When financing healthcare innovations, prioritize value for health and society rather than commercial value

What are you researching, and how did you come to this research topic?

"My doctoral research focuses on the financing of healthcare innovations in the Netherlands, specifically looking at how these innovations are financed - from initial funding to the reimbursement of innovations. In the research, we made a distinction between product innovations - such as medical technologies, and process innovations - such as changes in healthcare processes wherever investing in collaboration is important. We examined the challenges innovators face and why some innovations receive funding while others do not. Additionally, we investigated whether valuable innovations actually reach healthcare practice, or if financing is a barrier.

My academic background forms the foundation of my doctoral journey. After high school, I chose to study health sciences in Maastricht because I wanted to have an impact on the health of society as a whole, rather than just on individual people. However, I felt that I needed more tools to address complex issues, so I decided to study health economics at Erasmus University Rotterdam. This led to the PhD program that was offered to me through Medical Delta. What attracted me to this topic is the wonderful combination of my degrees, which focus on both healthcare system management and economic knowledge."

What insights have you gained during your research?

"That successful healthcare innovations, especially technologies, are often selected based on their commercial potential for profit or savings, while their societal value should actually be the focus. This conflicts with the goal of healthcare innovations: contributing to health and well-being. Current funding mechanisms often prioritize innovations with high commercial value, pushing societal interests into the background.

In my dissertation, I recommend prioritizing societal value and health value in funding and reimbursement decisions. If we truly want innovation to help us solve major healthcare challenges, we must ensure that the innovations that eventually make it into our healthcare system actually have value for the patient or society as a whole. And often they don't, because the primary focus is on commercial value: can profit be made from the innovation, or can savings be achieved? The value for health and society is secondary, and this is reflected in the considerations made during the innovation process.

The early stages of innovations are often funded with public funds, and innovators make use of knowledge and infrastructure that stem from public money. However, there comes a phase where innovators are often dependent on private investments. What determines these private investments is often whether the innovation can generate profit or savings, rather than the potential health benefits for society.

How can this be changed?

"In my dissertation, we propose ways to prioritize value for health and society. This can be done, for example, by innovating with a mission-driven approach and making democratic decisions about which health goals we want to focus on. Private investments often follow the opportunities provided by public funds, so in this way, we can steer innovations that are valuable for health and society.

Too often, subsidies are currently allocated to anything that sounds interesting and new, but at the same time, to ideas that don’t deviate too much from current practice. However, if you allocate every subsidy to the newest and latest invention, you won't facilitate necessary further development. At the same time, if you only distribute these subsidies based on the current state of practice and science, you limit the possibilities for groundbreaking innovation.

Another important conclusion is the need for sufficient leeway for experimentation and adequate resources to organize the innovation process in practice. We are heading towards a future of scarcity, which creates pressure to account for every euro spent. While understandable, this hinders innovation. Innovation requires leeway to experiment and sometimes fail. Valuable ideas often emerge transdisciplinarily: through collaboration between healthcare professionals, engineers, and patients. The majority of good ideas come from (healthcare) practice. To preserve this innovative capacity, financial flexibility is essential.

When I present the research findings, I often hear: ‘This is relatable’. Yet, it contains an important message that has not yet been learned. Real action is still lacking. Perhaps this is the strength of the dissertation; it convincingly captures what many experience, allowing it to serve as a mirror. The key lessons are especially relevant for policymakers. They need to change policies. This is not a task for any one individual innovator, but requires a collective effort.”

How does interdisciplinary collaboration contribute to your research?

"This research was only possible thanks to intensive, interdisciplinary collaboration. At Erasmus School of Health Policy & Management, various disciplines come together; in my team, we worked with a combination of health economics and management. Through Medical Delta, I was part of a network where I collaborated with experts in health technology evaluation, governance and sociology, while I focused on the financial aspect of healthcare innovation.

Medical Delta gave me access to innovative environments such as healthcare institutions and TU Delft. Here, I performed qualitative research and conducted interviews with passionate innovators. These conversations were the highlights of my doctoral journey, and it inspired me to see how driven these individuals are. Many work on developing their ideas in their free time and invest their own savings into them. A doctor told me: 'This idea is my life's work.' This dedication highlights the passion of innovators."

What advice would you give to a future Medical Delta PhD candidate?

"The time you invest in building connections with people outside of your immediate environment is never wasted. It's not always necessary to go to meetings with a clear goal or presentation; simply being present is often already valuable. Whether it's large conferences or small coffee chats, every conversation helps you form a better picture of reality."

The previous interviewee, Rick Waasdorp, asks: What challenges do you see with the increasing interdisciplinarity of research?

"Interdisciplinary research requires PhD candidates to have a greater degree of independence, as they often do not follow the same approach as their predecessors. This requires courage, curiosity, and a Pippi Longstocking mentality: ‘I’ve have never tried it before, so I think I can do it.' However, the bigger challenge lies on the receiving side. Research is increasingly being conducted interdisciplinarily, but the academic world remains strongly organized in silos. This is evident in the titles of professors, the journals in which articles are published, and the conferences that are organized. As a result, researchers who move between different fields often encounter more obstacles.

We must take on the challenge of collaborating and stepping out of our silos. This is not an easy task, as each discipline has its own written and unwritten rules. It can be difficult to explain to outsiders why you don't fully fit within these frameworks. Fortunately, I had a close-knit doctoral team that understood the need for interdisciplinary collaboration and strongly supported me in this."