German-speaking Countries Meet to Discuss Report; Neuausrichtung der Ausbildung für Gesundheitsfachleute
Eighty high-ranking experts and policy makers from Switzerland, Austria and Germany came together in February 2012 at the Swiss Re Center on Global Dialogue near Zürich to discuss the Lancet Commission report. The symposium—called the Careum Dialogue—was organized by Careum Foundation, a major Swiss Foundation that is committed to developing innovative approaches to health and care in the 21st century. Careum aims to explore new challenges at the interface of health and professional education and has already translated the Lancet report to ensure its dissemination in German-speaking countries.
A key goal of the symposium was to facilitate dialogue between representatives of both the health and the education systems, academics engaged in developing new approaches to professional education as well as representatives from patient organizations, health insurers and professional organizations, reports Ilona Kickbusch of the Careum Foundation, who submits the following short summary of the day’s discussions:
Two panels aimed to clarify what challenges each of the systems—health and education—were facing and to analyze why cooperation and reform was proving to be so difficult in each of the countries. A whole morning was dedicated to an in-depth debate of the Lancet report. This was considered most timely, since all three countries are engaged in major health system reforms as well as education reforms.
Most participants found the report’s recommendations—in particular the call for integrated and interdisciplinary education of health professionals—most helpful in supporting their reform efforts. Switzerland has already conducted an in-depth analysis of how the Lancet report recommendations could be operationalized in the context of the Swiss system—showing what reforms would be necessary in the education and the health system respectively. A number of innovative educational models that reflected Report-type innovations were presented by participants from all three countries, but these have not yet been brought to scale.
A number of drawbacks to the Lancet report were also identified based on the experiences of the participants. Commentaries highlighted that the Commission report was biased toward national health systems—and that the complexity of decentralized, social health insurance systems implied an additional set of challenges. It was also felt that the report was still too rooted in medical science as the lead paradigm for professional education—many of the participants indicated that they were challenged by health problems that required a much deeper understanding of social factors and mental health issues. One insurance company shared data that showed that depression and anxiety were the leading health burden of their clients/insurees. The report also did not highlight health promotion and prevention sufficiently, said others, and did not pay enough attention to the active role of patients.
Many participants were skeptical that leadership for change would come from within the health sector itself. Strongly entrenched professional interests have already stood in the way of many reform initiatives. Also there was a certain amount of reform fatigue in both systems. (From the standpoint of the report's Commissioners, constructive comments like these underscore the importance of local adaptation of the Commission's recommendations, critical for successful adaptation.)
There was general agreement though that the Lancet report has helped initiate a most productive debate. A number of follow-up dialogues within the three countries are being planned.
Downloads of meeting presentations are also available in German on the Careum website at: http://www.careum.ch/report-careum-dialog-2012