Summer staff shortages push Belgian hospitals to the brink, Novo Nordisk urges caution on Wegovy prescriptions ahead of the drug's German debut, and more in our roundup of healthcare news from around the world.

• Australia: Calvary transitions to Canberra Health Services: As of July 3, the former Calvary Public Hospital Bruce will be known at North Canberra Hospital. Operations of Canberra's northside acute public hospital and Clare Holland House hospice, along with almost 2,000 staff, officially transitioned to Canberra Health Services. (Background reading on this contentious decision to nationalize Calvary Bruce: link, link).
• Australia: How Royal Adelaide Hospital is reducing their 'hidden waitlist': CALHN, in partnership with two tech companies, is using a new communication tool to replace phone calls and letters in the scheduling phase for outpatient backlog appointments. Three weeks prior to their clinic appointment, patients are invited to join the Personify Care platform. It sends their preparation needs and notifies their upcoming appointment. It also alerts staff in advance of patients who are rescheduling or unable to attend. Since running the pilot of the digital pathway project (which started in 2021), RAH saw failure-to-attend rates at the Outpatients Orthopedics unit go down by 56%. This tool helped CALHN launch My Prehab which has garnered notoriety. Personify Care has received a A$5.6 million ($3.7 million) contract from SA Health to extend its digital patient pathways project across the entire state over the next two years.
• Belgium: New financing model announced for GPs on call: A new €22 million funding model for GPs on call has been approved by medical authorities and will supersede the previous model from 2025. The number of GPs working weekends and public holidays will now be determined beforehand. A minimum of three practitioners for 300,000 inhabitants will have to be on duty with at least one accessible call center. Moreover, mobile services will also be able to provide services at patients' homes. There will now be two options available for out-of-hours services: either GPs remain on duty, or the mobile services can be used for patients to call up.
• Belgium: 'Dying in silence': Summer staff shortages push Belgian hospitals to the brink: Hospitals in Belgium are under increasing strain due to staff shortages, burnout, and the residual effects of the pandemic. Health provision is likely to get worse in the coming weeks as vacationing staff are replaced by undertrained medical students. According to the Federal Centre for Health Care Expertise, the current ratio of nurses to patients in Belgium is half the officially recommended amount (1:10 rather than 1:5). Inadequate staff numbers also recently caused Belgium's Health Ministry to remove 5% of available hospital beds across the country, an area where they are ahead of their OECD peers.
• Brazil, Canada, Israel, US: Mayo Clinic Platform expands with Israel's Sheba, 3 other hospitals: Mayo Clinic expanded its distributed data network "Mayo Clinic Platform Connect" to Sheba (Israel), Albert Einstein (Brazil) and UHN (Canada). The "first of its kind global alliance" creates a data-sharing network that "accelerates artificial intelligence-based solutions by using current data science and years of clinical data to create better patient outcomes around the world." Each partner org will be able to use aggregated, de-identified clinical data to identify diseases early and the most appropriate treatment options.
• Canada: Lack of key specialists means HHS likely to miss cardiac surgery targets in Hamilton: HHS says a shortage of perfusionists (skilled health workers that operate circulation equipment and are essential to running a cardiac surgical OR) has decreased the number of the cardiac producers the system has been able to perform. HHS has relied on support from specialists from nearby regions.
• Canada: EDs face worse wait-times this summer, as 'waiting-room' medicine gets creative: Experts are warning that EDs across Canada face "record-setting wait times and closures" this summer, increasing the risk of patients dying while waiting for care. EDs across Canada are already facing overcrowding, long wait times, lack of hospital beds, closures, and staff burnout. The pressure is leading to providers conducting "waiting room medicine" in chairs and ambulances. The head of the emergency medicine department at HHN attributed the problem in part to patients "looking to [EDs] for 24/7 access to unscheduled care." Some solutions proposed include expanding scope of practice for nurse practitioners, dietitians, and counselors; staffing emergency call centers with doctors, nurses, and paramedics; and allowing community paramedics to follow up on patients post-discharge.
• Canada: A future without code blues? Oak Valley Health and Thoughtwire team up with Digital Twin Technology: Oak Valley partnered with ThoughtWire and LTC facilities to implement an early warning technology and scoring system to improve detection and prevention of patient deterioration. The technology will nearly eliminate code blue calls, which signal a medical emergency or cardiac arrest in a hospital.
• Denmark/Sweden: Medicon Valley: how the initiative shaped biotech ecosystems in Denmark and Sweden: With a combined market value of over $7 billion, the life science sectors in Sweden and Denmark are thriving, with over a thousand healthcare companies being set up over the past few years. Much of this is owing to the cross-border cluster that spans regions of eastern Denmark and southern Sweden, the "Medicon Valley." At the frontline of this cluster is the Medicon Valley Alliance, a nonprofit organization that works to strengthen collaboration between the Danish and Swedish life science sector, with an interest in promoting the hub as an attractive destination for setting up healthcare companies.
• Denmark/Germany: Novo Nordisk urges caution on Wegovy prescriptions ahead of German debut: Novo Nordisk has urged doctors in Germany to limit prescriptions of its popular Wegovy weight-loss drug to patients with medical needs, citing limited supplies as the company prepares to launch in Europe's largest pharmaceutical market. Production problems and Novo Nordisk's struggle to keep up with overwhelming demand in the U.S., by far its largest market, have led to a slower-than-expected roll out in Europe. A lot of the surging demand is driven by non-obese people who want to shed extra pounds, including celebrities eager to make that known on social media.
• Denmark: Landmark study shows higher suicide risk for transgender people: Transgender people in Denmark have a significantly higher risk of suicide than other groups, according to an analysis of health and legal records from nearly seven million people over the last four decades. The study is the first in the world to analyze national suicide data for this group. Transgender people in the country had 7.7x the rate of suicide attempts and 3.5x the rate of suicide deaths compared with the rest of the population, and transgender people in Denmark died — by suicide or other causes — at younger ages than others. Denmark has a centralized data repository for all of its citizens, enabling researchers to conduct massive and rigorously controlled studies.
• Denmark: The location of training courses for ambulance attendants is straining recruitment for the profession: The latest figures from Denmark's Central Region show that this month there are up to 50 ambulance attendant vacancies. This is resulting in many existing attendants taking on additional shifts and overtime and is impacting availability of ambulances across the region. Many candidates for the position blame the regions sparse and diffuse educational offerings for the role — some residents have to drive at least 150 kilometers to get to their training courses. The region disagrees as they still receive more applicants than they can employee. In the last six months alone, the region received 240 applicants for 16 positions as ambulance attendants.
• Germany: What you need to know about Germany's hospital reform: Government ministers have agreed on a plan to change the way hospitals in Germany are financed and organized. Currently, hospitals are funded by insurers through DRGs. While the DRG system did bring ALOS down over time (from 10 to 7 days), it has also led many hospitals — particularly in low-population areas — to take on too many patients or patients who have serious illnesses that they are not equipped to treat so they may secure funding. The reforms aim to shift the focus to quality over quantity – moving away from the flat rate per case DRG system and toward one that is tied to outcomes. This future model is not clarified in detail. To determine performance, providers will operate within a designated "Performance Group" of similar facilities that will benchmark an array of quality and outcomes data. This designation will also ensure that certain cases and procedures only go to the provider most suited to deliver it — particularly stroke and heart attacks. Government ministers are also working on the so-called Transparency Act as part of the reforms. In future, the Transparency Act will allow patients to find out more information about hospitals like the quality and kind of care they offer and even the waiting times for specific treatments.                                                                                                                                       
  • Also worth reading: How to save Germany's hospitals: The shift away from DRGs will be paired with another reform: equipping hospitals to better mix outpatient and inpatient services — something already standard in many European countries. It would mean getting rid of hospitals that treat only inpatients with a variety of ailments and creating more specialized hospitals able to take more outpatients.
• Global: Ramsay, Sime Darby tap Bank of America, Deutsche Bank to sell $1.3 billion Asia healthcare venture: Ramsay and Malaysia's Sime Darby have hired the two banks to sell their joint venture. Its portfolio consists of 1,530 beds across seven hospitals in Malaysia and Indonesia, according to Sime Darby's 2022 annual report. The company employs 4,500 people. An earlier effort to sell Ramsay Sime Darby to IHH Healthcare fell through last September, soon after a KKR & Co Inc-led consortium withdrew a near $15 billion offer for Ramsay. No party has commented, but the next two months should decide whether a sale goes through.
• KSA: Saudi Arabia marks healthcare transformation boom: Tourists from the Middle East account for over 30% of total spending on medical tourism. As part of the Saudi Vision 2030, the country's leaders launched several initiatives to strengthen the foundation of the Kingdom's medical tourism sector:
  • Clinique La Prairie in the KSA: A "health resort" that will include a hotel and facilities for preventative medicine, genetics, and epigenetics. The resort will further run on 100% renewable energy.
  • Growth of healthcare privatization: The Saudi Arabian General Investment Authority granted 100% ownership to foreign investors involved in healthcare, following a renewed pledge made by the Government to privatize 295 state hospitals in 2020.
  • Rise of medical cities: While the rest of the world moves care out of acute hospitals, Saudi Arabia concentrates more care into more medical cities, which offer an almost complete array of clinical services. KSA has five new medical cities in the pipeline.
• Norway: Fewer deaths occur when the elderly are treated locally: Elderly patients may not need the resources of a hospital but do require more advanced help than a nursing home can usually offer. Intermediate care units are primarily intended to replace an acute hospital admission and are occasionally also used following admission. Norway has been developing this service over the last ten years as part of a 2012 reform that forced all municipalities to set up municipal acute care units. The introduction took place gradually, with the aim to provide an integrated service that was tailored to each individual user. The introduction of these units is associated with lower mortality and fewer readmissions.
• Norway: The entire South-East buys healthcare services from private suppliers for close to NOK 5 billion: During 2023, Helse Sør-Öst will purchase services from private health institutions for over NOK 4.2 billion, for inpatient mental health services in particular. Agreements with private service providers still give the patients an opportunity to choose the place of treatment. The private providers range from small non-profit organizations to large commercial players, who offer treatment and services in somatics, laboratory operations, radiology, mental health care, interdisciplinary specialized drug treatment and rehabilitation.
• Portugal: Fidelidade plans IPO of private hospital unit Luz Saude: The Portuguese insurer that owns Luz Saude is considering listing it on the stock market. They hope to secure a valuation of more than €1 billion. This would mark a return of Luz Saude to the stock market — the healthcare group stopped trading in 2018.
• Singapore: Singapore General Hospital assesses patients' surgery risk using predictive AI: The Singapore General Hospital has deployed a machine learning tool used in the pre-operative planning phase to predict a patient's suitability for surgery. The tool, called CARES-ML, generates a surgery risk report and score using a patient's medical history, physical status classification, and investigative test results, including X-rays and blood tests to predict post-operative complications. It was trained on a local dataset of 100,000 cases from 2015-2022.  It can predict the risk of a patient requiring intensive care with an accuracy of 90% or of dying within 30 days of surgery with an accuracy of over 80%. Perhaps most importantly, it also flags the factors that increase risk, such as BMI or type of anesthesia used. They are now expanding the model to predict pneumonia and stroke LOS.
• Switzerland: RayCare in clinical use with CyberKnife at Lausanne University Hospital (CHUV) in Switzerland: CHUV has treated their first patient using the RayStation treatment planning system together with the oncology information system RayCare in combination with the CyberKnife treatment delivery system. The CyberKnife System is the only radiation delivery system that features a linear accelerator mounted on a robot to deliver the high-energy X-rays or photons used in radiation therapy. The robot moves and bends around the patient, to deliver radiation doses from potentially thousands of unique beam angles, significantly expanding the possible positions to concentrate radiation to the tumor while minimizing dose to surrounding healthy tissue.