Colombo Francesca, García-Goñi Manuel, Schwierz Christoph
Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France.
Department of Applied Economics II, Universidad Complutense de Madrid, Madrid, Spain.
J Comorb. 2016 Feb 17;6(1):21-27. doi: 10.15256/joc.2016.6.74. eCollection 2016.
Patients with multimorbidity are responsible for more than half of all healthcare utilization, challenging the healthcare budgets of all European nations. Although the European Union is showing signs of a fragile economic recovery, achieving sustainable growth will depend on delivering a combination of fiscal responsibility, structural reforms, and improved efficiency. Addressing the challenges of multimorbidity and providing more effective, affordable, and sustainable care, has climbed the political agenda at a global, European, and national level. Current healthcare systems are poorly adapted to cope with the challenges of patients with multimorbidity. Little is known about the epidemiology and natural history of multimorbidity; the evidence base is weak; clinical guidelines are not always relevant to this population; and financing and delivery systems have not evolved to adequately measure and reward quality and performance. Pockets of innovation are, however, beginning to emerge. In Spain, for example, the ongoing economic crisis has forced regional governments to deliver substantial efficiency savings and, with this in mind, integrated care programmes have been introduced across the country for people with chronic disease and multimorbidity. Early results suggest that formalized integrated care for patients with multimorbidity improves their perceptions of care coordination, reduces hospital and emergency admissions and readmissions, and reduces average costs per capita. Such innovations require meaningful investments at a national level - something that is now supported within the framework of the European Union's Stability and Growth Pact.
患有多种疾病的患者占所有医疗保健利用率的一半以上，这对所有欧洲国家的医疗保健预算构成了挑战。尽管欧盟正显示出经济复苏脆弱的迹象，但实现可持续增长将取决于财政责任、结构改革和提高效率的综合实施。应对多种疾病的挑战并提供更有效、负担得起且可持续的护理，已在全球、欧洲和国家层面上升至政治议程。当前的医疗保健系统难以应对患有多种疾病的患者所带来的挑战。人们对多种疾病的流行病学和自然史知之甚少；证据基础薄弱；临床指南并非总是适用于这一人群；融资和提供系统尚未发展到能够充分衡量和奖励质量与绩效的程度。然而，创新的端倪已开始显现。例如，在西班牙，持续的经济危机迫使地方政府大幅节省效率，出于这一考虑，全国各地已为慢性病和患有多种疾病的人群引入了综合护理计划。初步结果表明，针对患有多种疾病的患者进行正规化的综合护理可改善他们对护理协调的认知，减少住院和急诊入院及再入院情况，并降低人均成本。此类创新需要在国家层面进行有意义的投资——这一点目前在欧盟《稳定与增长公约》的框架内得到了支持。
