The Krakow Workshop

Krakow workshop: background and context

Health care systems are under great pressure to show that spending on assets provides value for money, and that the end results of capital investment are flexible and adaptable to changing circumstances.  Across Europe, governments and citizens expect to see a return on investment, in terms of improving:

• Service to patients
• Health service finances
• Regional economic performance
• Social cohesion

Although different countries and regions start from different positions, the above principle applies almost everywhere - particularly in the case of countries that will rely on structural aid funding to finance reform of their healthcare infrastructure.

It is never easy to arrive at decisions on capital infrastructure spending, especially in the face of increasing cost pressures, the rise of chronic illness, and ageing populations.  These three factors also put in question the traditional priority given to technology-driven, acute hospitals.  On a more positive note, we should recognise that healthcare assets can act as catalysts for social and economic regeneration.  This was implicit in the Lisbon Agenda, which endorsed the principle that the core business of healthcare is investment in people.

Krakow workshop: learning points

The Krakow CI workshop provided a lot of material in terms of the practical experiences of partner regions, case study examples, informed debate, and guidance from invited external speakers.  The lessons from Krakow are being synthesised into a discussion paper, to be circulated in early-mid June.  However, it is worth raising some of the key points from the workshop now, since they give a good flavour of the interactive sessions and provide some framework for the Policy Forum discussions in Graz in June 2006:

• When thinking about strategic asset planning and how best to invest capital, it is important to take an integrated approach (see Fig. 1).   In other words, investment in healthcare assets should be considered in the context of shifts in service provision, the needs of other sectors (e.g. social services, community care, regional training and skills development), developments in technology, and broader societal values.
• Equality of access to health care should be a key component in planning.
• The health landscape has common elements across regions (cost increase, the move from acute to primary care), but governance, politics, and power relationships can vary greatly.
• Differences in capital policy between and within countries make it unlikely that projects or financing models can be simply transferred; the key is to understand the principles and processes that led to success (or lack of success).
• Where private finance plays a role in the public arena, it is essential to have high quality management of procurement and a stable team of planners, health service managers and capital experts, in order to ensure the most effective and beneficial use of capital.

The Krakow workshop demonstrated that current trends in infrastructure policy reveal some conflicts of interest.  Both direct taxation and insurance fund-based systems are seeing a move towards market-led strategies in health and healthcare infrastructure investment.  While there is an underlying principle of getting better value for money, it is also true that shareholders in the private sector do not necessarily have the same values as public citizens.  As an example, new hospitals are often built out of town (where land is cheaper), without fully taking into account questions of access and the social value of a centrally located place of healing, rehabilitation and research.

Source: Macroeconomics and Health: Investing in Health for Economic Development, Report of the Commission on Macroeconomics and Healths, World Health Organisation, 2001