So how was it booking your last doctor's appointment?
If I'm honest, here in London, getting a doctor's appointment can be impossible, sometimes being sold I've got a wait months just to see a doctor. It can be able an nine.
Yeah, I don't book any doctor's appointments.
I tried to actively avoid it because it's so hard to book.
It took me almost well more than a year and.
A half booking my last doctor's appointment. It was a bit of a difficulty considering the way in time when you're booking it over the phone.
From Bloomberg News and iHeartRadio it's the big tag. I'm Westcasova. Today, healthcare systems across Europe are starting to crack. For decades, the UK's National Health Service and public healthcare systems in Sweden, France and other European nations were held up as a model to the world. Unlike in the US, where a simple doctor's visit can mean a staggering bill, the European systems provide cradle to grave care for everyone at low
cost to patients. But in recent years some of those systems have come under extreme financial strain, and they're now struggling to keep up with the needs of the people they serve.
I think we need to be flexible, be open, and bring innovations so that we can adapt to the changing needs of the population.
That's doctor Thomas Zapata of the World Health Organization. He's here to talk about how governments are trying to prevent these systems from collapsing. It's a problem one who official liken to a ticking time bomb. But first Bloomberg's Naomi Kresky and Jonas Ekblom on why this is happening now in so many countries at the same time.
In one third of countries in Europe, more than forty percent of doctors are more than fifty five years old. And if you do the math on that, you can see that there's a big problem ahead. The workforce of medical workers is older in the EU than it is in the US. I crunched these numbers myself, and every time I hear them it just shocks me again. In Italy, fifty six percent of doctors are over the age of
fifty five. In France it's about forty four percent. In Germany almost forty five percent of doctors are over the age of fifty five. They don't have enough young doctors to replace the doctors who are getting older and other types of medical workers as well. So the ticking time bomb issue is really this age issue, but that's just a piece of a broader problem.
And Jonas, what are some of those other problems.
You're talking about, like the huge demographic changes, an aging population that requires not only more advanced care but also more like prolonged care. Medical care and medical treatment is becoming increasingly advanced and increasingly expensive as well, Like we're not talking about necessarily simple drugs, we're talking about very expensive drugs, which like way on like healthcare budget even more, and machines and other treatments are also getting more expensive.
So healthcare systems are really stuck between like a rock and a hard place when it comes to European healthcare, and obviously in a lot of other developed countries around the world as well, So but it's very pronounced in Europe.
It's sort of a dual demographic challenge where demographics are driving an increase in the need for healthcare at the same time that demographics are reducing the ability of hospitals and healthcare systems to provide healthcare. I was talking recently with a European politician who said that the cost of medicines issue alone is like a giant Iceberg that European healthcare systems are sort of driving toward as if they were the Titanic because all of this is so expensive.
The situation is quite similar Europe. Just take for example, the UK and their National Health Service, where doctors and nurses are striking and talk about increasingly poor working conditions like long hours and not being able to provide sufficient care for their patients and also working with extremely low pay on the same isstry for like a lot of other places in Europe.
So here we are, we're talking about the health system. We started out talking about a taking time bomb. Then Naomi, you compared it to the Titanic hitting in Iceberg. So pretty dramatic situation For those of us who aren't as familiar with the European healthcare systems. What's the sort of broad differences between the European style model of healthcare and the US healthcare model.
There's sometimes a sort of a mistake and equation of all European health systems being the same as the National Health Service in England, like a single payer system where the government is organizing everything and paying things, and that's not necessarily the care. There are many different ways that healthcare is provided in Europe, but the overarching difference, I think is that you don't have to be worried in Europe as a consumer of healthcare about whether your healthcare
is going to bankrupt you. If you walk into a hospital in France or in Germany and you need health care, in some cases, you might not even see the bill. It doesn't mean that your healthcare is free, but the overarching idea is that there will be fair and equitable care available for everybody who needs it.
And Jonas, I guess the other big difference between the US and all the various European models is that healthcare isn't tied to your job. That you don't feel like you have to stay in a job for fear of not being able to pay for your medication or your health needs exactly.
And I feel like that comes back to what Naomi was saying. It's like fair and equitable to everyone because even if it might be paid from for example, like you know, deduction from your pay or your wages or whatnot, it's still funded in a fashion that it doesn't rely on you holding down a job or something like that.
You're in Stockholm, and Sweden is often held up as a real example of a healthcare system that treats people. Well, how does it work there? When you go to the doctor in Sweden, so.
You pay actually your own contribution, We're talking about the range of like thirty forty dollars. You only do that up to like two hundred dollars per year. After that everything is completely free. The same goes for like for a time, like drugs and medicine like up into an amount of about like you know, two hundred dollars. You pay the cost yourself. Otherwise you just stroll up to your be it like a primary care facility or the hospital,
and most is taken care of you. But like every single visit, be it an emergency room or like in a multi day hospital stay or whatever, it's still only that thirty dollars cost for you as a private individual.
And Yaomi, you're based in Berlin, you go see your doc in Berlin. How does it work?
In Germany? There's a network of nonprofit public insurers that actually compete with one another. They offer maybe slightly different things, and some are seen as better and more desirable than others. There are a lot of them. The last time I looked, I think they were about three hundred of these, So about nine tenths of people have this public insurance and about one tenth have private insurance, which is slightly cheaper when you're younger, more expensive when you're older. And when
you go to the doctor. If you're publicly insured, you have an insurance card that you present whether you receive a bill or not. It's not going to make you worry about bankrupting yourself for your healthcare. Personal example, my mom was visiting last summer. We wound up having to make an emergency room visit because she fell down so short outpatient visit, rode in in an ambulance to the hospital. Got the bill for the ambulance. I think it was
one hundred and sixty dollars. The outpatient visit for the hospital was like about a hunt Red Books. I think, if I'm recalling correctly, we're talking about like very low three digit numbers. And this is without insurance at all. We just paid it. The cost structure is just a completely different one.
Jonas both you and Naomi are in big European cities, but you're right that the situation is much different in rural areas, and that's kind of part of the big tension here.
As healthcare grows increasingly complex when it comes to forzon be it fairly simple conditions to like cancer or like cardiac care or whatever, there's been a trend to centralize and specialize in the bigger cities, which goes hand in
hand with like decreasing costs too. But that obviously creates a bit of a dilemma because care again might be a bit more limited to the bigger cities, like a big problem in Sweden of for example, which it's as big as California as it comes to like the size of the country, a lot of empty space like rural areas too, and a fairly specialized emergency care for like
pregnancy care and like delivery rooms. And there's been like a lot of places where like pregnant women like about to give birth, like needs to try for like you know, several hours to actually get into a deliver room that can actually accept them.
There's this idea of the medical desert, and in France, a very large portion of the area of the country actually is medical desert like places where people can't get to a doctor quickly, and it's a big political problem.
In France, they don't have enough general practitioners in small towns or rural places, or in some cases in poor neighborhoods of big cities, like sort of the poor suburbs surrounding Paris might also be medical desert where people are not able to get quick access to a general practitioner who's close by. They might wind up in the emergency room because they did not get that care from their primary care.
Doctor after the break. Health systems compete to lure doctors away from neighboring countries.
Junior doctors in the UK have begun a four day walkout. Unions have made a final plea for the Prime Minister Whisunak to discuss higher pay settlements for workers in the NHS.
The largest nursing strike in NHS history is underway.
Thousands of junior doctors are striking today and they'll be on strike until seven o'clock on Saturday morning.
What you heard there is just what's going on in the UK, and medical professionals have been striking across Europe Naomi. What are some of the problems that doctors and nurses are facing right now that has them so upset.
There's a pay issue, certainly, and we see that in France with healthcare workers striking, marching in the streets. There's a big debate over the amount of money that doctors get per visit. There is a push to double it to fifty euros per visit, which when you think about it, is actually still a very small number. It's also important to put all of us into context of the COVID
nineteen pandemic. Spending on healthcare in Europe had risen for decades and then at around the time of the financial crisis in two thousand and eight, it kind of went flat as a percentage of GDP and stopped rising. Then tensions were building in the systems. There wasn't as much increase in money as there used to be, plus demographic issues that we've discussed, and then COVID happens and the
healthcare systems are under extreme strain. Also, a lot of money is pouring into the systems all of a sudden, but a lot of it is for things like COVID vaccines and short term solutions for beds and clinics. There's not a whole lot of money coming into structure reform. It's more like putting a lot of band aids on some very big problems. And now for a few years, workers have been super stressed, they're super burnt out, nurses
are leaving coming out of COVID. We just had a horrible winter in Europe for as I'm sure in the US as well, for respiratory diseases pneumonia RSV, really stressed emergency rooms. And then add of course in cost of living crisis, which healthcare workers also feel, and you've got this bubbling pot of resentment, I would say in hospitals in many different European countries.
A lot of these issues free date the COVID pandemic by years or even decades like sometimes, and the healthcare professionals and the healthcare staff is really being pinched in like every direction here, like Naomi was saying, and a big thing too, like talking to healthcare professionals, you hear they want to work in this field, they want to provide care, and they do very often put their heart into their jobs.
And that's of course something that healthcare workers in the US and everywhere else seem to be experiencing too these incredible strains that wind up affecting their own lives. And you spoke to a number of healthcare workers in different European cities, what do they have to say about what it's been like for them?
We and our colleagues in Paris and Rome, who also worked on this story, spoke to a number of doctors in different countries and nurses as well, and they all kind of had similar things to say that they feel like they're not serving their patients as they could because
they're spread tooth thin. And I talked to one orthopedic surgeon in Madrid who talked about how when she has her mourning shift, like morning shift in this Madrid hospital is sort of I think from eight am to like three pm or two pm, so it's a pretty long shift. She has to get through forty patients. She would normally have twenty patients, that's the number of appointments she has, but the administrative staff at her hospital double books each
single appointment, and so she'll have forty people there. So she has like five minutes per patient, and she doesn't really have time to do much more than speak in a really superficial way with them. She said, a lot of them are older people who have you know, arthritis, degenerative disease, joint problems, and she can't fix their issues in five minutes. She doesn't even really have time to explain to them that this is an issue of aging
and that they might actually not feel better. And I think what she said to me is they might have an incurable disease, but you can't tell them that in three minutes. And so what she winds up doing is maybe giving a few bits of advice and then booking them in for another consold six months down the line. And it just creates the snowball effect of people just coming back in order to make them feel like she's giving something to them, She'll give them these repeat appointments,
but it doesn't solve anything. It's not the way that she would prefer to be giving care to these people.
Yeah, I can only agree, Like, I feel like the most heartbreaking thing talking to healthcare staff is this fact like they want to provide a more holistic, long term type of care which allows them to care for the whole human and not just like the most urgent symptom or illness they might be suffering from. Like right, there, and.
Then Jonas, let's hear what one doctor in Stockholm you spoke to had to say about what it's like to practice medicine there.
Right now, our hospitals are getting full almost every day, and it leads to one in one out situation where we have to choose between different patients that all need hospital care. We're constantly forced to break rule routines and are moral compass. When I come as an I see a consultant to the emergency room, and perhaps there are free patients that need intensive care and we just have one last intensive care of bad left. Then I have to choose which patient that gets that spot and which
two patients that don't. So I have to choose which patients will get the greatest chance to survive. That's not how it should be.
And here's a nurse in France who's talking about what work these days is like for her.
In France, nobody applies to hospital jobs anymore because those jobs aren't attractive at all. Salaries are low compared to other places, and working conditions are deteriorating a lot. So these days, to provide our care services, we're always in a rush. It's care that we do back to back and not well. We don't have time to drink or eat. We don't have time to go to the bathroom. We barely have time to sit down. We don't have time to talk to patients, to families, to communicate with them.
What's going on, Naomi. One of the things you write in the story is that lower income countries in the EU have become what you call feeder nations for their wealthier neighbors. What does that mean?
That was something that somebody at the World Health Organization pointed out to me. He cited the example of Romania, which produces the most medical school graduates per capita in the European Union, but at the same time has a below average density of healthcare workers. And that's because the doctors are migrating in Germany, where I think more than one in ten doctors were educated elsewhere. Romanian doctors are the biggest immigrant group.
Because they can make more money practicing in Berlin than they can at home.
Correct the average annual pay for a specialist doctor in Germany is about one hundred and sixty six thousand euros a year. That's depending on exchange rate, about one hundred and seventy six thousand dollars and that's at least three times more than what doctors would get in Romania, so they are clear economic incentives. And then at the same time, German doctors moved to Switzerland, which pays even better, and doctors from Eastern Europe will also wind up in Sweden.
With a single market comes in ability for high skill workers to go elsewhere, and they do.
We started this conversation with this idea of a social contract in Europe that people feel that they have cradled to grave healthcare coverage. How is this crisis affecting the kind of public trust in the healthcare systems?
It harms the trust in healthcare systems, and that in turn is a political liability for politicians in Europe because how people I view healthcare is really linked to their trust in government as well. And we've seen, you know, European countries and politicians acknowledging and responding to the problem. In January, the French President Emmanuel Macrong acknowledged what he called the personal and collective exhaustion that healthcare workers have had to deal with, and he pledged to spend more
money and to do some reforms. In Germany, health Minister Karl Lauterbach is working to overhaul the hospital system. I guess we'll have to see how effective those reforms are.
Naomi Jonas, thanks so much for speaking with me today.
Thanks it was a pleasure.
Thanks for having.
Us when we come back. What can be done to turn these ailing health systems around? So where do things go from here? Our producer Frederica Romaniello spoke to someone who thinks about this question all the time, doctor Thomas Zapata. He heads the World Health Organization's Office of Health, Workforce and Service Delivery in Europe.
At the end of March, the World Health Organization held the High Level of Regional Meeting to discuss just how serious the situation in Europe is and offer actions for governments to take. What are the recommendations that the who came up with.
We need to better retain health workers. That means that those health workers that are already in the health systems all over Europe. We need to improve the working conditions, so they want to stain the system. That includes a fat muneration that depends on the country. That include increased flexibility in working arrangements. We need, for example, zero tolerance to viole against health workers. That's something that is coming up in some countries as well. Is important also as
part of improving working conditions. One of the main areas that we have is that in rural areas in many countries in the region, is difficult to recruit and retain health workers in rural areas. So for that we need to bring a combination of incentives, not only financial, to make it more attractive for health workers to work in
rural areas. Then we have measures in order to improve education in terms of not only improving numbers, but I think we need to improve the quality and what we teach, which competencies are we teaching to our health workers and the future generations of health workers. Then a third element is optimizing the performance. So we have limited health workers, so we need to make the best use of the time that they have, and for that we need to
reduce all the bureaucracy attached to clinical practice. We need to optimize and reorganize the organ nice health services so that we can maximize that time, that clinical time of the physician, of the nurse and other types of health professionals with the patient. And in order to do all this we need to enablers. One of them is improved planning of the health work force and the second enabler is investing. We need to invest more and also more smartly in those areas that really add value.
Where do you see the state of the healthcare workforce in Europe head in the years to come.
We have a window of opportunity at the moment and countries are taking seriously this. So if they take the actions in terms of all the actions that we have mentioned, we should be able to go in a future direction when we have a sufficient health work force in terms of numbers, also in terms of skills of competencies, in order to deliver services that is adequately distributed in rural,
remote and underserved area. Yes, and also with a healthwalk force that is performing adequately, that is motivated and with higher standards of performance and quality. Of course, I think we need to be flexible, be open and bring innovations so that we can adapt to the new changing needs of the population. We know that population is aging, more chronic diseases, more the morbidity. There are also increased expectations
by the patients. We also have backlocks from the COVID pandemic, so all these things are making that the demand for services are increasing, so we need to factor all these things in the future so that we can start preparing the health workforce now to be able to cope with that increased demand in the future.
Doctor Tomasa Pata, thank you so much for joining me.
Thank you so much for the Erica.
Thanks for listening to us here at the Big Tach. It's a daily podcast from Bloomberg and iHeartRadio. From more shows from my Heart Radio, visit the iHeart Radio app, Apple or wherever you listen, and we'd love to hear from you. Email us questions or comments to Big Take at Bloomberg dot net. The supervising producer of The Big Take is Vicky Virgalina. Our senior producer is Katherine Fink. Federica Romanello is our producer. Our associate producer is Zennab Sidiki.
Hilde Garcia is our engineer. Our original music was composed by Leo Sidrin. I'm Westkasova. We'll be back tomorrow with another Big Take.