Healthcare services everywhere are becoming more complex by the hour—and so are the population's demand patterns. Massive amounts of data must be collected and analysed to gain insight on what healthcare professionals are doing and whom they are working with. To meet these needs, healthcare providers are cooperating with each other to coordinate the provision of care and to centralise information. Such partnerships, networks, and alliances (PNAs) largely determine the efficiency of a community's or country's health system, which leads to a number of questions: where is there room for improvement? Which links need to be strengthened? And also, importantly: how can research facilities, educational institutions, and commercial players be brought into the fold of the system?
The local outlook
In Luxembourg, we have seen a great deal of progress in the last decade. Ten years ago, from a research point of view, Luxembourg was fragmented—no convergence of activities was outwardly foreseen. But thanks to widespread efforts, including several mergers and infrastructural investments, this system has become much more coordinated and organised.
Through the Fédération des Hôpitaux Luxembourgeois (FHL), Luxembourg's hospitals have implemented an exchange platform that has been in use for more than 50 years now, with efforts being made through the years to mutualise their activities. More and more purchases, ranging from medicine to equipment, are made together by the hospitals via the FHL. This enables them to have greater power during negotiations (thus reducing costs), but it also enables them to harmonise the quality of care throughout the country. It can be said that the hospitals are finally in a position to better master their purchases and the corresponding costs.
To further push the initiative of collaboration, Luxith was created in 2012 to mutualise the exploitation of software and infrastructure for hospitals: it has become a common datacentre hosting mutualised applications and providing a high-speed network for hospitals. Luxith also works in close collaboration with the Agency eSanté, which put in place the Dossier de Soins Partagés (DSP). This electronic file-sharing system cataloguing patients' medical histories is currently being developed—when finished, it will majorly cut down the time spent sharing patient information while also helping create more continuity in care provision. It will enable the centralisation of information related to the health of patients and will give all the healthcare providers of the country (physicians, hospitals, laboratories, pharmacy, and care homes) access to this information (with the patient's consent).
While these achievements certainly denote progress, there are still goals to be reached.
If Luxembourg is to succeed in its initiative to put in place centres of competences through its hospitals that allow them to focus time and effort on their critical mass, then the purpose of this initiative and a clear vision regarding its strategic deployment within the hospitals needs to be defined.
In the 2010 reform of the healthcare sector, the idea was introduced to foster hospitals to form alliances to focus on the interdisciplinary provision of care for certain pathologies. The intention was, and still is, to avoid having everything done everywhere, to enable hospitals to achieve a critical mass and an expertise, to reduce costs, and to avoid unnecessary multiplication of equipment. Six years later, however, the sector still encounters difficulties when it comes to putting this concept in place. Even though it is foreseen in the new bill, it is subject to several criticisms which range from the definition of the term "competence centre", to worries that the sanitary card lacks reliability, to the question of governance of these competence centres, to the control of the results and the quality thereof, and to the guidance for putting these competence centres in place. Ideally, the competence centres should be proposed by hospitals (in a context of relative competition), and viewed in a European/Grande-Region context.
A prescription for change
The lesson from our analysis of world health systems is that partnerships are what help the medicine go down. From the initial strategy-forming to the final implementation there will be a host of challenges, but the fact remains: digital interconnection has facilitated (indeed, revolutionised) many fields, and just because health and medical research networks are vast, complex, and expensive should not exclude them from our attention. In fact, just the reverse.
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