Associate Professor Esther de Bekker-Grob: 'We need collaboration to be truly useful for society, not just enjoying ourselves doing research for the sake of research.’
She wanted to become a doctor, she wanted to make people healthier, and for three years she tried to get into a Medicine programme – but got passed over. So she chose Health Sciences instead. Now she is Associate Professor at the Erasmus School of Health Policy & Management (ESHPM) and one of the earliest contributors to Challenge Accepted. She believes that through multidisciplinary collaboration, Erasmus University Rotterdam can contribute to true innovation in tomorrow’s health-policy decisions. ‘If something is difficult, that doesn’t mean you shouldn’t try.’
What is the reason you’ve become involved in Smarter Choices for Better Health?
‘I specialise in healthcare evaluation. My motivation is to search for optimal decisions in healthcare. The Netherlands has spent 97 billion on healthcare last year. That is 13 percent of the GDP. It’s a lot. Is it a problem? Not if you get value for your money. But we also know that the money is perhaps not always spent in the best ways possible. Medicines are wasted, medical devices are left unused, there is still big social inequality in access to healthcare.’
‘Because the cost/benefit balances are not optimised. For example: until now we mainly looked at health benefits, like the length and the quality of life. But we should be looking at broader benefits. Take, for instance, mental healthcare, or social care. It seems more interesting and more efficient to look at well-being, far more than just looking at physical health or life extension. For example, we know from research that some patients prefer social activity above extra home-care hours.’
But if you are healthier, wouldn’t your well-being or happiness increase naturally?
‘Of course. But there’s more factors that play a role here. We have to make decisions in cure and care – these are two different things. A cure is not always preferred over care. If we want the best for society, we should find a more sophisticated scale by which to measure healthcare.
Several stakeholders would agree. But nobody exactly knows how to achieve this. With the Initiative Smarter Choices for Better Health we aim to tackle this challenge. First, we will develop an instrument that can measure benefits of cure and care like social well-being, financial well-being, independence, but also pleasure or joy – all these things which are important in life besides health.’
'People are getting older and older, money is scarce, and technology is developing fast but is increasingly expensive. Choices have to be made, and we want them to be the smartest choices.'
Isn’t that difficult?
‘Because we work in a multidisciplinary way we can look at this from different points of view. That is the big advantage of the initiative. Besides: if something is difficult, that doesn’t mean you shouldn’t try.
There is something else we must take into account: the moment of measurement. If someone ends up in a wheelchair due to an accident, the first period in the wheelchair will be emotionally tasking. It’ll feel like a limitation in life. But we also know that people can and will adjust. This same person will probably feel more at ease in the wheelchair after a few years, and although he objectively may still be in the same health status the effect of the initial health shock on his wellbeing will have reduced. So what is interesting: at what time do we measure someone’s well-being?
And: we should look at non-compliance at a micro-level, a big obstacle to the effective delivery of health care. Why do so many patients stop using prescribed medicine that supposedly improves their health?
We should take all these factors into account to finally come to smarter and fairer choices in health policy and make sure health care remains affordable.’
Is this a new perspective, or have you been doing this work for longer?
‘Actually, the way we look at this now is indeed very new. Until now there wasn’t an instrument by which to measure all these things simultaneously. We want to develop this instrument, something that can be used to inform policy makers better about the benefits of policies. Working together with different faculties helps a lot. For example, Philosophy has a different view on well-being, and this is helpful. I believe in innovation through integration. In my career I’m always looking for collaboration. We need this in order to develop something which can be truly useful for society, not just enjoying ourselves doing research for the sake of research.
We should try to connect as many pieces as possible to finally complete this complicated puzzle. We should take into account the patients as well as the doctors and policymakers. Prevention as well as education. We would like to develop this instrument so that it can provide valid and reliable guidance, to know how to and where to best spend the limited healthcare budget in order to make as many people as healthy and happy as possible.’
Why is this important for you?
‘It’s necessary, we cannot escape this challenge anymore. People are getting older and older, money is scarce, and technology is developing fast but is increasingly expensive. Choices have to be made, and we want them to be the smartest choices. I believe we can only shape the future by working together with different scientists from different faculties, with alumni as well as donors. There’s a beautiful opportunity to really make a difference.’