this new center, which cost 37 million euros, all of which were obtained through donations.

A mature fundraising model was developed, after some mistakes. The campaign began on February 15, 2017 and in 2022 this center has been launched.

The result of the fundraising was as follows:

  • Micro-donations, 1.8 M euros (6%)
  • Companies, 2.9 M euros (10%)
  • Founding donors, 25.3 M euros (84%)

7 days in healthcare (July 4th-10th, 2022)

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Summary

From the point of view of biomedicine, to highlight the finding that cancer drugs significantly reduce the mortality of patients hospitalized for covid.

With regard to Global Health, an important WHO report on mental health, the last of said organization on the same subject dates back to 2001. The Lancet publishes an interesting article on road safety: no less than 1.35 million deaths a year and 50 million injuries depend on that security. Compared to what was usual in the years before covid and the war in Ukraine, hunger has grown in the world, moving us away from the Sustainable Development Goals. The development of health systems in Africa collides with the shortage of professionals.

Regarding international health policy, it should be noted that the USA has just bought 2.5 million vaccines against monkeypox. The WHO and the EMA warn of the new wave of covid. New “centaurus” subvariant of covid, originating in India, but already widely disseminated. Biden signs an executive order, in order to protect abortion rights. The United States doubles the use of telehealth since the outbreak of the pandemic.

If we talk about national health policy (Spain), the wave of covid continues to grow, with an increased impact on hospitals. New approved version of the Framework Statute of Health Personnel, which tries to avoid prolonged temporary periods, which was necessary, but consolidating the statutory regime, which we believe is not good news and in line with what the public health system needs , although perhaps the unions. First regulation in relation to nursing prescription, long awaited. Important report from the Platform of Patient Organizations, showing how chronic patients suspend the health care they receive. Javier Murillo, the undisputed leader in the health insurance sector, warns about the risk of disappearance of administrative mutualism (MUFACE model), since it continuously produces losses. The CAPFF, chaired by the prestigious economist Félix Lobo, releases his report, demanding changes in the regulation of the price of medicines in the SNS, to reinforce “legal certainty.”

In the field of companies, FEFE gives us the news that the pharmaceutical industry already sells more in hospitals than in primary care, a great change. The ASEBIO Report highlights the growth of the sector both in business volume and in investments. It seems that HIPRA, the Spanish vaccine against covid, is getting closer to being approved by the EMA.

Biomedicine

Global health

International health policy

National health policy

Companies

 

7 days in healthcare (June 20th-26th, 2022)

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Summary

From the point of view of biomedicine, to highlight the article in The Lancet that shows that the covid vaccine has saved 20 million lives in the first year of its use.

As far as Global Health is concerned, it is confirmed that covid 19 may be wreaking havoc in North Korea.

Regarding international health policy, it should be noted that the WHO has decided not to declare monkeypox an international health emergency. Strong rise in the incidence of COVID throughout Europe. Controversial annulment in the United States of the Roe v Wade ruling that declared abortion a constitutional right. Now abortion will have to be regulated by the States. Serious public health problems are expected, as in the pre-Roe v Wade era, although mitigated by the widespread use of the abortion pill, which can even be purchased online. For the first time in the history of the United States, an agreement is reached to limit, albeit in a very limited way, the use of weapons, with President Biden having signed a law in this regard. Instead, the Constitutional Court declared illegal any limitation on the display of weapons in public, as some States had legislated. More Americans are dying from drug overdoses than ever before. The European Medicines Agency approves the Valneva covid vaccine, the sixth covid vaccine approved in Europe (after Pfizer-BioNTech, Moderna, AstraZeneca, J&J and Novavax).

If we talk about national health policy (Spain), we are witnessing a growth in the incidence of covid, some speak of a seventh wave. Published in the Official Bulletin of the Congress of Deputies the project of equity law. Important statement from the Consorci Sanitari de Catalunya saying that more than the management model, we must focus on quality and results. The National Market and Competition Commission (CNMC) publishes a report on wholesale pharmaceutical distribution, which is considered a boost to the use of generics and biosimilars.

In the field of companies, it should be noted that Alphabet (Google’s parent company) is making a strong investment to become a powerhouse in health. Its fields of action will be: wearables, clinical records, artificial intelligence applied to health and extension of human longevity. The medical marijuana business is making its way.

Biomedicine

Global health

International health policy

National health policy

Companies

 

7 days in healthcare (March 28-April 3, 2022)

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SUMMARY

From the point of view of biomedicine, the publication in Science that completes the analysis of the human genome should be highlighted, which seems to open the door to the therapy of various diseases.

As far as Global Health is concerned, polio reappearance in Malawi is of concern.

As for international health policy, problems with the covid-zero policy in China continue, which has led to the confinement of millions of people in Shanghai. As it happens, many older Chinese are unvaccinated, apparently out of fear. The satisfaction of the British public with the NHS falls to the lowest levels in history. At this rate, the UK is going to lose faith in what is said to be their last remaining religion.

If we talk about national health policy (Spain), we are witnessing a new phase of the pandemic, with cases on the rise and hospitalizations on the decline. The Lancet shows that the consumption of opioid analgesics is higher in Spain than in the United States.

In the field of companies, from the international point of view, the plan of the Cleveland Clinic to build a hospital in the center of London, with a large investment of 1 Billion pounds, should be highlighted, which could herald the landing of hospitals Americans in Europe. In our country, the private equity company KKR will pay almost 3 Billion euros for IVI, the largest fertility company in the world, in what is one of the largest operations of its kind in Spain. IMQ approves the sale of shares (50% of the insurer) to SegurCaixa Adeslas, which was already a minority shareholder in the company. Important announcement by Sanitas to launch its fifth hospital in Spain. It will be in Valdebebas, it will come into operation in 2025 and will have 100 beds, 23 of which are for mental health, which is a very innovative element in the Spanish hospital landscape.

BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

  • COVID

o Many older Chinese remain unvaccinated, many out of fear (https://www.economist.com/china/2022/04/02/why-so-many-elderly-chinese-are-unvaccinated)

o Lockdown in Shanghai, while covid cases rise throughout China (https://www.theguardian.com/world/2022/mar/28/shanghai-to-lock-down-millions-for-mass-testing-as -chinas-covid-cases-surge)

o The FDA allows a second “booster” for those over 50 (https://www.nytimes.com/2022/03/29/us/politics/second-coronavirus-booster-shot.html)

o The CDC lifts the order that prevented immigration during the pandemic (https://www.nytimes.com/2022/03/30/us/politics/immigration-cdc-biden.html)

  • Other themes

o British public satisfaction with the NHS drops to lowest levels since 1997 (https://www.theguardian.com/society/2022/mar/30/public-satisfaction-with-nhs-sinks-to-lowest- level-since-1997)

o The growth of health spending in the USA was reduced, after the pandemic. In 2021 it rose 4.2%, while in 2020 it had risen 9.7% (https://www.wsj.com/articles/us-healthcare-spending-slowed-in-2021-after-covid-19- surge-11648497601)

NATIONAL HEALTH POLICY (SPAIN)

  • COVID

o New phase of the pandemic: cases on the rise and hospitalizations on the decline (https://elpais.com/sociedad/2022-03-29/espana-entra-en-la-nueva-fase-de-control-de- the-pandemic-with-cases-on-the-rise-and-hospitalizations-on-the-low.html)

  • Other themes

o The flu gets out of control in Spring, it already supposes more hospitalizations than covid in several autonomous communities (https://www.elespanol.com/espana/20220331/descontrola-primavera-supone-ingresos-hospitalarios-covid-ccaa/660934368_0. html)

o The health plan against tobacco will raise its price and will prohibit smoking in cars and terraces, seeking a 25% drop in smoking (https://theobjective.com/sociedad/2022-03-30/sanidad-tabaco-precio- taxes/)

o Spain exceeds the United States in the consumption of opioid analgesics, according to The Lancet (https://www.elindependiente.com/vida-sana/salud/2022/03/31/espana-supera-a-eeuu-en-el -consumption-of-opioid-analgesics-according-to-the-lancet/)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

  • International News

o United Health buys home care firm LHC for $5.4 billion (https://www.wsj.com/articles/unitedhealth-to-buy-home-health-firm-lhc-group-for-5-4- billion-11648550701)

o Great bet by the Cleveland Clinic, to build a hospital in central London for 1 Billion pounds (https://www.ft.com/content/c42bc01c-346c-4ae7-a931-4bbf0605e3ec)

o BioNTech returns almost 2 Billion euros to shareholders after the success of the vaccine (https://www.ft.com/content/db1c6786-6707-4d22-bf43-9c7686cbe97b)

o Fresenius acquires mABxscience and Ivenix to accelerate “biopharma” and “medtech” (https://www.plantadoce.com/empresa/fresenius-acquires-mabcience-and-ivenix-to-accelerate-in-biopharma-and-medtech .html)

  • National News

o The EMA begins the evaluation of HIPRA, the Spanish vaccine against covid (https://www.eldiario.es/sociedad/ema-comienza-evaluacion-hipra-vacuna-espanola-covid-19_1_8871634.html)

o The private equity company KKR will pay almost 3 Billion euros for IVI, the Spanish company that is the largest fertility company in the world (https://www.elconfidencial.com/empresas/2022-03-28/kkr-ivi -rma-transition-fertility_3399221/)

o IMQ approves the sale of shares to SegurCaixa Adeslas (https://www.redaccionmedica.com/secciones/privada/los-medicos-de-imq-aproven-la-venta-del-grupo-a-segurcaixa-adeslas-1096 )

o IMED hospitals opens a new polyclinic in Alcoy (https://www.plantadoce.com/empresa/imed-hospitales-abre-una-nueva-policlinica-en-alcoy.html)

o Sanitas will open a new hospital in Madrid, in the Valdebebas neighbourhood, it will be its fifth hospital in Spain and it is expected to open in 2025. It will have 100 individual rooms, 22 dedicated to mental health. Sanitas will be the tenant, the property will be owned by Pryconsa (https://cincodias.elpais.com/cincodias/2022/04/01/companias/1648816602_273605.html)

o LetsGetChecked acquires the Spanish biotechnology company Veritas (https://www.europapress.es/corporate-y-ma/noticia-letsgetchecked-adquiere-100-biotecnologica-espanola-veritas-20220329123245.html)