During the last edition of the European Health Forum in Gastein, interesting questions were debated. One plenary session was specifically dedicated to investment. We know that strategic investments in health are required but shouldn´t we also discuss return on invested capital (ROIC)? The first benefit concerns clearly the patient, patient satisfaction with care delivered by attentive health professionals. The second one must be economic adaptation and how to provide quality care at a reasonable cost in all EU Member States while respecting budget limitations. The answer to this complex question is the private sector specificity, limiting unnecessary costs by managing a talented workforce and offering modern treatment solutions. Our challenge is to concretize the framework presented in Gastein, transforming the idea into a reality accessible to all European Citizens.

It is a question of breaking free of an accounting approach to health, disconnected from the field, to better integrate the evolution of the patients ‘needs and the new expectations of health professionals.

The final goal is both simple and fundamental: to enable everyone not just to have access to care but access to relevant care of proven quality.

Quality of care is a key issue which cannot be reduced to a stack of medico-administrative procedures and rules. What is important is the time and energy that teams devote to the patient. It is therefore necessary to take medical quality into account remaining as closely as possible to reality, and to grasp with finesse what constitutes the "value" of a treatment, resulting from a balance between its therapeutic benefit and its human and financial cost.

Only evaluation by "peers", ie specialists in each medical discipline, according to benchmarks developed with all stakeholders, enables the quality of medical practices to be assessed. It is a philosophy of action that the French Federation of Private Hospitals supports and argues with the Ministry and Health Agencies, because it is based on the acknowledgement of the value of skills.

The patient experience is also something that the private hospital sector needs to integrate more into its approaches. Meeting the challenge of quality and relevance of care will only be possible with a patient who is both informed and responsible, co-builder of his care.

We appreciate that, in PLFSS 2019, the share allocated to quality financing increases substantially. But adding coercive measures is ineffective. It is important to keep the positive and encouraging nature of the approach, so that it acts as a real lever for improving practices and consideration for the professionals.

Continuously improving the quality of care is a powerful factor of motivation for professionals, but it is also, and perhaps above all, a question of finally making the service provided to the patient the foundation of all public action in health.

This is in short the conclusion of the study.

Private hospitals demonstrate efficiency

In average, personnel costs represented 60% of German hospital operating revenue, material costs 27%. Public hospitals scores are in average 8% higher than private hospitals.

Although private hospitals handle less ‟cases” per full-time employee in 2017, the Case-Mix-Index calculating the severity of ‟cases” treated in relation with the amount of economic resources engaged, shows that private hospitals work more efficiently.

The bed occupancy rate reached almost 78% in private hospitals for the year 2017, the best rate.

German private hospitals also achieve the best ranks in the financial analysis part, liquidity, investment rate, indebtedness, etc. and show the highest own capital investment capacity. The EBITDA ratio for private hospitals amounts 8% (public sector -6%).

A video transmission system between the OR, laboratory and lecture halls has also been foreseen.

The second prize awarded the Ebody Ärzte App, an application developed by physicians from the private clinic Maria Hilf in Klagenfurt. This digital tool enables practitioners to access patients medical data, in a safe way and everywhere. Doctors not only keep track of treatment schedules, but also have access to findings and diagnosis.

The third place went to last year's winner The Rehabilitation Center Münster for a therapeutic concept that supports the treatment of multiple sclerosis patients by learning a foreign language.

‟The level of submissions was particularly high this year”, said Dr. Josef Macher, President of the Austrian Private Hospitals Federation. ‟From employee-oriented projects to innovative therapy and nursing concepts to the development of evidence-based studies, the jury of the award has received a wide variety of submissions. The first-class quality that characterizes Austria's private hospitals is significantly influenced by a continuous development and technical progresses - but above all by the initiative and know-how of our employees.”

Picture: Tyrolean private clinic Hochru, 1st prize

The "Health a Priority" survey carried out under the "3F - Financing, Formula for the Future" project, promoted by the Portuguese Association of Hospital Administrators (APAH), concluded that Portuguese patients have a higher regard, in many aspects, for private hospitals than for public hospitals. The study was developed for APAH by GFK, a market research company.

On a scale of zero to ten, public hospitals score 5.7, while private hospitals have an overall satisfaction score of 7.5.

The respondents evaluated more positively in private hospitals:

• The waiting time to schedule consultations and / or exams (negative 4.2 score for public hospitals, while private providers score 7.8);
• The quality of the facilities and the equipment (on a scale of zero to ten, 6 for the public and 7.6 for the private sector);
• The waiting time regarding consultations and/or exams admission (only 4.4 for the public and 7.6 for the private);
• Access to more recent and innovative treatments (5.8 for the public and 7.5 for the private);
• Competence and knowledge of health professionals (Portuguese patients gave a 6.8 score to the public sector and 7.6 to the private sector)

The survey also shows that 3 out of 4 Portuguese patients consider that Health is not a priority for the Government and that 7 out of 10 consider that the investment in health is insufficient.

This report lead to ten recommendations to innovate the Portuguese Financing and Healthcare model, in order to truly place the citizen at the centre of the system.

What is the place of your hospitals group within the Romanian healthcare system?

MedLife is the largest private healthcare service provider in Romania. In the 22 years of MedLife’s activity, we are delighted to say that it has been through our actions that we have taken medicine to a different level, we have contributed to the accomplishment of important performances in the Romanian healthcare sector and we have proven Romanian patients that they can find, in their home country, the same expertise, technology and methods of treatment as they would find abroad, as well as extraordinary physicians, for whom the patients’ health comes first.

Patients need full solutions, both for their diagnostic and for their treatment. That is why we developed the MedLifeHealthcare System, which includes clinics, laboratories, hospitals, maternity hospitals, centres of excellence, pharmacies and a stem cell bank, and it provides integrated healthcare services under the same roof.

As regards its national coverage, MedLife means: 50 clinics, 20 hyperclinics, 155 sample collection units, 12 pharmacies, 10 hospitals, 10 dentistry centres, 4 maternity hospitals, 33 laboratories, 1 stem cell bank.

The healthcare team comprises 2500 physicians and 1800 nurses, and over 5 million patients have visited us over the years.

What is the shape and the history of your group?

MedLife is a company that has developed organically and by associating with local entrepreneurs, with whom it has managed to build stronger centres. The MedLife Healthcare System did not choose a single niche – laboratory, clinical investigations, hospital, or corporate, but instead it chose all four. Consequently, the MedLife structure is a balanced one.

MedLife is a business built by Romanians, with Romanians, for Romanian medicine.

MedLife has consolidated its nationwide position both with its 20 acquisitions and by developing greenfield locations in key cities of Romania. The most important acquisitions in the past 3 years: DENT ESTET, Anima and Polisano.

The MedLife Healthcare System is the only private healthcare company that comprises a second brand – Sfanta Maria laboratories.

What are your projects / prospects for the coming years?

MedLife will continue to invest in large-scale projects in development, extension, innovation and medical technology, but most of all in digitalisation and online media. At the same time, we have launched actions to see to what extent MedLifecan be present with its own units in neighbouring countries such as Bulgaria, Hungary, or Serbia.

In your opinion, in which way does your group best contribute to public health in your country?

MedLife, through Sfanta Maria brand, is one of the largest private outpatient healthcare service providers having an agreement with the National Health Insurance House (CNAS). Sfanta Maria has a large network of general practitioners and specialist physicians having agreements with CNAS, it is a financially solid company, with a good quality of the medical act.